Shen H H, Xu Y M, Wang N, Wang J, Ren L, Chen R
Department of Respiratory Medicine, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai 200042, China.
Zhonghua Yi Xue Za Zhi. 2019 Jul 23;99(28):2187-2192. doi: 10.3760/cma.j.issn.0376-2491.2019.28.007.
To explore the therapeutic efficacy of nasal Continuous Positive Airway Pressure (CPAP) and aerobic exercise of different intensity in patients with Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) and Type 2 Diabetes Mellitus (T2DM). A total of 112 patients with OSAHS and T2DM, including 53 males and 59 females, with a mean age of (66.9±7.8) years old, from the Fourth Rehabilitation Hospital of Shanghai and the Second Affiliated Hospital of Soochow University from January 2017 to December 2018 were enrolled prospectively. There were divided into two groups based on whether received nasal CPAP therapy: 50 cases in nasal CPAP+aerobic exercise group and 62 cases in aerobic exercise group. Subsequently, patients in nasal CPAP+aerobic exercise group were randomly divided into two subgroups: moderate and low intensity aerobic exercise (26 and 24 cases respectively). All patients completed nasal CPAP and (or) aerobic exercise of different intensity for 20 weeks. The therapeutic efficacy of polysomnography (PSG) parameters, glycolipid metabolism, 6 minutes walking distance (6 MWD), and rate of perceived exertion (RPE) were compared between each group before and after treatment. Pre-and post-intervention, PSG parameters, body mass index (BMI) [(26.6±3.7) vs (24.3±2.8) kg/m(2)], RPE [(16.4±1.3) vs (12.2±2.6) score], 6 MWD [(372.6±59.7) vs (441.5±75.6) m] and glucolipid metabolism indexes were improved significantly in nasal CPAP+aerobic exercise group (all 0.05), such as fasting blood glucose [(7.4±2.4) vs (6.2±1.6) mmol/L], glycosylated hemoglobin [(7.6±1.2)% vs (6.6±0.7)%], fasting insulin [(10.8±4.4) vs (6.9±3.4) μU/L], insulin resistance index [(3.5±1.9) vs (1.9±1.2)], total cholesterol [(4.0±0.9) vs (3.5±0.9) mmol/L], low density lipoprotein cholesterol [(4.2±0.6) vs (3.1±0.8) mmol/L]; BMI, exercise endurance, some glucolipid metabolism indexes and PSG parameters were also improved in aerobic exercise group (0.05). After 20 weeks' intervention, it showed statistically significant differences in PSG parameters, glycometabolism, some lipid metabolism indexes and RPE (all 0.05), and no significantly difference in BMI [(24.3±2.7) vs (24.3±2.8) kg/m(2)] between the two groups. Compared with the low intensity subgroup, there were significant improvement in 2 hours' postprandial insulin, insulin resistance index, low density lipoprotein cholesterol, lipoprotein A, RPE, 6 MWD in moderate subgroup (0.05). Nasal CPAP combined with moderate intensity aerobic exercise can effectively improve the glucolipid metabolism, insulin resistance and exercise tolerance in patients with OSAHS and T2DM.
探讨经鼻持续气道正压通气（CPAP）及不同强度有氧运动对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并2型糖尿病（T2DM）患者的治疗效果。前瞻性纳入2017年1月至2018年12月期间来自上海市第四康复医院及苏州大学附属第二医院的112例OSAHS合并T2DM患者，其中男性53例，女性59例，平均年龄（66.9±7.8）岁。根据是否接受经鼻CPAP治疗分为两组：经鼻CPAP+有氧运动组50例，有氧运动组62例。随后，将经鼻CPAP+有氧运动组患者随机分为两个亚组：中等强度和低强度有氧运动亚组（分别为26例和24例）。所有患者均完成经鼻CPAP和（或）不同强度的有氧运动20周。比较各组治疗前后多导睡眠图（PSG）参数、糖脂代谢、6分钟步行距离（6MWD）及主观用力程度分级（RPE）的治疗效果。干预前后，经鼻CPAP+有氧运动组的PSG参数、体重指数（BMI）[（26.6±3.7） vs （24.3±2.8）kg/m²]、RPE[（16.4±1.3） vs （12.2±2.6）分]、6MWD[（372.6±59.7） vs （441.5±75.6）m]及糖脂代谢指标均有显著改善（均P<0.05），如空腹血糖[（7.4±2.4） vs （6.2±1.6）mmol/L]、糖化血红蛋白[（7.6±1.2）% vs （6.6±0.7）%]、空腹胰岛素[（10.8±4.4） vs （6.9±3.4）μU/L]、胰岛素抵抗指数[（3.5±1.9） vs （1.9±1.2）]、总胆固醇[（4.0±0.9） vs （3.5±0.9）mmol/L]、低密度脂蛋白胆固醇[（4.2±0.6） vs （3.1±0.8）mmol/L]；有氧运动组的BMI、运动耐力、部分糖脂代谢指标及PSG参数也有改善（P<0.05）。干预20周后，两组间PSG参数、糖代谢、部分脂代谢指标及RPE差异有统计学意义（均P<0.05），BMI[（24.3±2.7） vs （24.3±2.8）kg/m²]差异无统计学意义。与低强度亚组相比，中等强度亚组的餐后2小时胰岛素、胰岛素抵抗指数、低密度脂蛋白胆固醇脂蛋白A、RPE、6MWD有显著改善（P<0.05）。经鼻CPAP联合中等强度有氧运动可有效改善OSAHS合并T2DM患者的糖脂代谢、胰岛素抵抗及运动耐量。
