Pretl Martin, Lattová Zuzana, Polák Andrea Plíhalovájan, Westlake Kateřina
Cas Lek Cesk. 2019 Fall;158(5):185-192.
Epidemiologic studies show that both atypical sleep time and obstructive sleep apnea (OSA) are independently associated with higher risk of metabolic disease development, particularly obesity and type 2 diabetes mellitus (T2DM). OSA is an independent risk factor for cardiovascular mortality, which is amongst the most common causes of death in T2DM. It is advisable to screen patients for OSA due to the high prevalence of the disease in T2DM patients. For screening are recommended questionnaires and home sleep monitoring. OSA diagnosis is then verified by home sleep apnea testing (using polygraphy) or by polysomnography. Positive airway pressure (PAP) is a gold standard in the treatment of moderate and severe OSA. PAP prevents hypoxia and sleep fragmentation, eliminating excessive daytime sleepiness and decreasing the risk of cardiovascular diseases. Studies have not yet shown an effect of PAP treatment on T2DM compensation and glucose metabolism. Despite this a positive effect of PAP on insulin resistance and glucose tolerance has been proven in patients with prediabetes. PAP therapy is advised in obese patients of the central type with OSA, bariatric surgery has been proven to decrease the severity of OSA.
流行病学研究表明，非典型睡眠时间和阻塞性睡眠呼吸暂停（OSA）均与代谢性疾病发生风险升高独立相关，尤其是肥胖症和2型糖尿病（T2DM）。OSA是心血管疾病死亡的独立危险因素，而心血管疾病死亡是T2DM最常见的死因之一。鉴于T2DM患者中该疾病的高患病率，对患者进行OSA筛查是可取的。推荐使用问卷和家庭睡眠监测进行筛查。然后通过家庭睡眠呼吸暂停检测（使用多导睡眠图）或多导睡眠监测来确诊OSA。气道正压通气（PAP）是治疗中重度OSA的金标准。PAP可预防缺氧和睡眠片段化，消除日间过度嗜睡并降低心血管疾病风险。研究尚未显示PAP治疗对T2DM代偿和葡萄糖代谢有影响。尽管如此，PAP对糖尿病前期患者的胰岛素抵抗和糖耐量有积极作用已得到证实。建议对伴有OSA的中心型肥胖患者采用PAP治疗，减肥手术已被证明可降低OSA的严重程度。
