Kabeloğlu Vasfiye, Senel Gulçin Benbir, Karadeniz Derya
Bakirkoy Prof. Dr Mazhar Osman Education and Research Hospital, Department of Neurology, Istanbul, Turkey.
Istanbul University-Cerrrahpasa, Cerrrahpasa Faculty of Medicine Department of Neurology, Istanbul, Turkey.
Ideggyogy Sz. 2020 Nov 30;73(11-12):417-425. doi: 10.18071/isz.73.0417.
The relationship among obstructive sleep apnea syndrome (OSAS), type 2 diabetes mellitus (DM2) and obesity is very complex and multi-directional. Obesity and increased visceral fat are important perpetuating factors for DM2 in patients with OSAS. On the other hand, OSAS itself leads to obesity by causing both leptin and insulin resistance as a consequence of activation of the sympathetic nervous system. Risk for developing DM2 further increases in patients with OSAS and obesity. Data regarding effects of positive airway pressure (PAP) therapy, gold standard treatment for OSAS, on glycemic control were inconsistent due to variability in duration of and adherence to PAP therapy. In our cohort study we investigated effects of PAP treatment on glucose metabolism in normal-weighted non-diabetic OSAS patients, in obese non-diabetic OSAS patients, and in OSAS patients with DM2.
We prospectively analyzed 67 patients diagnosed with OSAS and documented to be effectively treated with PAP therapy for three months.
Apnea-hypopnea index was highest in the diabetic group, being significantly higher than in the normal-weighted group (p=0.021). Mean HOMA values were significantly higher in obese (p=0.002) and diabetic group (p=0.001) than normal-weighted group; the differences were still significant after PAP therapy. HbA1c levels were significantly higher in diabetic group compared to those in normal-weighted (p=0.012) and obese (p=0.001) groups. After PAP treatment, decrease in HbA1c levels were significant in normal-weighted (p=0.008), obese (p=0.034), and diabetic (p=0.011) groups. There was no correlation with the change in HbA1c levels and age (p=0.212), BMI (p=0.322), AHI (p=0.098) or oxygen levels (p=0.122).
Our study showed that treatment of OSAS by PAP therapy offers beneficial effect on glucose metabolism, not only in diabetic patients, but also in obese and normal-weighted OSAS patients. Although data regarding overall effects of PAP therapy on glycemic control present contradictory results in the literature, it should be emphasized that duration and adherence to PAP therapy were main determinants for beneficial outcome of treatment.
阻塞性睡眠呼吸暂停综合征（OSAS）、2型糖尿病（DM2）和肥胖之间的关系非常复杂且具有多向性。肥胖和内脏脂肪增加是OSAS患者发生DM2的重要持续因素。另一方面，OSAS本身通过激活交感神经系统导致瘦素和胰岛素抵抗，进而引发肥胖。OSAS和肥胖患者发生DM2的风险进一步增加。由于持续气道正压通气（PAP）治疗的持续时间和依从性存在差异，关于PAP治疗（OSAS的金标准治疗方法）对血糖控制影响的数据并不一致。在我们的队列研究中，我们调查了PAP治疗对体重正常的非糖尿病OSAS患者、肥胖非糖尿病OSAS患者以及患有DM2的OSAS患者糖代谢的影响。
我们前瞻性分析了67例被诊断为OSAS且记录显示接受PAP治疗3个月有效的患者。
糖尿病组的呼吸暂停低通气指数最高，显著高于体重正常组（p = 0.021）。肥胖组（p = 0.002）和糖尿病组（p = 0.001）的平均稳态模型评估值显著高于体重正常组；PAP治疗后差异仍然显著。糖尿病组的糖化血红蛋白水平显著高于体重正常组（p = 0.012）和肥胖组（p = 0.001）。PAP治疗后，体重正常组（p = 0.008）、肥胖组（p = 0.034）和糖尿病组（p = 0.011）的糖化血红蛋白水平均显著下降。糖化血红蛋白水平的变化与年龄（p = 0.212）、体重指数（p = 0.322）、呼吸暂停低通气指数（p = 0.098）或血氧水平（p = 0.122）均无相关性。
我们的研究表明，PAP治疗OSAS不仅对糖尿病患者，而且对肥胖和体重正常的OSAS患者的糖代谢都有有益影响。尽管关于PAP治疗对血糖控制的总体影响的数据在文献中存在矛盾结果，但应强调的是，PAP治疗的持续时间和依从性是治疗取得有益结果的主要决定因素。
