Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Sleep Med. 2021 Apr;80:193-198. doi: 10.1016/j.sleep.2021.01.033. Epub 2021 Jan 28.
Respiratory complications represented by obstructive sleep apnea (OSA), cardiovascular disease (CVD), and metabolic disorders including insulin resistance (IR) are common in patients with acromegaly. OSA is further associated with a higher risk of IR and CVD in the general population. However, significant information on the effect of OSA on IR and CVD risk for patients with acromegaly remains to be scarce.
This retrospective study included 125 patients with active acromegaly. Medical history, anthropometric parameters, polysomnographic and fasting biochemical measurements were collected. Ten-year Framingham CVD risk scores were calculated and categorized as low, moderate, and high. IR was assessed using the homeostasis model assessment (HOMA-IR).
OSA was confirmed in two thirds of the enrolled patients. Compared with patients without OSA, patients with both OSA and acromegaly were found to have higher proportion of HOMA-IR and moderate-to-high 10-year CVD risk. Logistic regression analysis showed that OSA, HOMA-IR, and low-density lipoprotein cholesterol were all risk factors for moderate-to-high CVD risk. Meanwhile, no mediating effect of HOMA-IR in the association between OSA and Framingham CVD risk was observed in patients with acromegaly.
The coexistence of OSA might increase the CVD risk for patients with acromegaly, and IR might independently contribute to CVD risk in acromegalic patients with OSA.
由阻塞性睡眠呼吸暂停（OSA）、心血管疾病（CVD）和代谢紊乱（包括胰岛素抵抗[IR]）引起的呼吸并发症在肢端肥大症患者中很常见。OSA 进一步与普通人群中 IR 和 CVD 的风险增加相关。然而，关于 OSA 对肢端肥大症患者 IR 和 CVD 风险的影响的重要信息仍然很少。
本回顾性研究纳入了 125 例活动性肢端肥大症患者。收集了病史、人体测量参数、多导睡眠图和空腹生化测量值。计算了 10 年Framingham CVD 风险评分，并分为低、中、高风险。使用稳态模型评估（HOMA-IR）评估 IR。
三分之二的入组患者被确诊为 OSA。与无 OSA 的患者相比，同时患有 OSA 和肢端肥大症的患者的 HOMA-IR 比例和中高度 10 年 CVD 风险更高。Logistic 回归分析表明，OSA、HOMA-IR 和低密度脂蛋白胆固醇都是中高度 CVD 风险的危险因素。同时，在患有 OSA 的肢端肥大症患者中，HOMA-IR 并未在 OSA 和 Framingham CVD 风险之间的关联中发挥中介作用。
OSA 的共存可能会增加肢端肥大症患者的 CVD 风险，IR 可能独立增加 OSA 肢端肥大症患者的 CVD 风险。
