Kansanen M, Vanninen E, Tuunainen A, Pesonen P, Tuononen V, Hartikainen J, Mussalo H, Uusitupa M
Department of Otolaryngology, Kuopio University Hospital, Finland.
Clin Physiol. 1998 Jul;18(4):377-85. doi: 10.1046/j.1365-2281.1998.00114.x.
The aim of this study was to examine the effect of a very low-calorie diet (VLCD)-induced weight loss on the severity of obstructive sleep apnoea (OSA), blood pressure and cardiac autonomic regulation in obese patients with obstructive sleep apnoea syndrome (OSAS). A total of 15 overweight patients (14 men and one woman, body weight 114 +/- 20 kg, age 52 +/- 9 years, range 39-67 years) with OSAS were studied prospectively. They were advised to follow a 2.51-3.35 MJ (600-800 kcal) diet daily for a 3-month period. In the beginning of the study, the patients underwent nocturnal sleep studies, autonomic function tests and 24-h electrocardiograph (ECG) recording. In addition, 15 age-matched, normal-weight subjects were studied. They underwent the Valsalva test, the deep-breathing test and assessment of heart rate variability at rest. The sleep studies and autonomic function tests were repeated after the weight loss period. There was a significant reduction in weight (114 +/- 20 kg to 105 +/- 21 kg, P < 0.001), the weight loss being 9.2 +/- 4.0 kg (range 2.3-19.5 kg). This was associated with a significant improvement in the oxygen desaturation index (ODI4) during sleep (31 +/- 20-19 +/- 18, P < 0.001). Before the weight loss the OSAS patients had significantly higher blood pressure (150 +/- 18 vs. 134 +/- 20, P < 0.05, for systolic blood pressure, 98 +/- 10 vs. 85 +/- 13, P < 0.05, for diastolic blood pressure) and heart rate (67 +/- 10 beats min-1 vs. 60 +/- 13, P < 0.05) at rest than the control group. They had also lower baroreflex sensitivity (4.7 +/- 2.8 ms mmHg-1 vs. 10.8 +/- 7.1 ms mmHg-1, P < 0.01). During the weight reduction, the blood pressure declined significantly, and the baroreflex sensitivity increased by 49%. In conclusion, our experience shows that weight loss with VLCD is an effective treatment for OSAS. Weight loss improved significantly sleep apnoea and had favourable effects on blood pressure and baroreflex sensitivity that may have prognostic implications.
本研究的目的是探讨极低热量饮食（VLCD）诱导的体重减轻对阻塞性睡眠呼吸暂停综合征（OSAS）肥胖患者阻塞性睡眠呼吸暂停（OSA）严重程度、血压及心脏自主神经调节的影响。前瞻性研究了15例患有OSAS的超重患者（14例男性和1例女性，体重114±20kg，年龄52±9岁，范围39 - 67岁）。建议他们在3个月期间每日遵循2.51 - 3.35兆焦耳（600 - 800千卡）的饮食。在研究开始时，患者接受夜间睡眠研究、自主神经功能测试及24小时心电图（ECG）记录。此外，研究了15例年龄匹配的正常体重受试者。他们接受了瓦尔萨尔瓦试验、深呼吸试验及静息心率变异性评估。在体重减轻期后重复进行睡眠研究和自主神经功能测试。体重显著降低（从114±20kg降至105±21kg，P < 0.001），体重减轻了9.2±4.0kg（范围2.3 - 19.5kg）。这与睡眠期间氧去饱和指数（ODI4）的显著改善相关（从31±20降至19±18，P < 0.001）。在体重减轻前，OSAS患者静息时的血压（收缩压：150±18 vs. 134±20，P < 0.05；舒张压：98±10 vs. 85±13，P < 0.05）和心率（67±10次/分钟 vs. 60±13，P < 0.05）显著高于对照组。他们的压力反射敏感性也较低（4.7±2.8毫秒/毫米汞柱 vs. 10.8±7.1毫秒/毫米汞柱，P < 0.01）。在体重减轻期间，血压显著下降，压力反射敏感性增加了49%。总之，我们的经验表明，VLCD减肥是治疗OSAS的有效方法。体重减轻显著改善了睡眠呼吸暂停，并对血压和压力反射敏感性产生了有利影响，这可能具有预后意义。
