Continuous Positive Airway Pressure Therapy Improves Hypoadiponectinemia in Severe Obese Men With Obstructive Sleep Apnea Without Changes in Insulin Resistance
Continuous Positive Airway Pressure Therapy Improves Hypoadiponectinemia in Severe Obese Men With Obstructive Sleep Apnea Without Changes in Insulin Resistance
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DOI：
10.1089/met.2009.0019
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发表时间：
2009-12-01
影响因子：
2.1
通讯作者：
Tufik, Sergio
中科院分区：
文献类型：
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作者：
Carneiro, Glaucia;Togeiro, Sonia Maria;Tufik, Sergio
背景：阻塞性睡眠呼吸暂停（OSA）与多种可能促进心血管和代谢功能障碍发作的疾病有关。持续气道正压 (CPAP) 治疗已被证明可以改善与 OSA 相关的心血管发病率和死亡率，但这种关联的机制尚不完全清楚。 目的：本研究的目的是评估睡眠呼吸暂停是否会导致胰岛素抵抗和炎症标志物改变，并评估经鼻 CPAP 治疗对严重肥胖 OSA 患者的益处。方法：血浆炎症细胞因子和胰岛素抵抗指数 (HOMA-IR、在患有 OSA 的严重肥胖男性 (n = 16) 中测量胰岛素敏感性指数 (ISI)，并与体重指数 (BMI) 匹配的无 OSA 男性对照 (n = 13) 进行比较。 7 名严重睡眠呼吸暂停患者（呼吸暂停低通气指数 >30 次事件/小时）在经鼻 CPAP 治疗 3 个月后进行了重新评估。结果：OSA 患者的脂联素水平显着低于肥胖对照者（8.7 +/- 1.18 ng/mL vs. 15.0 +/- 2.55 ng/mL，P = 0.025）。 HOMA-IR、ISI、肿瘤坏死因子-α（TNF-α、C反应蛋白（CRP）和白细胞介素-6（IL-6）水平在各组之间没有差异。虽然nCPAP治疗3个月后胰岛素抵抗指数和BMI值没有变化，但脂联素水平升高（P = 0.036），TNF-α水平趋于下降（P = 0.065）。脂联素的变化nCPAP 治疗期间的脂联素水平与最低氧饱和度的改善呈正相关（r = 0.773；P = 0.041），与 TNF-α 水平的变化呈负相关（r = -0.885；P = 0.008）。 结论：nCPAP 治疗可能通过减少缺氧和炎症活动来逆转患有 OSA 的肥胖男性中存在的低脂联素血症水平。
Background: Obstructive sleep apnea (OSA) is associated with several conditions that could facilitate the onset of cardiovascular and metabolic dysfunctions. Continuous positive airway pressure (CPAP) therapy has been shown to improve cardiovascular morbidity and mortality related to OSA, but the mechanisms underlying this association are not fully understood.Objective: The aim of the present study was to evaluate whether sleep apnea contributes to insulin resistance and inflammatory marker alterations and to evaluate the benefits of nasal CPAP therapy in severe obese patients with OSA.Methods: Plasma inflammatory cytokines and the homeostasis model assessment of insulin resistance index (HOMA-IR, Insulin Sensitivity Index [ISI]) were measured in severe obese male with OSA (n = 16) and compared with body mass index (BMI)-matched male controls without OSA (n = 13). Seven patients with severe sleep apnea (apnea-hypopnea index >30 events/h) were reevaluated after 3 months of nasal CPAP therapy.Results: OSA patients had a significantly lower adiponectin levels than obese controls (8.7 +/- 1.18 ng/mL vs. 15.0 +/- 2.55 ng/mL, P = 0.025). HOMA-IR, ISI, tumor necrosis factor-alpha (TNF-alpha, C-reactive protein (CRP), and interleukin-6 (IL-6) levels were not different between groups. Although insulin resistance index and BMI values did not change after 3 months of nCPAP therapy, adiponectin levels increased (P = 0.036) and the levels of TNF-alpha tended to decrease (P = 0.065). Changes in adiponectin levels during nCPAP therapy were positively correlated with an improvement in minimum oxygen saturation (r = 0.773; P = 0.041) and negatively correlated with changes in TNF-alpha levels (r = -0.885; P = 0.008).Conclusions: nCPAP therapy reverses hypoadiponectinemia levels present in obese men with OSA, probably through reductions in hypoxia and inflammation activity.