Abnormalities of Lipoprotein Concentrations in Obstructive Sleep Apnea Are Related to Insulin Resistance
Abnormalities of Lipoprotein Concentrations in Obstructive Sleep Apnea Are Related to Insulin Resistance
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DOI：
10.5665/sleep.4678
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发表时间：
2015-05-01
期刊：
影响因子：
5.6
通讯作者：
Reaven, Gerald M.
中科院分区：
文献类型：
--
作者：
Liu, Alice;Cardell, James;Reaven, Gerald M.
研究目的：阻塞性睡眠呼吸暂停（OSA）患者的心血管疾病（CVD）患病率增加，可能与这些个体的血脂异常有关。胰岛素抵抗在OSA中也很常见，但其在OSA血脂异常中的作用尚不清楚。本研究的目的是确定脂蛋白代谢异常，阻塞性睡眠呼吸暂停综合征的临床措施，胰岛素抵抗之间的关系。设计：横断面研究。OSA的严重程度由多导睡眠图中的呼吸暂停低通气指数（AHI）定义。缺氧指标表示为最低和平均氧饱和度，以及氧去饱和指数。通过在胰岛素抑制试验期间测定稳态血糖（SSPG）浓度来量化胰岛素抵抗。空腹血浆脂质/脂蛋白的评价垂直自动profilemethods.Setting：学术医疗center.Participants：107非糖尿病，超重/肥胖adultes. Measures和结果：脂蛋白颗粒没有相关性AHI或任何缺氧措施，也没有注意到的OSA严重程度的类别的差异。与此相反，即使校正年龄、性别和BMI后，SSPG与甘油三酯（r = 0.30，P < 0.01）、极低密度脂蛋白（VLDL）及其亚类（VLDL 1 +2）（r = 0.21-0.23，P < 0.05）和低密度脂蛋白4亚类（LDL 4）（r = 0.30，P < 0.01）仍呈正相关。SSPG与高密度脂蛋白（HDL）（r =-0.38，P < 0.001）及其亚类（HDL 2和HDL 3）（r =-0.32，-0.43，P < 0.01）和载脂蛋白A1（r =-0.33，P < 0.01）呈负相关。这些脂蛋白浓度跨SSPG三分位数的线性趋势也显着。结论：阻塞性睡眠呼吸暂停（OSA）的促动脉粥样硬化脂蛋白异常与胰岛素抵抗有关，但不OSA的严重程度或缺氧程度。胰岛素抵抗可能代表OSA相关血脂异常和心血管疾病风险增加之间的联系。
Study Objective: Prevalence of cardiovascular disease (CVD) is increased in patients with obstructive sleep apnea (OSA), possibly related to dyslipidemia in these individuals. Insulin resistance is also common in OSA, but its contribution to dyslipidemia of OSA is unclear. The study's aim was to define the relationships among abnormalities of lipoprotein metabolism, clinical measures of OSA, and insulin resistance.Design: Cross-sectional study. OSA severity was defined by the apnea-hypopnea index (AHI) during polysomnography. Hypoxia measures were expressed as minimum and mean oxygen saturation, and the oxygen desaturation index. Insulin resistance was quantified by determining steadystate plasma glucose (SSPG) concentrations during the insulin suppression test. Fasting plasma lipid/lipoprotein evaluation was performed by vertical auto profile methodology.Setting: Academic medical center.Participants: 107 nondiabetic, overweight/obese adults.Measurements and Results: Lipoprotein particles did not correlate with AHI or any hypoxia measures, nor were there differences noted by categories of OSA severity. By contrast, even after adjustment for age, sex, and BMI, SSPG was positively correlated with triglycerides (r = 0.30, P < 0.01), very low density lipoprotein (VLDL) and its subclasses (VLDL1+2) (r = 0.21-0.23, P < 0.05), and low density lipoprotein subclass 4 (LDL4) (r = 0.30, P < 0.01). SSPG was negatively correlated with high density lipoprotein (HDL) (r = -0.38, P < 0.001) and its subclasses (HDL2 and HDL3) (r = -0.32, -0.43, P < 0.01), and apolipoprotein A1 (r = -0.33, P < 0.01). Linear trends of these lipoprotein concentrations across SSPG tertiles were also significant.Conclusions: Pro-atherogenic lipoprotein abnormalities in obstructive sleep apnea (OSA) are related to insulin resistance, but not to OSA severity or degree of hypoxia. Insulin resistance may represent the link between OSA-related dyslipidemia and increased cardiovascular disease risk.