Association of obstructive sleep apnea in rapid eye movement sleep with reduced glycemic control in type 2 diabetes: therapeutic implications.
Association of obstructive sleep apnea in rapid eye movement sleep with reduced glycemic control in type 2 diabetes: therapeutic implications.
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DOI：
10.2337/dc13-0933
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发表时间：
2014-02
期刊：
影响因子：
16.2
通讯作者：
Mokhlesi B
中科院分区：
文献类型：
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作者：
Grimaldi D;Beccuti G;Touma C;Van Cauter E;Mokhlesi B
阻塞性睡眠呼吸暂停（OSA）的严重程度与2型糖尿病患者血糖控制较差相关。目前尚不清楚快速眼动（REM）睡眠期间的阻塞性事件是否与非REM（NREM）睡眠期间的阻塞性事件具有不同的代谢影响。阻塞性睡眠呼吸暂停症的治疗通常局限于前半夜，此时NREM睡眠而不是REM睡眠占主导地位。我们旨在量化2型糖尿病受试者中REM与NREM睡眠中OSA对血红蛋白A1 c（HbA 1c）的影响。所有参与者均接受多导睡眠描记术，并通过HbA 1c评估血糖控制。我们的分析队列包括115名受试者（65名女性;年龄55.2 ± 9.8岁; BMI 34.5 ± 7.5 kg/m2）。在多元线性回归模型中，REM呼吸暂停低通气指数（AHI）与HbA 1c水平升高独立相关（P = 0.008）。相反，NREM AHI与HbA 1c无关（P = 0.762）。平均调整后的HbA 1c从REM AHI最低四分位数受试者的6.3%增加到REM AHI最高四分位数受试者的7.3%（线性趋势P = 0.044）。我们的模型预测，持续气道正压通气（CPAP）使用4小时将使60%的REM睡眠未得到治疗，并将与HbA 1c降低约0.25%相关。相比之下，使用7小时CPAP将覆盖超过85%的REM睡眠，并与HbA 1c降低1%相关。在2型糖尿病中，REM睡眠期间的OSA可能会影响长期的血糖控制。CPAP治疗的代谢益处可能无法通过每晚4小时的典型坚持来实现。
Severity of obstructive sleep apnea (OSA) has been associated with poorer glycemic control in type 2 diabetes. It is not known whether obstructive events during rapid eye movement (REM) sleep have a different metabolic impact compared with those during non-REM (NREM) sleep. Treatment of OSA is often limited to the first half of the night, when NREM rather than REM sleep predominates. We aimed to quantify the impact of OSA in REM versus NREM sleep on hemoglobin A1c (HbA1c) in subjects with type 2 diabetes. All participants underwent polysomnography, and glycemic control was assessed by HbA1c. Our analytic cohort included 115 subjects (65 women; age 55.2 ± 9.8 years; BMI 34.5 ± 7.5 kg/m2). In a multivariate linear regression model, REM apnea–hypopnea index (AHI) was independently associated with increasing levels of HbA1c (P = 0.008). In contrast, NREM AHI was not associated with HbA1c (P = 0.762). The mean adjusted HbA1c increased from 6.3% in subjects in the lowest quartile of REM AHI to 7.3% in subjects in the highest quartile of REM AHI (P = 0.044 for linear trend). Our model predicts that 4 h of continuous positive airway pressure (CPAP) use would leave 60% of REM sleep untreated and would be associated with a decrease in HbA1c by approximately 0.25%. In contrast, 7 h of CPAP use would cover more than 85% of REM sleep and would be associated with a decrease in HbA1c by as much as 1%. In type 2 diabetes, OSA during REM sleep may influence long-term glycemic control. The metabolic benefits of CPAP therapy may not be achieved with the typical adherence of 4 h per night.