Risk for obstructive sleep apnea in obese, nondiabetic adults varies with insulin resistance status.
Risk for obstructive sleep apnea in obese, nondiabetic adults varies with insulin resistance status.
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DOI：
10.1007/s11325-012-0696-0
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发表时间：
2013-03
影响因子：
2.5
通讯作者：
Reaven, Gerald M.
中科院分区：
文献类型：
--
作者：
Liu, Alice;Kushida, Clete A.;Reaven, Gerald M.
阻塞性睡眠呼吸暂停（OSA）是一种越来越常见的睡眠障碍，尤其是在肥胖的成年人中。早期识别有阻塞性睡眠呼吸暂停风险的成年人将大有裨益；然而，肥胖流行的规模要求筛查要明智地进行。该研究的目的是利用问卷来评估阻塞性睡眠呼吸暂停的风险和症状，以检验胰岛素抵抗最严重的肥胖个体患阻塞性睡眠呼吸暂停的风险最高的假设。非糖尿病、超重到肥胖的志愿者在胰岛素抑制试验中通过测量稳态血浆葡萄糖浓度直接量化胰岛素敏感性。对胰岛素敏感和胰岛素抵抗的受试者分别进行Berlin和STOP问卷调查，以确定OSA风险状况，并使用Epworth嗜睡量表（ESS）评估白天嗜睡。进行空腹胰岛素和脂质/脂蛋白测量。在同样肥胖、胰岛素抵抗（n=22）和胰岛素敏感（n=14）的个体之间，胰岛素介导的葡萄糖处理差异为3倍（p<0.001），这与胰岛素抵抗个体的空腹胰岛素和甘油三酯较高以及高密度脂蛋白胆固醇（HDL-C）浓度较低有关。两份问卷均发现胰岛素抵抗者有14人（64%），而胰岛素敏感者有2人（14%）有OSA的高风险（p<0.01）。一半的胰岛素抵抗个体符合ESS白天过度嗜睡的标准，而只有1个胰岛素敏感个体符合（p=0.011）。在胰岛素抵抗的肥胖人群中，阻塞性睡眠呼吸暂停和白天过度嗜睡的风险很高。基于空腹胰岛素、甘油三酯和/或HDL-C的胰岛素抵抗替代估计可用于帮助识别那些从OSA筛查和转诊多导睡眠图中获益最多的肥胖成年人。
Obstructive sleep apnea (OSA) is an increasingly common sleep disorder, especially among obese adults. Early identification of adults at risk for OSA would be of substantial benefit; however the magnitude of the obesity epidemic requires that screening be performed judiciously. The study's aim was to utilize questionnaires that assess OSA risk and symptoms to test the hypothesis that the most insulin-resistant subset of obese individuals is at highest risk for OSA. Non-diabetic, overweight-to-obese volunteers underwent direct quantification of insulin sensitivity by measuring steady-state plasma glucose concentrations during the insulin suppression test. Insulin-sensitive and insulin-resistant individuals were administered the Berlin and STOP questionnaires to determine OSA risk status, and Epworth Sleepiness Scale (ESS) to evaluate daytime sleepiness. Fasting insulin and lipid/lipoprotein measurements were performed. Insulin-mediated glucose disposal differed 3-fold (p<0.001) between equally obese, insulin-resistant (n=22) and insulin-sensitive (n=14) individuals, associated with higher fasting insulin and triglyceride and lower high-density lipoprotein cholesterol (HDL-C) concentrations in insulin-resistant individuals. Fourteen (64%) insulin-resistant as compared with 2 (14%) insulin-sensitive individuals were found to be at high risk for OSA by both questionnaires (p<0.01). Whereas half of insulin-resistant individuals met ESS criteria for excessive daytime sleepiness, only 1 insulin-sensitive individual did (p=0.011). High risk for OSA and excessive daytime sleepiness is prevalent amongst the insulin-resistant subgroup of obese individuals. Surrogate estimates of insulin resistance based on fasting insulin, triglycerides, and/or HDL-C can be used to help identify those obese adults who would benefit most from OSA screening and referral for polysomnography.
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影响因子：
120.7
作者：
Flegal, Katherine M.;Carroll, Margaret D.;Curtin, Lester R.
通讯作者：
Curtin, Lester R.
影响因子：
16.2
作者：
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--
DOI：
10.1016/j.ecl.2008.06.005
发表时间：
2008-09-01
影响因子：
4.5
作者：
Reaven, Gerald M.
通讯作者：
Reaven, Gerald M.
影响因子：
9.3
作者：
Li, Chaoyang;Ford, Earl S.;Reaven, Gerald M.
通讯作者：
Reaven, Gerald M.
影响因子：
7.7
作者：
GREENFIELD, MS;DOBERNE, L;REAVEN, G
通讯作者：
REAVEN, G