The relation of serum 25-hydroxyvitamin-D levels with severity of obstructive sleep apnea and glucose metabolism abnormalities
The relation of serum 25-hydroxyvitamin-D levels with severity of obstructive sleep apnea and glucose metabolism abnormalities
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DOI：
10.1007/s12020-012-9595-1
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发表时间：
2012-06-01
期刊：
影响因子：
3.7
通讯作者：
Delibasi, T.
中科院分区：
文献类型：
--
作者：
Bozkurt, N. Colak;Cakal, E.;Delibasi, T.
阻塞性睡眠呼吸暂停（OSA）和25-羟基维生素D-3（25-OH-D）缺乏是与肥胖、炎症和糖代谢受损相关的两种独立的疾病。我们的目的是调查OSA患者的维生素D状况，了解低维生素D水平与糖代谢异常之间的潜在联系，糖代谢异常是OSA的主要不良结局之一。研究组由190名怀疑患有OSA的非糖尿病受试者组成。受试者接受多导睡眠图检查，并根据呼吸暂停低通气指数（AHI）分为对照组（AHI < 5，n = 47）、轻度OSA（千分之5的货币符号AHI < 15，n = 46）、中度OSA（千分之15的货币符号AHI < 30，n = 47）和重度OSA（千分之30的货币符号AHI a，n = 50）。测定血清25-OH-D、HbA 1 c、胰岛素水平，并进行75 g葡萄糖耐量试验。OSA患者血清25-OH-D水平（ng/ml）低于对照组（17.4 +/-A6.9 vs.19.9 +/-A7.8），下降程度与OSA严重程度平行;作为18.2 +/- A 6.4（5 a千分之一货币符号AHI < 15），17.5 +/- A 7.4（15 a/1000货币符号AHI < 30）和16.3 +/-A6.9（AHI > 30）（P = 0.097，r = -0.13）。重度OSA组女性25-OH-D水平显著低于对照组（11.55ng/ml），而对照组男性25-OH-D水平最高（21.7ng/ml）（P < 0.001）。OSA患者中胰岛素抵抗（IR）发生率为48%，糖尿病前期发生率为41%，糖尿病发生率为16%。胰岛素抵抗受试者的平均25-OH-D水平（HOMA-IR < 2.7，n = 77，AHI = 35.5）低于非胰岛素抵抗受试者（HOMA-IR < 2.7，n = 113，AHI = 19.8），分别为16.18 +/-A7.81和19.2 +/-A6.6（P = 0.004）。91例非糖尿病患者（n = 91，AHI = 19.7）的25-OH-D水平为19.5 +/-A7.4，糖尿病前期患者（n = 75，AHI = 28.7）为17.45 +/-A6.9，糖尿病患者（n = 24，AHI = 46.3）为13.8 +/-A5.3（P = 0.02）。我们发现，具有更严重的OSA指数（AHI每千日元15分之一）的受试者倾向于呈现与IR、前驱糖尿病和糖尿病的患病率增加相关的较低的维生素D水平。维生素D缺乏可能在葡萄糖代谢方面发挥作用和/或加重OSA的不良后果。OSA患者可以考虑进行补充治疗，这表明可以改善异常的葡萄糖代谢和炎症。
Obstructive sleep apnea (OSA) and 25-hydroxyvitamin-D-3 (25-OH-D) deficiency are two separate disorders associating with obesity, inflammation, and impaired glucose metabolism. We aimed to investigate the vitamin D status of OSA patients regarding to potential links between lower vitamin D levels and abnormal glucose metabolism, which is one of the main adverse outcomes of OSA. Study group is composed of 190 non-diabetic subjects who were suspected of having OSA. Subjects undergone polysomnography and were grouped due to apnea-hypopnea indices (AHI) as controls (AHI < 5, n = 47), mild OSA (5 a parts per thousand currency sign AHI < 15, n = 46), moderate OSA (15 a parts per thousand currency sign AHI < 30, n = 47), and severe OSA (AHI a parts per thousand yen 30, n = 50). Serum 25-OH-D, HbA(1)c, insulin levels were measured and 75-g oral glucose tolerance test was performed. Serum 25-OH-D level (ng/ml) of OSA patients were lower than control subjects (17.4 +/- A 6.9 vs. 19.9 +/- A 7.8), and decrement was parallel to severity of OSA; as 18.2 +/- A 6.4 (5 a parts per thousand currency sign AHI < 15), 17.5 +/- A 7.4 (15 a parts per thousand currency sign AHI < 30), and 16.3 +/- A 6.9 (AHI > 30), respectively (P = 0.097, r = -0.13). However, severe female OSA patients had significantly lower 25-OH-D levels (11.55 ng/ml), while control males had the highest mean value (21.7 ng/ml) (P < 0.001). Frequency of insulin resistance (IR) was 48%, prediabetes 41%, diabetes 16% in OSA patients. Mean 25-OH-D level of insulin resistant subjects (HOMA-IR a parts per thousand yen 2.7, n = 77, AHI = 35.5) was lower than non-insulin resistant subjects (HOMA-IR < 2.7, n = 113, AHI = 19.8) as 16.18 +/- A 7.81 versus 19.2 +/- A 6.6, respectively (P = 0.004). 25-OH-D level of 91 non-diabetic subjects (n = 91, AHI = 19.7) was 19.5 +/- A 7.4, prediabetics (n = 75, AHI = 28.7) was 17.45 +/- A 6.9, and diabetics (n = 24, AHI = 46.3) was 13.8 +/- A 5.3 (P = 0.02). We showed that subjects with more severe OSA indices (AHI a parts per thousand yen 15) tended to present lower vitamin D levels correlated to increased prevalence of IR, prediabetes, and diabetes. Vitamin D deficiency may play a role and/or worsen OSA's adverse outcomes on glucose metabolism. OSA patients may be considered for supplementation treatment which was shown to ameliorate abnormal glucose metabolism and inflammation.