Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes
Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes
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DOI：
10.1164/rccm.200909-1423oc
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发表时间：
2010-03-01
影响因子：
24.7
通讯作者：
Tasali, Esra
中科院分区：
文献类型：
--
作者：
Aronsohn, Renee S.;Whitmore, Harry;Tasali, Esra
基本原理：阻塞性睡眠呼吸暂停（OSA）是一种可治疗的睡眠障碍，与非糖尿病个体的葡萄糖代谢改变有关，是2型糖尿病的一种高度流行的合并症。然而，目前尚不清楚OSA的严重程度是否是糖尿病患者血糖控制的预测因子。目的：确定OSA对2型糖尿病住院患者糖化血红蛋白（HbA1c）的影响，HbA1c是血糖控制的主要临床指标。我们对2007年2月至2009年12月期间从门诊招募的60名糖尿病患者进行了多导睡眠图研究并测量了HbA1c测量和主要结果：77%的糖尿病患者患有OSA（呼吸暂停低通气指数[AHI] >= 5）。在控制了年龄、性别、种族、体重指数、糖尿病药物数量、运动水平、糖尿病年数和总睡眠时间后，OSA严重程度的增加与血糖控制较差相关。与非OSA患者相比，轻度OSA患者的HbA1c校正均值增加1.49%（P = 0.0028），中度OSA患者增加1.93%（P = 0.0033），重度OSA患者增加3.69%（P <0.0001）（线性趋势P < 0.0001）。OSA严重程度的测量，包括总AHI（P = 0.004），快速眼动AHI（P = 0.005），以及总眼动睡眠和快速眼动睡眠期间的氧饱和度下降指数（分别为P = 0.005和P = 0.008）与HbA1c水平升高呈正相关。在2型糖尿病患者中，OSA的严重程度增加与血糖控制较差相关，与肥胖和其他混杂因素无关，其效应大小与广泛使用的降糖药物相当。
Rationale: Obstructive sleep apnea (OSA), a treatable sleep disorder that is associated with alterations in glucose metabolism in individuals without diabetes, is a highly prevalent comorbidity of type 2 diabetes. However, it is not known whether the severity of OSA is a predictor of glycemic control in patients with diabetes.Objectives: To determine the impact of OSA on hemoglobin A1c (HbA1c), the major clinical inclicator of glycemic control, inpatients with type 2 diabetes.Methods: We performed polysomnography studies and measured HbA1c in 60 consecutive patients with diabetes recruited from outpatient clinics between February 2007 and August 2009.Measurements and Main Results: A total of 77% of patients with diabetes had OSA (apnea-hypopnea index [AHI] >= 5). Increasing OSA severity was associated with poorer glucose control, after controlling for age, sex, race, body mass index, number of diabetes medications, level of exercise, years of diabetes and total sleep time. Compared with patients without OSA, the adjusted mean HbA1c was increased by 1.49% (P = 0.0028) in patients with mild OSA, 1.93% (P = 0.0033) in patients with moderate OSA, and 3.69% (P < 0.0001) in patients with severe OSA (P < 0.0001 for linear trend). Measures of OSA severity, including total AHI (P = 0.004), rapid eye movement AHI (P = 0.005), and the oxygen desaturation index during total and rapid eye movement sleep (P = 0.005 and P = 0.008, respectively) were positively correlated with increasing HbA1c levels.Conclusions: In patients with type 2 diabetes, increasing severity of OSA is associated with poorer glucose control, independent of adiposity and other confounders, with effect sizes comparable to those of widely used hypoglycemic drugs.