Eight Hours of Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea Improves Glucose Metabolism in Patients with Prediabetes A Randomized Controlled Trial
Eight Hours of Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea Improves Glucose Metabolism in Patients with Prediabetes A Randomized Controlled Trial
复制标题
DOI：
10.1164/rccm.201408-1564oc
复制
发表时间：
2015-07-01
影响因子：
24.7
通讯作者：
Tasali, Esra
中科院分区：
文献类型：
--
作者：
Pamidi, Sushmita;Wroblewski, Kristen;Tasali, Esra
理由：尽管阻塞性睡眠呼吸暂停（OSA）与糖耐量受损和糖尿病有关，但持续气道正压通气（CPAP）治疗OSA是否具有代谢益处尚不清楚。目的：探讨每晚8小时CPAP治疗对糖尿病前期和OSA患者糖代谢的影响。方法：在一项随机对照平行组研究中，39名参与者被随机分配接受8小时每晚CPAP （n = 26）或口服安慰剂（n = 13）。每晚在实验室用多导睡眠记录仪记录睡眠情况。持续监测确保CPAP的依从性。参与者在实验室外继续他们的日常活动。在基线和指定治疗2周后，通过口服和静脉葡萄糖耐量试验评估葡萄糖代谢。主要终点是通过2小时口服葡萄糖耐量试验中葡萄糖曲线下面积来量化的总体葡萄糖反应。次要结局包括空腹和2小时血糖和胰岛素、胰岛素和胰岛素分泌曲线下面积、去甲肾上腺素、胰岛素敏感性、急性胰岛素对葡萄糖的反应和24小时血压。测量结果和主要结果：总体葡萄糖反应降低（治疗差异：-1,276.9 [mg/dl]）。最小值[95%置信区间，- 2392.4至-161.5]；P = 0.03)，胰岛素敏感性提高(治疗差异：0.77 [mU/L]（-1）。Min(-1)[95%置信区间，0.03-1.52]；P = 0.04)。此外，与安慰剂相比，CPAP降低了去甲肾上腺素水平和24小时血压。结论：在糖尿病前期患者中，与安慰剂相比，每晚8小时CPAP治疗2周可改善葡萄糖代谢。因此，CPAP治疗可能有利于降低代谢风险。
Rationale: Although obstructive sleep apnea (OSA) is associated with impaired glucose tolerance and diabetes, it remains unclear whether OSA treatment with continuous positive airway pressure (CPAP) has metabolic benefits.Objectives: To determine the effect of 8-hour nightly CPAP treatment on glucose metabolism in individuals with prediabetes and OSA.Methods: In a randomized controlled parallel group study, 39 participants were randomly assigned to receive either 8-hour nightly CPAP (n = 26) or oral placebo (n = 13). Sleep was polysomnographically recorded in the laboratory on each night. CPAP adherence was ensured by continuous supervision. Participants continued their daily routine activities outside the laboratory. Glucose metabolism was assessed at baseline and after 2 weeks of assigned treatment using both the oral and intravenous glucose tolerance tests. The primary outcome was the overall glucose response as quantified by the area under the curve for glucose during 2-hour oral glucose tolerance testing. Secondary outcomes included fasting and 2-hour glucose and insulin, the area under the curves for insulin and insulin secretion, norepinephrine, insulin sensitivity, acute insulin response to glucose, and 24-hour blood pressure.Measurements and Main Results: The overall glucose response was reduced (treatment difference: -1,276.9 [mg/dl].min [95% confidence interval, -2,392.4 to -161.5]; P = 0.03) and insulin sensitivity was improved (treatment difference: 0.77 [mU/L](-1).min(-1) [95% confidence interval, 0.03-1.52]; P = 0.04) with CPAP as compared with placebo. Additionally, norepinephrine levels and 24-hour blood pressure were reduced with CPAP as compared with placebo.Conclusions: In patients with prediabetes, 8-hour nightly CPAP treatment for 2 weeks improves glucose metabolism compared with placebo. Thus, CPAP treatment may be beneficial for metabolic risk reduction.