Ketogenic diet acutely improves gas exchange and sleep apnoea in obesity hypoventilation syndrome: A non-randomized crossover study.
Ketogenic diet acutely improves gas exchange and sleep apnoea in obesity hypoventilation syndrome: A non-randomized crossover study.
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生酮饮食可显着改善肥胖低通气综合征中的气体交换和睡眠呼吸暂停：一项非随机交叉研究。
DOI：
10.1111/resp.14526
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Jun,JonathanC
中科院分区：
文献类型：
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作者：
Osman,Adam;Gu,Chenjuan;Kim,DavidE;Duan,Daisy;Barron,Bobbie;Pham,LuuV;Polotsky,VsevolodY;Jun,JonathanC
背景和目的肥胖换气不足综合征（OHS）导致高碳酸血症，目前的治疗方法通常难以治疗。我们研究是否高碳酸血症在OHS可以改善生酮饮食intervention.MethodsWe进行了单臂交叉临床试验，研究生酮饮食对CO2水平的影响，OHS患者。指导患者坚持1周的常规饮食，2周的生酮饮食，然后在门诊环境中坚持1周的常规饮食。通过毛细血管血酮水平和动态血糖监测评估依从性。在每周的访问中，我们测量了血气，热量测定，身体成分，代谢概况和睡眠研究。结果进行了评估与线性混合models.ResultsA共20名受试者完成了研究。血酮从正常饮食时的0.14 ± 0.08增加到生酮饮食2周后的1.99 ± 1.11 mmol/L（p< 0.001）。生酮饮食使静脉CO2降低了3.0 mm Hg（p= 0.008），碳酸氢盐降低了1.8 mmol/L（p= 0.001），体重降低了3.4 kg（p <0.001）。睡眠呼吸暂停严重程度和夜间血氧水平显著改善。生酮饮食降低了呼吸商、脂肪量、身体水分、葡萄糖、胰岛素、甘油三酯、瘦素和胰岛素样生长因子1。恢复正常饮食后观察到反弹性高碳酸血症。CO2降低依赖于基线高碳酸血症，并与循环酮水平和呼吸商相关。生酮饮食耐受性良好。ConclusionThis study demonstrates for the first time that a ketogenic diet may be useful for control of hypercapnia and sleep apnea in patients with obesity hypocentilation syndrome.
Background and ObjectiveObesity hypoventilation syndrome (OHS) causes hypercapnia which is often refractory to current therapies. We examine whether hypercapnia in OHS can be improved by a ketogenic dietary intervention.MethodsWe conducted a single‐arm crossover clinical trial to examine the impact of a ketogenic diet on CO2levels in patients with OHS. Patients were instructed to adhere to 1 week of regular diet, 2 weeks of ketogenic diet, followed by 1 week of regular diet in an ambulatory setting. Adherence was assessed with capillary ketone levels and continuous glucose monitors. At weekly visits, we measured blood gases, calorimetry, body composition, metabolic profiles, and sleep studies. Outcomes were assessed with linear mixed models.ResultsA total of 20 subjects completed the study. Blood ketones increased from 0.14 ± 0.08 during regular diet to 1.99 ± 1.11 mmol/L (p< 0.001) after 2 weeks of ketogenic diet. Ketogenic diet decreased venous CO2by 3.0 mm Hg (p= 0.008), bicarbonate by 1.8 mmol/L (p= 0.001), and weight by 3.4 kg(p <0.001).Sleep apnoea severity and nocturnal oxygen levels significantly improved. Ketogenic diet lowered respiratory quotient, fat mass, body water, glucose, insulin, triglycerides, leptin, and insulin‐like growth factor 1. Rebound hypercapnia was observed after resuming regular diet. CO2lowering was dependent on baseline hypercapnia, and associated with circulating ketone levels and respiratory quotient. The ketogenic diet was well tolerated.ConclusionThis study demonstrates for the first time that a ketogenic diet may be useful for control of hypercapnia and sleep apnoea in patients with obesity hypoventilation syndrome.