阻塞型睡眠呼吸暂停低通气综合征与颈动脉硬化、胰岛素抵抗的相关性研究

Study on the relationship between obstructive sleep apnea-hypopnea syndrome and carotid atherosclerosis, insulin resistance

关键词:  睡眠呼吸暂停  颈动脉  内膜中层厚度  胰岛素抵抗

Key words:  sleep apnea  carotid artery  intima-media thickness  insulin resistance

摘要:

[目的] 探讨阻塞型睡眠呼吸暂停低通气综合征（OSAHS）与颈动脉内膜中层厚度（IMT）、胰岛素抵抗（IR）之间的关系。[方法] 以在大连医科大学附属第二医院就诊，经多导睡眠初筛仪检测，睡眠呼吸暂停低通气指数(AHI)≥5次/h的31例患者作为研究对象。选择同期在本院就诊，经多导睡眠初筛仪检测AHI<5次/h的31例患者作为对照组。两组受试对象性别比、年龄、血压、BMI、TC分布差异显著性意义（均P>0.05）。比较两组患者的稳态模型胰岛素抵抗指数（HOMA-IR）和颈动脉IMT的差异。再分别对HOMA-IR及颈动脉IMT与AHI、呼吸暂停及低通气的总时间、夜间最低脉搏血氧饱和度(SpO2)、平均SpO2进行 Spearman相关分析。并分别以HOMA-IR及颈动脉IMT为因变量，以年龄、体重指数（BMI）、总胆固醇（TC）、AHI、夜间最低SpO2、呼吸暂停及低通气的总时间为自变量，进行多元逐步回归分析。[结果] 与正常对照组相比，OSAHS组患者的HOMA-IR及颈动脉IMT明显增高（均P<0.05）。Spearman相关分析显示颈动脉IMT及HOMA-IR均与AHI、呼吸暂停及低通气的总时间呈正相关，与夜间最低SpO2呈负相关。多元逐步回归分析显示，影响IMT的因素依次是夜间最低SpO2、AHI、年龄、呼吸暂停及低通气的总时间。影响HOMA-IR的因素依次是夜间最低SpO2、BMI、AHI、呼吸暂停及低通气的总时间。[结论] OSAHS是引起颈动脉硬化及胰岛素抵抗的危险因素，改善OSAHS患者的低氧血症对防治动脉粥样硬化及胰岛素抵抗有重要意义。

Abstract:

[Objective] To discuss the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and carotid intima-media thickness (IMT), insulin resistance (IR). [Methods] All subjects were selected from the patients attending the second Affiliated Hospital of Dalian Medical University. After test by portable polysomnograph, patients whose sleep apnea-hypopnea index (AHI) ≥5 times/h (31 patients) were included in the research group. During the same period, patients whose AHI<5 times/h (31 patients) were included in the control group. There were no significant differences between sex ratio, age, BMI, TC of the two groups（P>0.05）. Then the comparison of difference was made between HOMA-IR and carotid IMT of the 2 groups. The relativity between HOMA-IR, carotid IMT and AHI, total time of apne a and hypopnea, the lowest SpO2, average SpO2 were respectively assessed by Spearman correlation test. Carotid IMT and HOMA-IR were respectively chosen as the dependent variables, and age, body mass index（BMI）, total cholesterol（TC）, AHI, the lowest SpO2, total time of apnea and hypopnea were chosen as the independent variables for multiple stepwise regression analysis. [Results] Compared with the normal group, HOMA- IR and carotid IMT in OSAHS group increased significantly（P<0.05）. Spearman correlation analysis revealed that carotid IMT and HOMA-IR were both associated positively with AHI, total time of apnea and hypopnea, while they were both associated negatively with the lowest SpO2. Multiple stepwise regression analysis revealed that factors influencing IMT were the lowest SpO2, which was followed by AHI, age, total time of apnea and hypopnea. Factors influencing HOMA-IR were the lowest SpO2, which was followed by BMI, AHI, total time of apnea and hypopnea. [Conclusions] OSAHS is a risk factor of carotid artherosclerosis and insulin resistance. Treatment of hypoxemia has important role in preventing carotid artherosclerosis and insulin resistance.