阻塞性睡眠呼吸暂停与胰岛素抵抗和型糖尿病张希龙

1、会计学1阻塞性睡眠呼吸暂停与胰岛素抵抗和型阻塞性睡眠呼吸暂停与胰岛素抵抗和型糖尿病张希龙糖尿病张希龙结论：结论：对对2型糖尿病患者应常规进行型糖尿病患者应常规进行OSA的筛选的筛选间歇性低氧引起胰岛素抵抗间歇性低氧引起胰岛素抵抗Iyiori et al. Am J Respir Crit Care Med 2007; 175:851-857 OSAS & Insulin resistance(IR)NormalNormalIncreased Normal or IGT Diabetes mellitus DecreasedPancreatic islets cell compensat

2、ion cell failureInsulinsecretion by cells Blood glucoseOSAS CIHOSAS CIHOSAS CIHOSAS CIHOSAS CIHOSAS CIHOSAS CIHOSAS CIHOSAS CIHNormalNormalIncreased Normal or IGT Diabetes mellitus DecreasedPancreatic islets cell compensation cell failureInsulinsecretion by cells Blood glucoseOSAS CIHFasting and 2 h

3、 (post glucose load) insulin and glucose levels (mean +/- sem) by AHIPunjabi et al 2002睡眠剥夺对激素分泌的影响睡眠剥夺对激素分泌的影响Spiegel, K. J Clin Endo & Met: 89 (11) 5762-5771; 2004LeptinCortisolHOMA-IRYaggi et al. Diabetes Care 2006;29: 657-61 Models adjusted for:*The Nurses Study. Al-Delaimy. AJE 2002 155: 38

4、7-393 Adjusted for age, history of high cholesterol, history of high blood pressure, time period, smoking, BMI, physical activity, alcohol use, fam history of diabetes, usual sleeping position, number of hours of sleep per day, and years of shift-workThe Sleep Heart Health Study. AJE 2004 160(6):521

5、-530 * P 0.005 vs AHI 7.0mmol/lDM diagnosis*Adjusted for age and sex*Clinical Endocrinology(2003) 59, 374-379Glucose and insulin levels in normal subjects (NS), obese patients (OB) and obese patients with obstructive sleep apnea syndrome (OSAS) during OGTT 23Narkiewicz et al 1998 CirculationOSA &

6、; Insulin Resistance012345678910111213141234AHI 30AHI 30HOMA IRBMI = 24.4BMI = 26.9BMI = 28.4BMI = 29.5p 15 Homeostasis model assessment (HOMA) Fasting glucose & insulin levelHOMA-IR was independently associated with BMI /waist (p0.001), AHI /minimum O2 saturation (p 0.05) Seen in both obese and

7、 non-obese subjectsIp et al. Am J Resp Crit Care Med 200121. IA Harsch Department of Medicine I, Friedrich-Alexander University Erlangen Nuremburg, Erlangen, Germany.Am J Respir Crit Care Med. 2004;169(2):156-162Shows improvement of insulin sensitivity index (ISI) at baseline, 2 days and 3 months af

8、ter onset of CPAP treatment in 31 patents Within 48 hours, significant improvements have been demonstrated in Insulin Sensitivity using CPAP therapy 21 FastingBfastLunchDinnerBabu et al. Arch Intern Med. 2005;165:447-521 hr post-prandial* P 4h/dayCPAP use 4h/day结论：结论：对对2型糖尿病患者应常规进行型糖尿病患者应常规进行OSA的筛选的筛选* P 0.005 vs AHI 7.0mmol/lDM diagnosis*Adjusted for age and sex*Clinical Endocrinology(2003) 59, 374-379Glucose and insulin levels in normal subjects (NS), obese patients (OB) and obese patien