Objective To investigate the characteristic of dynamic glucose level in obstructive sleep apnea-hypopnea syndrome (OSAHS) patients with newly diagnosed type 2 diabetes mellitus (T2DM) and to evaluate the effect of continuous positive airway pressure (CPAP) treatment on the glucose level.Methods A total of 65 cases of patients with T2DM who were newly diagnosed by oral glucose tolerance test (OGTT) were enrolled from April 2014 to April 2015 in Gansu Provincial Hospital, and divided into simple T2DM group (n =30) and OSAHS with T2DM group (n =35) according to aponea-hypopnea index (AHI) which was monitored by polysomnography (PSG).Their general clinical data were collected, and glucose level of different periods was monitored by continuous glucose moitoring system (CGMS).Changes of glucose level were compared between two groups before and after CPAP treatment.Results Age, gender proportion, BMI, smoking and drinking history, glycosylated hemoglobin (HbA1c) and blood lipid profile had no significantly difference between two groups.Longer neck circumstance and higher waist-hip ration (WHR) ,higher systolic blood pressure and diastolic blood pressure, higher fasting plasma glucose (FPG) [(9.4 ±3.2) vs (7.3 ±2.1)mmol/L, P =0.028]and fasting insulin (FINS) [(19.2 ±8.7) vs (11.1 ±4.7) mU/L,P =0.044] level, more serious homeostasis model assessment insulin resistance (HOMA-IR) were found in OSAHS patients with T2DM when compared to patients in simple T2DM group.The average dynamic glucose level of 24 hours, daytime, nocturnal and sleep time in OSAHS with T2DM group were higher than that in the simple T2DM group (all P ＜ 0.05).The alarming times when the average dynamic glucose level of nocturnal time was more than 0.1 mmol · L-1 · min-1 in T2DM with OSAHS was more than that in control group (P =0.001).After treatment of CPAP, the level of AHI [(5.9 ± 3.6) vs (56.7 ± 11.4) times/h, P＜0.001], average dynamic glucose level of 24 hours, day, nocturnal and sleep time were obviously decreased (all P ＜ 0.05);lowest saturation oxygen (LSpO2) was significantly increased [(92.3 ± 3.7) % vs (81.5-± 20.2) %, P ＜ 0.001];the alarming times and HOMA-IR were obviously decreased (P =0.019,0.043).According to multiple linear regression analysis, the AHI(β =0.736, P ＜ 0.001) in OSAHS with T2DM group was positively related to the average dynamic glucose level during sleep time, but the LSpO2 (β =-0.889, P ＜ 0.001) was negatively correlated.Conclusions OSAHS patients with newly diagnosed T2DM have higher glucose level than that in simple T2DM patients, and CPAP therapy can obviously decrease the glucose level in newly diagnosed T2DM patients with OSAHS.AHI and LSpO2 may influence the average dynamic glucose level during sleep time.%目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并新诊断2型糖尿病(T2DM)患者动态血糖水平的特点和评估持续气道正压通气(CPAP)治疗对血糖水平变化的影响.方法 选择2014年4月至2015年4月在甘肃省睡眠医学中心住院的OSAHS合并新诊断T2DM患者35例,对照组为新诊断单纯T2DM患者30例.所有受试者经过多导睡眠呼吸监测(PSG)和连续动态血糖监测(CGMS)获取不同时段的血糖水平和读取夜间血糖升高＞0.1 mmol· L-1·min-1报警次数.对OSAHS合并新诊断T2DM患者进行CPAP治疗的同时继续行PSG监测和CGMS检测.本研究通过甘肃省人民医院伦理委员会批准.结果 两组间年龄、性别比例、体质指数(BMI)、吸烟史、饮酒史、糖化血红蛋白(HbA1c)和血脂谱之间差异均无统计学意义(均P＞0.05).与单纯T2DM患者比较,OSAHS合并新诊断T2DM组患者颈围、腰臀比(WHR)较大;收缩压和舒张压较高;空腹血糖(FPG)[(9.4±3.2)比(7.3±2.1) mmol/L,P=0.028]和空腹胰岛素(FINS)[(19.2±8.7)比(11.1±4.7) mU/L,P=0.044]升高;稳态模型胰岛素抵抗指数(HOMA-IR)较高;24 h、日间、夜间和睡眠期间的平均血糖水平均显著升高(均P ＜0.05).OSAHS合并新诊断T2DM患者组CGMS系统平均夜间血糖升高＞0.1 mmol·L-1·min-1报警次数显著增多(P =0.001),经过CPAP治疗后该组患者的睡眠呼吸暂停/低通气紊乱指数(AHI)显著降低[(5.9±3.6)比(56.7±11.4)次/h,P＜0.001],夜间最低血氧饱和度(LSpO2)明显提高[(92.3±3.7)%比(81.5±20.2)%,P＜0.001)];24 h、日间、夜间和睡眠期间的平均血糖水平均显著降低(均P＜0.05);CGMS系统平均夜间血糖升高＞0.1 mmol·L-1·min-1报警次数显著减少(P =0.019);HOMA-IR明显减轻(P =0.043).经过多重线性回归分析显示AHI与OSAHS合并T2DM组睡眠期间平均血糖水平呈正相关(β=0.736,P＜0.001),LSpO2与其呈负相关(β=-0.889,P＜0.001).结论 OSAHS合并新诊断T2DM患者血糖水平显著高于单纯新诊断T2DM患者;CPAP治疗可明显改善OSAHS合并新诊断T2DM患者的血糖水平;AHI和LSpO2可能是睡眠期间患者平均血糖水平的影响因素.
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