题名：Sleep apnoea syndrome and 10-year cardiovascular risk in females with type 2 diabetes: relationship with insulin secretion and insulin resistance.
作者：HERMANS MP; AHN SA; MAHADEB YP; ROUSSEAU MF;
来源：Diabetes Metab Res Rev. 2013 Mar;29(3):227-34. doi: 10.1002/dmrr.2387. [ IF= 0.00 ] ]
摘要：BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) is a risk factor for type 2
diabetes mellitus (T2DM) and promotes cardiovascular events, especially in men.
The prevalence of sleep apnoea and its association with microvascular and
macrovascular diseases and glycaemic control are poorly documented in T2DM women.
METHODS: A total of 305 T2DM women were sleep apnoea diagnosed through
(hetero)anamnesis, Epworth's score, oximetry and polysomnography. Sleep apnoea[+]
(n = 25) were compared with sleep apnoea[-] (n = 280) regarding cardiovascular
risk factors, glucose homeostasis, micro/macrovascular complications and the
United Kingdom Prospective Diabetes Study (UKPDS) 10-year risk. RESULTS: Mean (1
SD) age was 66 (12) years, diabetes duration 15 (9) years, sleep apnoea
prevalence 8.2% and metabolic syndrome 86%. There were no differences in age,
diabetes duration, education, smoking and blood pressure between groups. Sleep
apnoea[+] had significantly higher values of body mass index, waist,
relative/absolute fat, conicity, visceral fat (all p < 0.0001) and lower skeletal
muscle (p = 0.0008). The sleep apnoea[+] group was more insulin resistant
[homeostasis model assessment (HOMA S): 37 (20)% versus 59 (44)%; p < 0.0001] and
had lesser residual insulin secretion (HOMA B x S: 20 (12)% versus 30 (19)%; p =
0.0006), increased hyperbolic product loss (p = 0.0442) and poorer glycaemic
control (HbA1c 69 (12) versus 62 (13) mmol mol(-1) ; p = 0.0099). All atherogenic
dyslipidaemia components and inflammatory markers were worsened in sleep
apnoea[+]. Women with sleep apnoea had higher UKPDS risk of CAD: 18 (11)% versus
12 (10)% (p = 0.0136). Prevalent micro/macrovascular complications were not
different between groups. CONCLUSIONS: Sleep apnoea, a frequent comorbidity of
T2DM women, is associated with central fat, atherogenic dyslipidaemia,
inflammation, worsening beta-cell function, poorer glycaemic control and coronary
artery disease risk. Sleep apnoea may increase residual vascular risk for
microvascular and macrovascular events in T2DM women.