Analysis On Clinical Data Of Patients With Obstructive Sleep Apnea Syndrome And Metabolic Syndrome

Background: Metabolic syndrome(MS) has a high prevalence among patients with obstructive sleep apnea syndrome(OSAS). There is a close relationship between MS and OSAS, which play a synergetic role in aggravation of cardiovascular dysfunction. Therefore, development of basic and clinical study with respect to both diseases has profound significance not only for the diagnosis and treatment of OSAS and MS, but also for the prevention and treatment of cardiovascular and cerebrovascular diseases. Although domestic and foreign scholars have conducted some research on this issue, more studies concentrated on one or some aspects of MS. For this reason, our study analyses the impact of OSAS on the biomarkers of MS, related hormones and mediators of inflammation.Object: Considering MS as the core of this study, we screened for factors which presumably have influence on the incidence and severity of MS on the basis of comprehensive examination on parameters of OSAS. Sequentially, we evaluated the impact of severity of OSAS and other related parameters on MS, which can provide objective evidence for clinical practice of endocrine and metabolic diseases.Methods: We selected 103 patients with the diagnosis of OSAS in Respiratory Sleep Center from March 1st 2015 to March 1st 2016 in the Bethune First Hospital of Jilin University for screen and ultimately identified 73 patients conforming to the criteria as objects. Moreover, among these OSAS patients we selected 20 patients with MS combined with type 2 diabetes mellitus as a subgroup. We recorded the age, gender, weight, height, and BMI of all patients, examined the TST, sleep efficiency, N1 stage/TST, N2 stage/TST, N3 stage/TST, REM stage/TST, AHI, REM stage AHI, N-REM stage AHI, nadir Sp O2, mean Sp O2, ODI by polysomnography and collected venous blood sample for examining FBG, TC, TG, HDL-C and LDL-C level. For the subgroup patients including 20 patients with MS combined with type 2 diabetes mellitus, except for the parameters mentioned above we additionally examined or calculated Hb A1 c, FBG, fasting blood C peptide and insulin, 2 hours postprandial glucose and C peptide with 100 g bread test, HOMA-IR, CRP, cortisol and growth hormone at 8 a.m.Results:(1) Among the 73 cases of OSAS patients in this study, the evarage age was 45.42±11.26. 52 patients were male which took up 71.23% and 21 patients were female which took up 28.77%. As for the BMI distribution, 3 cases were in normal BMI(4.11%), 24 cases were overweight(32.88%), 46 cases were obesity(63.01%). According to AHI level, there were 8 in mild OSAS, 22 in moderate OSAS, 43 in severe OSAS and 10.96%, 30.14%, 58.90% in proportion respectively. The proportions of obesity in these three groups were 37.50%, 59.09%, 69.77% respectively. Besides, there was a positive correlation between AHI and BMI. According to nadir Sp O2 level, there were 4 without hypoxaemia, 21 in mild hypoxaemia, 15 in moderate hypoxaemia, 33 in severe hypoxaemia and 5.48%, 28.77%, 20.55%, 45.20% in proportion respectively. There were 51 complicated with MS(69.86%), 53 complicated with hypertension(72.60%), 23 complicated with diabetes(31.51%) and 50 complicated with hyperlipidemia(68.49%).(2) According to whether the patients complicated with MS, we divided the 73 OSAS patients into two groups, MS group(51 cases) and non-MS group(22 cases), statistical analysis showed that the two groups had statistically significant differences(P<0.05)in FBG, TG, TST, sleep efficiency, nadir Sp O2, ODI.(3) We regarded the patients with OSAS complicated with MS or not as dependent variables, regarded the differential factors which were screened using single factor analysis method as independent variables, and performed Logistic multivariate analysis. The results showed that the prevalence of OSAS and MS was related to FBG, we can consider FBG as an independent risk factor of OSAS patients complicated with MS, the increase of FBG will take 2.75 times risk of OSAS patients complicated with MS.(4) We selected the statistically significant factors of single factor analysis method to conduct correlation analysis, the results showed that TST is negative correlated with TG, HOMA-IR, fasting blood C peptide, 2 hours postprandial C peptide, cortisol at 8 a.m, nadir Sp O2 is negative correlated with Hb A1 c, TG, HOMA-IR, cortisol at 8 a.m.Conclusions:(1) In this study OSAS occured more often in elders, men and obese people, prevalence of combination with diabetes mellitus, hyperlipidemia and hypertension was higher.(2) In the OSAS patients, as the severity of OSAS grew, the proportion of the obesity increased. Moreover, obesity was related to the severity of OSAS.(3) In hospitalized OSAS patients of this study, the increase of FBG was an independent risk of OSAS accompanied by MS.(4) Among the OSAS patients with MS accompanied by type 2 diabetes mellitus, TST and nadir Sp O2 was related to Hb A1 c, TG, HOMA-IR, fasting blood C peptide, 2 hours postprandial C peptide and cortisol at 8 a.m. Therefore, we suggested that sleep disorder and hypoxaemia may be the vital mechanism of the development of MS.