Clinical Research On The Impact Of OSAHS On Glucose And Lipid Metabolism And Blood Pressure

Objective: The aim of this study was firstly to investigate the association between sleep fragmentation and dyslipidemia in a large-scale cross-sectional obstructive sleep apnea and hypopnea syndrome(OSAHS)population.And then evaluate the effect of upper airway surgeries on metabolic profiles including glucose level,insulin resistance,lipid level and blood pressure,and global cardiovascular risk in OSAHS patients.The the possible predictors of better metabolic profiles improvements were also evaluated.Methods: In the first study,we included 2686 OSAHS patients.Through multiple regression analysis,we evaluated the independent association between fasting blood lipid levels and the micro arousal index(MAI)after adjusting for metabolic syndrome factors(including obesity,diabetes,and hypertension)as well as nocturnal intermittent hypoxia.We further calculated odds ratios for various types of dyslipidemia according to MAI quartile by means of logistic regression.In the second study,we included OSAHS patients that had upper airway surgeries and were followed up after at least 6 months.The glucose,insulin resistance,lipid,blood pressure and Framinghan global cardiovascular risk were compared between preoperative and postoperative.Then,the possible predictors of better metabolic profiles changes after the surgeries were evaluated,and correlation tests were conducted to check whether there were some correlation between changes of sleep breath parameters and changes of metabolic profiles.Results: The cross-sectional study showed that MAI was positively associated with LDL-c level after adjustment of age,gender,metabolic syndrome factors including hypertension,obesity and diabetes and oxygen desaturation index.Furthermore,adjusted ORs(95% CI)for hyper LDL cholesterolemia were 1(reference),1.3(1.1-1.7),1.6(1.2-2.0),and 1.6(1.2-2.1)for MAI≤14.1,14.1<MAI≤26.5,26.5<MAI≤45.3 and MAI>45.3,respectively(P =0.001 for linear trend).The second study found significant improvements of both sleep breath parameters(P <0.05)and metabolic profiles including fasting blood glucose(P < 0.001),HOMA-IR(P = 0.034),TC(P < 0.001),LDL-C(P = 0.001)and apolipoprotein B(P < 0.001),systolic blood pressure(P = 0.004),diastolic blood pressure(P = 0.005)and age-adjusted global cardiovascular risk(P<0.001).The changes in metabolic parameters were associated with the improvements in some oxygen indexes(P<0.05).In addition,the improvements of metabolic parameters were better in patients with preoperative specific metabolic abnormalities(P<0.05).Conclusions: Dyslipidemia in OSAHS was not only associated with nocturnal intermittent hypoxia but also with sleep fragmentation.Treatment of OSAHS with upper airway surgeries helped in the reverse of metabolic disorders,especially in those with preoperative metabolic disorders,and the improvements of metabolic profiles might be related to the improvements of oxygen saturation.