Study On The Related Factors In Patients With Obstructive Sleep Apnea Hypopnea Syndrome Associated Insulin Resistent

Background and ObjectiveObstructive sleep apnea hypopnea syndrome in patients with recurrent hypoxemia,hypercapnia and sleep disorders,this can cause heart and brain pulmonary vascular complications and even organ damage,seriously affecting the quality of life and survival of patients’ time.Insulin resistance refers to the sensitivity of the target organ of insulin to insulin,which is the characteristic of type 2 diabetes and is thought to be the initiating factor of most T2 DM.The aim of this study was to further analyze the factors related to the occurrence of insulin resistance in OSAHS patients,as to provide reference for the early prevention and treatment of OSAHS related T2 DM.Subjects and MethodThis study collected 365 cases of OSAHS from August 2015 to February 2017 in the sleep diagnosis and treatment center of the First Affiliated Hospital of Zhengzhou University,which was eventually diagnosed as OSAHS.There are 175 cases with high HOMA-IR,190 cases without high HOMA-IR.Questionnaire survey,physical examination,polysomnography,fasting blood glucose and fasting insulin was performed for all the patients.Some indicate was monitored and recorded,such as age,gender,smoking history,drinking history,upper respiratory disease,hyperlipidemia,cerebrovascular disease,cardiovascular disease,hypertension,family history of OSAHS,family history of T2 DM,ESS score,weight,height,neck circumference,waist circumference,mandibular retrusion,tongue body hypertrophy,himantosis,uvula too wide,tonsil,the lateral wall of pharynx,the soft palate,AHI,LSaO2,MSaO2,CT90%,oxygen desaturation index,micro-arousal index,the longest apnea duration,the total time of apnea,calculate BMI,waist-to-height ratio and HOMA-IR.SPSS 21.0 software was used for data analyzing.According to the different variables,quantitative variables of the high HOMA-IR group and the normal HOMA-IR group were analyzed by using t test,qualitative variables were analyzed by chi-square test.The relationship between quantitative variables which were significant different between the two groups and HOMA-IR were analyzed by Spearman correlation analysis,association analysis was used between qualitative variables and HOMA-IR.A multiple linear regression model was developed between quantitative variables and HOMA-IR.Logistic multiple regression analysis was performed for HOMA-IR.Result(1)There are 365 cases in this research,including 175 cases with high HOMA-IR,the incidence is 47.9%.(2)The comparison of clinical data between two groups: There was a significant difference between two groups,while weight’s x ±s in high HOMA-IR group was 82.997±12.231 kg,normal HOMA-IR group was 77.099±13.479 Kg(t=-2.628,P=0.007);There was a significant difference between two groups,while BMI’s x ±s in high HOMA-IR group was 28.912±4.011 Kg/m2,normal HOMA-IR group was 26.123±4.132 Kg/m2(t=-2.499,P=0.009);There was a significant difference between two groups,while waist circumference’s x ±s in high HOMA-IR group was 101.913±11.211 cm,normal HOMA-IR group was 97.872±11.827 cm(t=-1.997,P=0.039);There was a significant difference between two groups,while ESS score’s x ±s in high HOMA-IR group was 13.592±4.961,normal HOMA-IR group was 11.522±4.876(t=-1.989,P=0.041);There was a significant difference between two groups,the hypertension’s incidence of high HOMA-IR group was 81.7% and normal HOMA-IR group was 34.2%(χ2=8.143,P=0.021).(3)The comparison of clinical data between two groups: There was a significant difference between two groups,while AHI’s x ±s in high HOMA-IR group was 46.331±22.471 times per hour,normal HOMA-IR group was 38.339±19.679 times per hour(t=-2.156,P=0.037);There was a significant difference between two groups,while LSaO2’ s x ±s in high HOMA-IR group was 63.233±11.885 %,normal HOMA-IR group was 72.273±12.342 %(t=3.779,P=0.001);There was a significant difference between two groups,while MSaO2’ s x ±s in high HOMA-IR group was 89.999±4.359 %,normal HOMA-IR group was 93.929±3.231 %(t=4.338,P=0.001);There was a significant difference between two groups,while CT90%’s x ±s in high HOMA-IR group was 23.978±21.009 %,normal HOMA-IR group was 13.900±15.631 %(t=-2.432,P=0.003);There was a significant difference between two groups,while oxygen desaturation index’s x ±s in high HOMA-IR group was 42.954±27.111 %,normal HOMA-IR group was 35.456±15.344 %(t=-2.447,P=0.025);There was a significant difference between two groups,while micro-arousal index’s x ±s in high HOMA-IR group was 28.086±15.123 %,normal HOMA-IR group was 22.104±14.119 %(t=-2.164,P=0.031);There was a significant difference between two groups,while the total time of apnea’s x ±s in high HOMA-IR group was 119.999±79.118 minutes normal HOMA-IR group was 89.987±61.667 minutes(t=-2.483,P=0.012).(4)Spearman rank correlation and Pearson chi-square independent test: LSaO2 and MSaO2 ware negative correlation with HOMA-IR,r values were-0.225 and-0.253;Weight,BMI,waist circumference,ESS score,AHI,CT90%,oxygen desaturation index,micro-arousal index,the total time of apnea and hypertension were positive correlation with HOMA-IR,r values were 0.158,0.169,0.184,0.213,0.839,0.826,0.129,0.181,0.822,0.196(P<0.05).(5)The multiple linear regression: The results indicated that the response variable HOMA-IR was affected by weight,ESS score,CT90% and the total time of apnea(P<0.05).(6)Use HOMA-IR as a final outcome variables to performed logistic regression analysis showed that CT90%,mean oxygen saturation,the total apnea time and hypertension were accepted in the model(P>0.05).OR values were 1.567,1.072,1.121 and 2.929.This shows that CT90%,mean oxygen saturation,the total apnea time and hypertension were risk factors for OSAHS patients with insulin resistance.ConclusionOSAHS and IR are closely related,large CT90%,high oxygen reduction index,the total apnea time these three suggest that patients may have chronic intermittent hypoxia indicators and the combination of hypertension is OSAHS patients with independent risk factors for IR.The total apnea time had the greatest effect on HOMA-IR,followed by CT90%.OSAHS patients regularly review PSG,monitoring CT90%,oxygen reduction index,total apnea time and other indicators of changes in OSAHS interventional treatment,hypertension in patients with hypertension treatment,and detection of FPG and FINS levels,early detection of OSAHS Patients with glucose metabolism disorders,to avoid or improve its IR phenomenon,to reduce the incidence of T2 DM and metabolic syndrome of the purpose.