Effect of smoking on glucose, lipid metabolism and sleep structure in postoperative patients with obstructive sleep apnea
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摘要: 目的 探讨吸烟对中重度阻塞性睡眠呼吸暂停(OSA)患者手术后糖脂代谢及睡眠结构的影响。方法 回顾性分析2016年1月-2017年12月诊治的103例成年男性中重度OSA患者, 均无法耐受持续正压通气, 经耳鼻咽喉科医师评估后接受了改良悬雍垂腭咽成形术。纳入研究的患者以是否吸烟分为吸烟组和不吸烟组。所有患者均进行整夜PSG监测、人体生理学数据测量、血液生化检查(包括血糖、血脂), 在术前进行问卷填写, 包括吸烟的问卷调查、Epworth嗜睡量表(ESS)等。术后6个月以后复查, 记录上述所有的数据资料。手术前后各项指标的变化量以Δ表示(Δ =术后数值-术前数值)。结果 OSA中度15例, 重度88例。治愈19例(18.4%), 显效24例(23.3%), 有效14例(13.6%), 总体有效57例(55.3%)。不吸烟组与吸烟组的手术有效率差异无统计学意义(59.7% vs.48.9%, P = 0.276)。所有患者术后AHI、SaO2、氧减指数、MAI、总胆固醇(TC)、空腹血糖(FINS)、空腹胰岛素(HOMA-IR)、BMI、ESS及N1、N3期睡眠占总睡眠时间的比例均较术前明显改善(P < 0.05)。不吸烟组与吸烟组间的ΔTC、ΔTG、ΔHDH-C、ΔLDL-C、ΔFINS、ΔHOMA-IR等代谢指标均差异无统计学意义(P>0.05);但在睡眠结构方面, 不吸烟组的ΔN3期睡眠改善的程度高于吸烟组(P = 0.039)。结论 上气道手术有助于改善OSA患者的糖脂代谢紊乱及睡眠结构; 吸烟对术后糖脂代谢的影响作用不明显, 但对睡眠结构有影响, 不吸烟的OSA患者, 术后睡眠结构的改善优于吸烟者。
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关键词:
- 睡眠呼吸暂停, 阻塞性 /
- 吸烟 /
- 糖脂代谢 /
- 睡眠结构 /
- 上气道手术
Abstract: Objective The aim of this study is to investigate the effect of smoking on the glucose, lipid metabolism and sleep structure in patients with moderate and severe obstructive sleep apnea (OSA) after operation.Methods A retrospective analysis of 103 adult male patients with moderate to severe OSA who were diagnosed and treated from January 2016 to December 2017. All of them could not tolerate continuous positive pressure ventilation. After evaluation by an otolaryngologist, they underwent modified uvulapalatopharyngoplasty surgery. All participants were grouped according to smoking status(non-smokers, smokers) for analysis. Laboratory-based polysomnographic variables, anthropometric measurements, biochemical indicators, and smoking history, Epworth sleepiness score(ESS) were collected preoperatively and postoperatively. And the difference of each variable preoperatively and postoperatively was demonstrated as delta(Δ, calculated as postoperative value minus preoperative value).Results Fifteen patients with preoperative moderate OSA and 88 patients with severe OSA. The overall successful rate of surgery was 55.3%(18.4% cured, 23.3% markedly effective and 13.6% effective), and there was no statistical difference between the non-smokers and the smokers(59.7% vs 48.9%, P = 0.276). After surgery, AHI, mean oxygen saturation, ODI, MAI, TC, FBG, fasting insulin, BMI, ESS, N1 and N3 were significantly improved(P < 0.05). The amelioration of glucose or lipid metabolism related traits(including ΔTC, ΔFBG, Δfasting insulin) were not significantly different between smokers and non-smokers. However, as to sleep structure, ΔN3 was significantly higher in non-smoker as compared to smokers(P = 0.039).Conclusion Upper airway surgery is helpful to improve the glucose and lipid metabolism disorder and sleep structure in OSA patients. Postoperative smoking was associated with worse sleep structure, but not glycolipid metabolism. The postoperative improvement of sleep structure in non-smoking OSA patients was better than smokers. -
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表 1 患者术前、术后各项指标的比较
变量 全部患者(n=103) 不吸烟组(n=62) 吸烟组(n=41) 术前 术后 P 术前 术后 P 术前 术后 P AHI 55.0±20.0 27.8±22.2 < 0.01 57.3±19.0 27.1±20.6 < 0.01 51.5±21.1 28.9±24.6 < 0.01 CT90/% 25.9±21.3 9.3±13.6 < 0.01 27.3± 21.9 9.0±13.5 < 0.01 23.8±20.3 9.7±14.0 < 0.01 meanSaO2/% 91.8±3.7 94.5±3.7 < 0.01 91.7±3.5 94.5±2.4 < 0.01 91.9±4.1 94.5±2.1 < 0.01 LSaO2/% 73.1±11.2 80.8±10.2 < 0.01 73.3±11.7 80.8±9.8 < 0.01 72.9±10.7 80.9±11.0 < 0.01 ODI 53.9±21.4 31.1±22.8 < 0.01 56.8±20.3 30.6±21.8 < 0.01 49.4±22.4 31.7±24.6 < 0.01 MAI 44.8±23.6 28.6±19.3 < 0.01 45.4±23.3 26.5±16.4 < 0.01 43.8±24.3 31.7±22.8 < 0.01 TC/(mmol·L-1) 5.0±1.0 4.6±0.9 < 0.01 5.0±0.9 4.6±0.8 < 0.01 5.0±1.1 4.7±1.0 < 0.01 TG/(mmol·L-1) 2.4±2.2 2.2±2.2 >0.05 2.3±2.0 2.2±2.4 >0.05 2.5±2.5 2.3±1.8 >0.05 HDL-C/(mmol·L-1) 1.1±0.2 1.1±0.2 >0.05 1.1±0.3 1.1±0.2 >0.05 1.1±0.2 1.1±0.2 >0.05 LDL-C/(mmol·L-1) 3.3±0.8 3.0±0.8 < 0.01 3.2±0.8 3.0±0.8 < 0.05 3.3±0.8 3.0±0.7 < 0.05 FBG/(mmol·L-1) 5.7±1.2 5.4±1.5 >0.05 5.6±1.3 5.5±1.7 >0.05 5.7±1.2 5.3±1.0 < 0.01 FINS/(μU·mL-1) 17.6±13.1 16.0±14.2 < 0.05 16.7±9.7 14.5±8.0 < 0.05 19.0±17.1 18.3±20.2 >0.05 HOMA-IR 4.5±3.6 4.0±4.0 < 0.01 4.3±2.8 3.6±2.3 < 0.01 4.9±4.6 4.5±5.6 >0.05 BMI 27.9±2.8 27.3±2.7 < 0.01 27.9±2.9 27.3±2.8 < 0.01 27.9±2.6 27.3±2.7 < 0.01 ESS评分 11.5±5.8 8.8±5.6 < 0.01 11.7±5.7 8.5±5.0 < 0.01 11.0±6.1 9.2±6.4 < 0.05 CT90：血氧饱和度低于90%累积时间；meanSaO2：平均动脉血氧饱和度；LSaO2：最低动脉血氧饱和度；ODI：氧减指数；MAI：微觉醒指数；TC：总胆固醇；TG：甘油三酯；HDL-C：高密度脂蛋白胆固醇；LDL-C：低密度脂蛋白胆固醇；FBG：空腹血糖；FINS：空腹胰岛素；HOMA-IR：胰岛素抵抗指数评估的稳态模型。 
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表 2 患者术前、术后睡眠结构的比较
变量/% 全部患者(n=103) 不吸烟组(n=62) 吸烟组(n=41) 术前 术后 P 术前 术后 P 术前 术后 P REM/TST 10.6±5.9 11.0±5.6 >0.05 11.8±6.1 11.4±5.3 >0.05 8.6±5.0 10.4±6.0 >0.05 N1/TST 23.5±13.2 18.7±12.0 < 0.01 21.9±13.0 17.0±11.7 < 0.05 25.9±13.2 21.1±12.2 >0.05 N2/TST 45.6±17.4 46.0±15.1 >0.05 47.7±16.8 48.6±16.2 >0.05 42.3±17.9 42.0±12.4 >0.05 N3/TST 10.3±13.3 14.3±11.5 < 0.05 7.9±11.2 14.6±11.2 < 0.01 13.8±15.4 13.8±12.2 >0.05 注：由于患者睡眠时间不同，不能单以时间进行比较，故以各期睡眠时间占TST的百分比进行比较分析。
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表 3 不吸烟组和吸烟组之间各指标差值的比较
变量 不吸烟组(n=62) 吸烟组(n=41) P ΔAHI -31.6(-45.6~12.8) -19.3(-36.9~-4.5) >0.05 ΔCT90 -15.2(-26.6~-1.0) -9.4(-26.2~-2.4) >0.05 ΔmeanSaO2 2.3(0.6~4.0) 2.0(0.1~0.5) >0.05 ΔLSaO2 7.0(0.0~15.0) 7.0(1.0~15.0) >0.05 ΔODI -28.4(48.3~5.8) -18.8(-34.6~0.1) >0.05 ΔMAI -16.8(-37.5~0.1) -6.8(-34.0~7.7) >0.05 ΔTC -0.2(-0.7~0.1) -0.2(0.8~0.1) >0.05 ΔTG -0.1(-0.7~0.4) 0.04(-0.4~0.3) >0.05 ΔHDL-C 0.02(-0.2~0.2) 0.01(-0.1~0.1) >0.05 ΔLDL-C -0.2(-0.6~0.1) -0.1(-0.6~0.1) >0.05 ΔFBG -0.1(-0.7~0.2) -0.2(-0.6~0.1) >0.05 ΔFINS -1.0(-3.7~0.4) -0.6(-3.2~1.0) >0.05 ΔHOMA-IR -0.4(-1.5~-0.1) -0.4(-1.4~-0.3) >0.05 ΔBMI -0.3(-1.7~0.03) -0.4(-1.4~0.01) >0.05 ΔESS -2.0(-5.0~0.1) 0.04(-3.0~0.1) >0.05
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表 4 不吸烟组和吸烟组之间各睡眠期差值的比较
变量/% 不吸烟组(n=62) 吸烟组(n=41) P ΔREM/TST -0.3(-4.3~2.9) 2.7(-3.3~6.6) >0.05 ΔN1/TST -4.4(-14~3.5) 0.1(-16.8~7.9) >0.05 ΔN2/TST 0.7(-8.3~11.5) 0.1(-14.5~14.4) >0.05 ΔN3/TST 5.7(0.1~11.8) 3.3(-7.5~7.0) 0.039
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表 5 手术前后患者血脂异常的个体数量变化的比较
例 组别 例数 术前 术后 P 血脂正常 血脂异常 血脂正常 血脂异常 不吸烟组 62 7 55 14 48 >0.05 吸烟组 41 4 37 9 32 合计 103 11 92 23 80 < 0.05
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[1] de Lima FF, Mazzotti DR, Tufik S, et al. The role inflammatory response genes in obstructive sleep apnea syndrome: a review[J]. Sleep Breath, 2016, 20(1): 331-338. doi: 10.1007/s11325-015-1226-7
[2] Tietjens JR, Claman D, Kezirian EJ, et al. Obstructive Sleep Apnea in Cardiovascular Disease: A Review of the Literature and Proposed Multidisciplinary Clinical Management Strategy[J]. J Am Heart Assoc, 2019, 8(1): e010440. doi: 10.1161/JAHA.118.010440
[3] Xia W, Huang Y, Peng B, et al. Relationship between obstructive sleep apnoea syndrome and essential hypertension: a dose-response meta-analysis[J]. Sleep Med, 2018, 47: 11-18. doi: 10.1016/j.sleep.2018.03.016
[4] Khan F, Walsh C, Lane SJ, et al. Sleep apnoea and its relationship with cardiovascular, pulmonary, metabolic and other morbidities[J]. Ir Med J, 2014, 107(1): 6-8.
[5] Arli B, Bilen S, Titiz AP, et al. Comparison of Cognitive Functions Between Obstructive Sleep Apnea Syndrome and Simple Snoring Patients: OSAS May Be a Modifiable Risk Factor for Cognitive Decline[J]. Appl Neuropsychol Adult, 2015, 22(4): 282-286. doi: 10.1080/23279095.2014.925901
[6] Dempsey JA, Veasey SC, Morgan BJ, et al. Pathophysiology of sleep apnea[J]. Physiol Rev, 2010, 90(1): 47-112. doi: 10.1152/physrev.00043.2008
[7] Li L, Zhan X, Wang N, et al. Does airway surgery lower serum lipid levels in obstructive sleep apnea patients? A retrospective case review[J]. Med Sci Monit, 2014, 20: 2651-2657. doi: 10.12659/MSM.892230
[8] Sun X, Yi H, Cao Z, et al. Reorganization of sleep architecture after surgery for OSAHS[J]. Acta Otolaryngol, 2008, 128(11): 1242-1247. doi: 10.1080/00016480801935509
[9] Kopa PN, Pawliczak R. Effect of smoking on gene expression profile-overall mechanism, impact on respiratory system function, and reference to electronic cigarettes[J]. Toxicol Mech Methods, 2018, 28(6): 397-409. doi: 10.1080/15376516.2018.1461289
[10] 朱华明, 易红良, 关建, 等. 吸烟与OSA严重程度的相关性研究[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(9): 862-865, 869. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201909016.htm
[11] Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine[J]. J Clin Sleep Med, 2012, 8(5): 597-619. doi: 10.5664/jcsm.2172
[12] Zhu H, Xu H, Chen R, et al. Smoking, obstructive sleep apnea syndrome and their combined effects on metabolic parameters: Evidence from a large cross-sectional study[J]. Sci Rep, 2017, 7(1): 8851. doi: 10.1038/s41598-017-08930-x
[13] Scott M, James I, Stephen R, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientifc Statement[J]. Circulation, 2005, 112(17): 2735-2752. doi: 10.1161/CIRCULATIONAHA.105.169404
[14] Cibi ková L', Karásek D, Langová K, et al. Correlation of lipid parameters and markers of insulin resistance: does smoking make a difference?[J]. Physiol Res, 2014, 63(Suppl 3): S387-393.
[15] Wong BW, Marsch E, Treps L, et al. Endothelial cell metabolism in health and disease: impact of hypoxia[J]. EMBO J, 2017, 36(15): 2187-2203. doi: 10.15252/embj.201696150
[16] Tripathi A, Melnik AV, Xue J, et al. Intermittent Hypoxia and Hypercapnia, a Hallmark of Obstructive Sleep Apnea, Alters the Gut Microbiome and Metabolome[J]. mSystems, 2018, 3(3): e00020-18.
[17] 刘海琴, 冯雅妮, 张一彤, 等. 成人不同程度睡眠呼吸紊乱白天过度嗜睡影响因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(3): 266-269. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202003021.htm
[18] Boakye D, Wyse CA, Morales-Celis CA, et al. Tobacco exposure and sleep disturbance in 498 208 UK Biobank participants[J]. J Public Health(Oxf), 2018, 40(3): 517-526. doi: 10.1093/pubmed/fdx102
[19] Pham LV, Schwartz AR. The pathogenesis of obstructive sleep apnea[J]. J Thorac Dis, 2015, 7(8): 1358-72.
[20] Attard R, Dingli P, Doggen C, et al. The impact of passive and active smoking on inflammation, lipid profile and the risk of myocardial infarction[J]. Open Heart, 2017, 4(2): e000620. doi: 10.1136/openhrt-2017-000620
[21] Takata K, Imaizumi S, Kawachi E, et al. Impact of cigarette smoking cessation on high-density lipoprotein functionality[J]. Circ J, 2014, 78(12): 2955-2962. doi: 10.1253/circj.CJ-14-0638
[22] Moraes W, Piovezan R, Poyares D, et al. Effects of aging on sleep structure throughout adulthood: a population-based study[J]. Sleep Med, 2014, 15(4): 401-409. doi: 10.1016/j.sleep.2013.11.791
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