Improvement on inflammation and insulin resistance after continuous positive airway pressure in patients with type 2 diabetes mellitus and obstructive sleep apnea hypopnea syndrome

Abstract

Objective To observe the effects of continuous positive airway pressure(CPAP) treatment on inflammation and insulin resistance in patients with type 2 diabetes mellitus(T2DM) and obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Seventy-four patients (51 males and 23 females, with an age range of 45-66 years old) diagnosed as T2DM and OSAHS syndrome from January 2012 to January 2014 were randomly and equally divided into the treatment group(n=37) and the control group(n= 37). Patients in the treatment group were treated with CPAP for 14 days. The fasting blood glucose (FBG), fructosamine (FMN), fasting insulin (FINS), white blood cell (WBC)count, high sensitive C reactive protein (hs-CRP), hypoxia inducible factor-1α(HIF-1α) and soluble vascular cell adhesion molecule-1(sVCAM-1) was detected before and after treatment. The homeostasis model assessment (HOMA) insulin resistance (HOMA-IR) index, the mean pulse oxygen saturation (MSpO2), the lowest pulse oxygen saturation (LSpO2) and apnea hypopnea index (AHI) were monitored by polysomnography (PSG) before and after treatment. T test, χ2 test and Spearman correlation analysis were used to evaluate the data. Results Compared to the control group, the level of FBG, FMN, FINS, MSpO2, LSpO2, AHI was improved in the treatment group by a certain degree after treatment(t =-123.761-120.676, all P<0.05). The level of hs-CRP, HIF-1α, sVCAM-1 and HOMA-IR was significantly reduced from(7.3±0.3)mg/L, (275±53) ng/L, (717±73) ng/L and 3.7±0.2 before treatment to(2.4±0.4)mg/L, (211±6) ng/L, (589±57) ng/L and 2.1±0.7 after treatment, respectively(t= -53.046, -19.827, -12.827, -28.342, respectively, all P<0.05). The improvements showed by Pearson analysis in HOMA-IR after treatment were positively correlated with HIF-1α and sVCAM-1 improvements (r=0.87, 0.86, both P<0.05). Conclusion CPAP may improves the inflammation status, sleep quality, insulin resistance in patients with T2DM and OSAHS. Key words: Sleep apnea, obstructive; Diabetes mellitus, type 2; Inflammatory factor