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作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　September 28, 2009 — 根據9月26日內科醫學誌(Archives of Internal Medicine)發表的多中心隨機研究結果，減重對於肥胖第2型糖尿病患者的阻塞性睡眠呼吸中止(OSA)可以有顯著的臨床改善。
　　
　　賓州Temple大學肥胖研究與教育中心的Gary D. Foster博士以及Look AHEAD研究團隊Sleep AHEAD研究小組的同僚寫道，支持減重可以改善OSA想法的經驗很少。有四個中心參與這次的研究，目的在於評估減重一年對於OSA的影響。
　　
　　研究樣本包括264個第2型糖尿病患者，隨機指派接受密集式生活型態介入(肥胖第2型糖尿病患的行為減重特定計畫)或者參加一個糖尿病支持教育團體(三組討論有效控制糖尿病的課程)。研究對象的平均年紀是61.2 ± 6.5歲、平均體重是102.4 ± 18.3公斤、平均身體質量指數(體重(kg)除以身高(米)平方)是36.7 ± 5.7 kg/m2，平均呼吸中止與淺呼吸指數(apnea-hypopnea index，AHI)為每小時發生23.2 ± 16.5次。
　　
　　與支持教育組相比，密集式生活型態介入組的病患在一年時減重較多(10.8公斤vs 0.6公斤；P < .001)，且AHI每小時相對減少9.7 ± 2.0次(P < .001)。密集式生活型態介入組的病患，在一年時完全緩解OSA 的人數是支持教育組的三倍以上，密集式生活型態介入組的嚴重OSA發生率是支持教育組的一半。最能預測一年時AHI變化的因素是開始時的AHI值與減重(P < .01)，體重減少至少10公斤的病患，其AHI減少最多。
　　
　　研究作者寫道，醫師與其病患能預期減重將使肥胖第2型糖尿病患者的阻塞性睡眠呼吸中止可以有顯著的臨床改善。男性病患、開始時OSA最嚴重者、減最多體重者，獲得的幫助最大。
　　
　　研究限制包括無法一般化到較年輕的病患、沒有第2型糖尿病的病患、或OSA較輕微的病患。此外，後續研究需針對OSA這些改善的潛在機轉、代謝與荷爾蒙機轉進行了解。
　　
　　研究作者結論表示，體重穩定病患在一年時的AHI值顯著增加，表示對於中年且肥胖的第2型糖尿病患，如果未治療，則OSA症狀會迅速惡化。
　　
　　國家健康研究中心(NIH)國家心肺與血液研究中心支持Sleep AHEAD研究。NIH之國家糖尿病與消化道與腎臟疾病研究中心支持Look AHEAD研究。研究作者之一(Sanders醫師)宣告與Philips-Respironics、Cephalon以及Sanofi-Aventis等的各種財務關係。

Weight Loss Should Improve OSA in Obese Patients With Type 2 Diabetes

By Laurie Barclay, MD
Medscape Medical News

September 28, 2009 — Weight loss should result in significant and clinically relevant improvements in obstructive sleep apnea (OSA) among obese patients with type 2 diabetes, according to the results of a multicenter randomized study published in the September 28 issue of the Archives of Internal Medicine.

"The belief that weight loss improves...OSA has limited empirical support," write Gary D. Foster, PhD, from the Center for Obesity Research and Education, Temple University in Philadelphia, Pennsylvania, and colleagues from the Sleep AHEAD Research Group of the Look AHEAD Research Group. "The purpose of this 4-center study was to assess the effects of weight loss on OSA over a 1-year period."

The study sample consisted of 264 participants with type 2 diabetes who were randomly assigned to either an intensive lifestyle intervention (behavioral weight loss program developed specifically for obese patients with type 2 diabetes) or to a diabetes support and education group (3 group sessions discussing effective diabetes management). Mean age was 61.2 ± 6.5 years, mean weight was 102.4 ± 18.3 kg, mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 36.7 ± 5.7 kg/m2, and mean apnea-hypopnea index (AHI) was 23.2 ± 16.5 events per hour.

Compared with participants in the support and education group, participants in the intensive lifestyle group lost more weight at 1 year (10.8 kg vs 0.6 kg; P < .001) and had a relative adjusted decrease in AHI of 9.7 ± 2.0 events per hour (P < .001). Total remission of OSA at 1 year occurred in more than 3 times as many participants in the intensive lifestyle group vs the support and education group, and the prevalence of severe OSA in the intensive lifestyle group was half that in the support and education group. The factors most predictive of changes in AHI at 1 year were initial AHI and weight loss (P < .01), with the greatest reductions in AHI occurring in participants with weight loss of at least 10 kg.

"Physicians and their patients can expect that weight loss will result in significant and clinically relevant improvements in OSA among obese patients with type 2 diabetes," the study authors write. "The greatest benefit was observed in men, in participants with more severe OSA at baseline, and in participants who lost the most weight."

Limitations of this study include lack of generalizability to younger patients, to patients without type 2 diabetes, or to patients with milder degrees of OSA. In addition, future research should address the mechanical, metabolic, and hormonal mechanisms underlying these improvements in OSA.

"The significant increase in AHI over 1 year in participants who were weight stable suggests that OSA is a rapidly progressing syndrome that will worsen without treatment in middle-aged obese adults with type 2 diabetes," the study authors conclude.

The National Institutes of Health (NIH) National Heart, Lung, and Blood Institute supported Sleep AHEAD. The NIH National Institute of Diabetes and Digestive and Kidney Diseases supported Look AHEAD. One of the study authors (Dr. Sanders) has disclosed various financial relationships with Philips-Respironics, Cephalon, and Sanofi-Aventis.

Arch Intern Med. 2009;169:1619-1626.