Objective: To explore the therapeutic efficacy of nasal Continuous Positive Airway Pressure (CPAP) and aerobic exercise of different intensity in patients with Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) and Type 2 Diabetes Mellitus (T2DM). Methods: A total of 112 patients with OSAHS and T2DM, including 53 males and 59 females, with a mean age of (66.9±7.8) years old, from the Fourth Rehabilitation Hospital of Shanghai and the Second Affiliated Hospital of Soochow University from January 2017 to December 2018 were enrolled prospectively. There were divided into two groups based on whether received nasal CPAP therapy: 50 cases in nasal CPAP+aerobic exercise group and 62 cases in aerobic exercise group. Subsequently, patients in nasal CPAP+aerobic exercise group were randomly divided into two subgroups: moderate and low intensity aerobic exercise (26 and 24 cases respectively). All patients completed nasal CPAP and (or) aerobic exercise of different intensity for 20 weeks. The therapeutic efficacy of polysomnography (PSG) parameters, glycolipid metabolism, 6 minutes walking distance (6 MWD), and rate of perceived exertion (RPE) were compared between each group before and after treatment. Results: Pre-and post-intervention, PSG parameters, body mass index (BMI) [(26.6±3.7) vs (24.3±2.8) kg/m(2)], RPE [(16.4±1.3) vs (12.2±2.6) score], 6 MWD [(372.6±59.7) vs (441.5±75.6) m] and glucolipid metabolism indexes were improved significantly in nasal CPAP+aerobic exercise group (all P<0.05), such as fasting blood glucose [(7.4±2.4) vs (6.2±1.6) mmol/L], glycosylated hemoglobin [(7.6±1.2)% vs (6.6±0.7)%], fasting insulin [(10.8±4.4) vs (6.9±3.4) μU/L], insulin resistance index [(3.5±1.9) vs (1.9±1.2)], total cholesterol [(4.0±0.9) vs (3.5±0.9) mmol/L], low density lipoprotein cholesterol [(4.2±0.6) vs (3.1±0.8) mmol/L]; BMI, exercise endurance, some glucolipid metabolism indexes and PSG parameters were also improved in aerobic exercise group (P<0.05). After 20 weeks' intervention, it showed statistically significant differences in PSG parameters, glycometabolism, some lipid metabolism indexes and RPE (all P<0.05), and no significantly difference in BMI [(24.3±2.7) vs (24.3±2.8) kg/m(2)] between the two groups. Compared with the low intensity subgroup, there were significant improvement in 2 hours' postprandial insulin, insulin resistance index, low density lipoprotein cholesterol, lipoprotein A, RPE, 6 MWD in moderate subgroup (P<0.05). Conclusion: Nasal CPAP combined with moderate intensity aerobic exercise can effectively improve the glucolipid metabolism, insulin resistance and exercise tolerance in patients with OSAHS and T2DM.
目的： 探讨经鼻持续气道正压通气（CPAP）结合不同强度有氧训练对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并2型糖尿病（T2DM）患者的疗效。 方法： 前瞻性地选取上海市第四康复医院及苏州大学附属第二医院2017年1月至2018年12月诊断为OSAHS合并T2DM的患者112例[男53例，女59例，年龄（66.9±7.8）岁]，根据是否采用经鼻CPAP治疗，分成经鼻CPAP+有氧训练组（50例）和有氧训练组（62例）两组，同时将经鼻CPAP+有氧训练组用随机数字表分为两个亚组：经鼻CPAP+中强度有氧训练组（26例）及经鼻CPAP+低强度有氧训练组（24例），所有患者均完成经鼻CPAP和（或）不同强度有氧训练共20周。治疗前后均进行多导睡眠图（PSG）监测、空腹糖脂代谢指标检测及6 min步行距离（6 MWD）、主观用力分级（RPE）评估运动耐力，比较治疗前后及组间各参数的差异。 结果： 两组OSAHS合并T2DM患者，经鼻CPAP和（或）不同强度有氧训练后，经鼻CPAP+有氧训练组PSG参数、体质指数（BMI）[（26.6±3.7）比（24.3±2.8）kg/m(2)]、RPE[（16.4±1.3）比（12.2±2.6）分]、6 MWD[（372.6±59.7）比（441.5±75.6）m]及糖脂代谢指标均明显改善，空腹血糖[（7.4±2.4）比（6.2±1.6）mmol/L]、糖化血红蛋白[（7.6±1.2）%比（6.6±0.7）%]、空腹血胰岛素[（10.8±4.4）比（6.9±3.4）μU/L]、胰岛素抵抗指数[（3.5±1.9）比（1.9±1.2）]、总胆固醇[（4.0±0.9）比（3.5±0.9）mmol/L]、低密度脂蛋白胆固醇[（4.2±0.6）比（3.1±0.8）mmol/L]均降低（均P<0.05）；有氧训练组BMI及运动耐力明显改善，部分糖脂代谢指标及PSG参数也有所改善（均P<0.05）。经鼻CPAP+有氧训练组PSG参数、糖代谢、部分脂代谢指标及RPE均显著优于有氧训练组（均P<0.05），而BMI[（24.3±2.7）比（24.3±2.8）kg/m(2)]差异无统计学意义。两亚组治疗后，中强度组在餐后2 h血胰岛素、胰岛素抵抗指数、低密度脂蛋白胆固醇、脂蛋白（A）、RPE、6 MWD均显著优于低强度组（均P<0.05）。 结论： 经鼻CPAP结合中等强度有氧训练对OSAHS合并T2DM患者的糖脂代谢、胰岛素抵抗及运动耐力有明显改善作用。.
Keywords: Aerobic exercise; Continuous positive airway pressure; Diabetes mellitus, type 2; Sleep apnea, obstructive.