1、1会计学OSAHS与糖尿病疾病与糖尿病疾病糖尿病的主要类型占占 95%+1981250,000250,0001983400,000400,0001990550,000550,0001995725,000725,00020001,000,0001,000,000Age group(years)%亚太地区糖尿病的发病趋势亚太地区糖尿病的发病趋势日本儿童的2型糖尿病发病趋势睡眠剥夺对激素分泌的影响睡眠剥夺对激素分泌的影响Spiegel,K.J Clin Endo&Met:89(11)5762-5771;2004LeptinCortisolHOMA(IR)YearLocationNProtocol a
2、nd result1984-94Uppsala University(2000)2668(3069 yrs)Sleep&metabolic disease questionnaireDeveloped DM2:Non snorers 2.4%;Snorers 5.4%Obese non-snorers:8.6%;obese snorers 13.5%1986-96Nurses Health StudyHarvard Uni(2002)69852(f)(40-65yrs)1957 developed DM2.By questionnaire:Occasional snoring vs non s
3、noring RR=1.48Regular snoring vs non snoring=2.25Indept of BMI,smoking,parental history1994-99Sleep heart health study(2004)2656Glucose intolerance by 2 hr glucose measurementRDI15,OR=1.46Independent age,gender,BMI,waist circumference4 yr follow-upWisconsin sleep cohort(2005)1387Diabetes;AHI15,15%;O
4、R=2.3OR for developing DM2 in 4 yrs=1.62Indept of age,sex,body habitus(Punjabi et al,J Appl Physiol,Vol 99,Nov 2005)Narkiewicz et al 1998 CirculationIp et al 2004 AJRCCMMinoguchi et al 2005 AJRCCM血清血清 IL-18 水平在肥胖对照组水平在肥胖对照组(n=16),轻度轻度 OSA组组(n=13),和和中、重度中、重度OSA组组(n=23)21.IA Harsch Department of Medic
5、ine I,Friedrich-Alexander University Erlangen Nuremburg,Erlangen,Germany.Am J Respir Crit Care Med.2004;169(2):156-162Shows improvement of insulin sensitivity index(ISI)at baseline,2 days and 3 months after onset of CPAP treatment in 31 patents Within 48 hours,significant improvements have been demo
6、nstrated in Insulin Sensitivity using CPAP therapy 21 FastingBfastLunchDinnerBabu et al.Arch Intern Med.2005;165:447-521 hr post-prandial*P 4h/dayCPAP use 4h/dayCLINICAL PATHWAYAlicePDx COMMUNICATIONNotice/article in DA NewsletterLiaison between area sleep physician/DANSW/diabetes educator/endocrino
7、logistEducation night for GPs in the area.Mail out to NDSS membersAlicePDx SCREENING WITH QUESTIONAIRE BY LOCAL PHARMACIST/DISTRIBUTORNEGATIVE SCREENIf no other symptoms or comorbidities:No further reviewWith symptoms,GP referral to Sleep Specialist for further reviewBORDERLINESCREENGP referral to S
8、leep Specialist for further reviewPOSITIVE SCREEN1.Referral to GP.2.GP prescribes auto titration PAP trial OR3.GP referral to Sleep Specialist for reviewResults of ApneaLink screening of type 2 diabetic patients in the Wagga region(n=54)AHI 1528%34%38%Results of ApneaLink screening of type 2 diabetic patients in Newcastle region(n=142)AHI 1520%36%44%亚太地区糖尿病的发病趋势亚太地区糖尿病的发病趋势睡眠剥夺对激素分泌的影响睡眠剥夺对激素分泌的影响Spiegel,K.J Clin Endo&Met:89(11)5762-5771;2004LeptinCortisolHOMA(IR)
