低碳水化合物饮食干预对日本肥胖男性阻塞性睡眠呼吸暂停和原发性甲状腺功能减退的影响。

Q1 Medicine Asia Pacific Family Medicine Pub Date : 2016-08-05 eCollection Date: 2016-01-01 DOI:10.1186/s12930-016-0029-8
Yoshio Tokuchi, Yayoi Nakamura, Yusuke Munekata, Fumio Tokuchi
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引用次数: 6

摘要

背景:肥胖是阻塞性睡眠呼吸暂停(OSA)的主要危险因素,在肥胖OSA患者的整体管理中,减肥是必要的。然而,初级保健医生只能通过生活方式干预提供有限的体重减轻,通常在6-18个月后仅使患者体重减轻2.5公斤或更少。病例介绍:一名45岁的日本男性因肥胖,白天嗜睡和睡眠时打鼾而被转介到我们诊所。体重130.7 kg,身体质量指数(BMI) 41.0 kg/m(2)。经多导睡眠图检查,发现OSA伴呼吸暂停低通气指数71.2次/小时(正常,500 μIU/mL;游离三碘甲状腺原氨酸1.4 pg/mL;游离甲状腺素,4000 IU/mL;总胆固醇(TC), 335 mg/dL;高密度脂蛋白胆固醇,45 mg/dL;甘油三酯(TGs), 211 mg/dL;低密度脂蛋白胆固醇,248mg /dL;空腹血糖:86 mg/dL;糖化血红蛋白(HbA1c), 6.1%。这些结果表明,他也有原发性甲状腺功能减退(桥本病)。开始持续气道正压通气(CPAP)、左旋甲状腺素替代和低碳水化合物饮食(LCD)。CPAP的使用和175 μg/d左甲状腺素诱导的甲状腺功能正常,使患者能够主动减轻体重。18个月后,患者体重减轻了32.4 kg(初始体重的25%),BMI降低了10.2 kg/m(2),实验室结果也有所改善,包括HbA1c水平降至5.3%,TC水平降至194 mg/dL, TG水平降至89 mg/dL。结论:LCD可能是日本肥胖OSA患者减肥的有效干预措施。与传统的卡路里限制饮食相比,LCD的减肥效果还需要进一步的研究。希望本病例报告将有助于改善亚洲肥胖OSA患者的管理,这些患者通常消耗大量的碳水化合物。
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Low carbohydrate diet-based intervention for obstructive sleep apnea and primary hypothyroidism in an obese Japanese man.

Background: Obesity is a major risk factor for obstructive sleep apnea (OSA), and weight loss is necessary in the overall management of obese patients with OSA. However, primary care physicians can provide only limited weight loss with lifestyle interventions, usually reducing a patient's body weight by only 2.5 kg or less after 6-18 months.

Case presentation: A 45-year-old Japanese man was referred to our clinic owing to obesity, daytime sleepiness, and snoring during sleep. His weight was 130.7 kg and his body mass index (BMI) was 41.0 kg/m(2). He underwent polysomnography, which revealed OSA with an apnea-hypopnea index of 71.2 events/h (normal, <5 events/h). His laboratory results were as follows: thyroid stimulating hormone, >500 μIU/mL; free triiodothyronine, 1.4 pg/mL; free thyroxine, <0.15 ng/dL; thyroid peroxidase antibody, 10 IU/mL; thyroglobulin antibody, >4000 IU/mL; total cholesterol (TC), 335 mg/dL; high-density lipoprotein cholesterol, 45 mg/dL; triglycerides (TGs), 211 mg/dL; low-density lipoprotein cholesterol, 248 mg/dL; fasting blood sugar, 86 mg/dL; and glycated hemoglobin (HbA1c), 6.1 %. These results showed that he also had primary hypothyroidism (Hashimoto's disease). Continuous positive airway pressure (CPAP), levothyroxine replacement, and a low-carbohydrate diet (LCD) were initiated. CPAP use and a euthyroid condition induced by 175 μg/day levothyroxine allowed the patient to proactively reduce his body weight. After 18 months, the patient achieved a weight reduction of 32.4 kg (25 % of his initial weight) and a BMI reduction of 10.2 kg/m(2), as well as improved laboratory results, including an HbA1c level of 5.3 %, TC level of 194 mg/dL, and TG level of 89 mg/dL.

Conclusion: An LCD may be an effective intervention for weight loss in obese Japanese patients with OSA. Further studies are needed to investigate the weight loss effect of an LCD compared with a conventional calorie-restricted diet. Hopefully, this case report will help to improve the management of obese Asian patients with OSA who typically consume a higher amount of carbohydrates.

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Asia Pacific Family Medicine
Asia Pacific Family Medicine Medicine-Family Practice
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