Obstructive sleep apnea, prediabetes and progression of type 2 diabetes: A systematic review and meta-analysis

Associations of polysomnographic measures of obstructive sleep apnea, and nocturnal oxygen saturation with incident type 2 diabetes mellitus in middle-aged and older men

Obstructive sleep apnea (OSA) has been associated with incident type 2 diabetes mellitus (T2DM); however, few prospective epidemiological studies have accounted for important T2DM predictors including pre-diabetes status and testosterone. Participants in the longitudinal Men Androgens Inflammation Lifestyles Environment and Stress (MAILES) study, who underwent eight-channel home-based polysomnography (PSG) in 2010-2011 (n = 824) and were free of diabetes at baseline were included in the analysis (n = 682). From 2015 to 2021, 78.6% (n = 536) completed at least one follow-up assessment. Incident T2DM was determined by self-reported doctor diagnosis, diabetes medications, plasma glucose (fasting ≥7.0 mmol/L or random ≥11.0 mmol/L) or glycated haemoglobin ≥6.5%. Conservative hierarchical Poisson regression models adjusted associations of PSG metrics (categorical and continuous) for age, waist circumference, baseline fasting glucose and testosterone concentrations. In all, 52 men (9.7%) developed T2DM over a mean (range) of 8.3 (3.5-10.5) years. Significant age- and waist circumference-adjusted association of incident T2DM with rapid eye movement (REM) sleep apnea-hypopnea index (AHI) ≥20 events/h (incidence rate ratio [IRR] 1.5, 95% confidence interval [CI] 0.8-2.8; p = 0.23] and highest quartile of delta index (IRR 2.1, 95% CI 0.95-4.6; p = 0.066) were attenuated after adjustment for baseline glucose and testosterone, and the association with the lowest quartile of mean oxygen saturation persisted (IRR 4.2, 95% CI 1.7-10.3; p = 0.029). Categorical measures of AHI severity, oxygen desaturation index, and hypoxia burden index (HBI) were not independently associated with incident T2DM. Associations with T2DM were similar when continuous PSG variables were used; however, HBI was significant (IRR 1.015, 95% CI 1.006-1.024; p = 0.007). In a sub-sample with OSA treatment data (n = 479), these significant associations persisted after excluding adequately treated OSA (n = 32). Understanding underlying OSA endotypes generating hypoxaemia may identify opportunities for diabetes prevention.

The association of the non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) with obstructive sleep apnea among adults aged ≥ 40 years: results from NHANES 2015-2018

BACKGROUND

The ratio of the non-HDL-cholesterol to HDL- cholesterol (NHHR) is a newly proposed lipid metric. Currently, few studies have explored the relationship between NHHR and obstructive sleep apnea (OSA) among middle-aged and elderly people. This study aims to investigate the potential association between NHHR and OSA.

METHODS

This study included participants from the NHANES 2015-2018 cycles, focusing exclusively on individuals aged 40 and above. OSA data were estimated based on questionnaire responses. NHHR was estimated as the ratio of non-HDL-C to HDL-C. Multivariable logistic regression, adjusted for covariates, subgroup analysis, and smoothing spline fittings were utilized to assess the link between NHHR and OSA.

RESULTS

A total of 5,858 participants were analyzed. Multivariable logistic regression highlighted a statistically significant positive relationship between NHHR and OSA [OR 1.06 (95% CI: 1.02, 1.11), p = 0.0053]. As NHHR increased by tertiles, the risk of OSA also showed an upward trend. Subgroup and interaction analyses confirmed the overall association was robust across most confounding factors except for gender and diabetes status. Further nonlinear analyses identified a significant inverted U-shaped curve (p-nonlinearity < 0.05) with peak risk at an NHHR of 5.3. This pattern was particularly evident in males (turning point = 3.97) and diabetics (turning point = 5.61).

CONCLUSION

From 2015 to 2018, among the NHANES population aged over 40, NHHR showed a significant and independent positive association with OSA risk. The consistency of this relationship across various subgroups suggests NHHR's potential as a complementary biomarker for metabolic risk assessment in OSA.

Intermittent Hypoxia as a Model of Obstructive Sleep Apnea: Present and Future

Intermittent hypoxia (IH) is an extremely frequent condition characterized by recurrent episodes of reduced oxygen levels interspersed with periods of normoxia, often seen in conditions like obstructive sleep apnea (OSA) and lung diseases. Among OSA patients, IH occurs due to periodic airway obstructions during sleep, leading to transient drops in blood oxygen saturation followed by reoxygenation. Future directions involve standardizing IH protocols, incorporating patient variability into the IH profiles being administered, and utilizing strategically developed animal models to enhance the reliability and applicability of IH-related research.

Association between obstructive sleep apnea syndrome and type1/type2 diabetes mellitus: A systematic review and meta-analysis

INTRODUCTION

Obstructive sleep apnea (OSA) is characterized by a complete or partial obstruction of the upper airway, along with hypoxemia, microarousals, and sleep fragmentation. Compelling evidence has clarified a bidirectional correlation between OSA and diabetes mellitus (DM). This paper was to assess the link between OSA and DM via meta-analysis, consisting of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

Four databases (PubMed, Cochrane Library, Embase, and CNKI) were screened from inception to March 2024 for observational studies of OSA and DM, including case-control studies and cohort studies. Bidirectional associations between OSA and DM were analyzed, consisting of T1DM and T2DM. Random-effect models were employed to determine the pooled odds ratio (OR) and 95% confidence intervals (CIs) to compare prevalence. Traditional subgroup analyses were implemented. Review Manager 5.3 and Stata 16.0 were utilized for data analyses.

RESULTS

Thirty-five studies were enrolled, including 12 prospective cohort studies, 4 retrospective cohort studies, and 19 case-control studies. DM prevalence was notably higher in OSA patients than in non-OSA patients (OR: 2.29, 95% CI: 1.93-2.72), and OSA prevalence was notably higher in DM patients than in non-DM patients (OR: 2.12, 95% CI: 1.73-2.60). Subgroup analysis uncovered that DM prevalence in the OSA population was more significant in the group <50 years (OR: 3.28, 95% CI: 2.20-4.89) and slightly decreased in the group >50 years (OR: 1.82, 95% CI: 1.38-2.40).

CONCLUSIONS

The meta-analysis reveals a bidirectional link between OSA and DM.

Using expanded diagnostic criteria mitigates gender disparities in diagnosis of sleep-disordered breathing

STUDY OBJECTIVES

Mitigating gender inequality in the diagnosis and management of sleep-disordered breathing (SDB) is of paramount importance. Historically, the diagnostic criteria for SDB were based on male physiology and did not account for variations in disease manifestation based on sex. Some payors use a definition of hypopnea that requires a 4% oxygen desaturation (AHI-4) to determine coverage for treatment, whereas the criteria recommended by the American Academy of Sleep Medicine require either a 3% oxygen desaturation or an arousal (AHI-3A). This study examined the diagnostic implications of these 2 definitions for men and women in a clinical setting.

METHODS

We reviewed polysomnography reports for all patients who completed a diagnostic polysomnography study at 1 sleep disorders center in 2019. Every polysomnography recording was scored using both sets of criteria to determine AHI-4 and AHI-3A.

RESULTS

Data from 279 women (64.7%) and 152 men (34.3%) were analyzed. Overall, the mean AHI-4 was 21.9 ± 27.3 and the mean AHI-3A was 34.7 ± 32.3 per hour of sleep. AHI-3A resulted in a diagnostic increase of 30.4% (P = .001) for women and 21.7% (P = .006) for men. Women saw a greater increase in diagnosis of mild and moderate SDB, and men saw a greater increase in severe SDB with the AHI-3A compared to the AHI-4 definition.

CONCLUSIONS

The definition of hypopnea used in the AHI-3A criteria is more consistent with the pathophysiology of SDB in women and results in higher rates of diagnosis. Use of the AHI-4 criteria may create a sex-based disparity in diagnosis, leading to symptomatic women remaining undiagnosed and untreated.

CITATION

Haile K, Mungarwadi M, Ibrahim NA, et al. Using expanded diagnostic criteria mitigates gender disparities in diagnosis of sleep-disordered breathing. J Clin Sleep Med. 2025;21(3):543-548.

The association of objective daytime sleepiness with impaired glucose metabolism in patients with obstructive sleep apnea: a multi-omics study

STUDY OBJECTIVES

To examine the joint effect of obstructive sleep apnea (OSA) and objective excessive daytime sleepiness (EDS) on glucose metabolism and the underlying mechanisms.

METHODS

We included 127 patients with OSA. The multiple sleep latency test (MSLT) and Epworth sleepiness scale (ESS) were used to assess objective and subjective EDS, respectively. Disordered glucose metabolism was defined as either a physician diagnosis or having fasting blood glucose levels ≥5.6 mmol/L. Values of fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) higher than the median values of our sample were defined as high fasting insulin and insulin resistance. Serum metabolomics and fecal microbiota were used to explore underlying mechanisms.

RESULTS

Lower MSLT values were associated with higher levels of fasting blood glucose, fasting insulin, and HOMA-IR. Furthermore, objective EDS was associated with increased odds of disordered glucose metabolism, elevated fasting insulin, and insulin resistance. Dysregulation of serum valine degradation and dysbiosis of fecal Bacteroides thetaiotaomicron were associated with impaired glucose metabolism in OSA with objective EDS. No association between subjective EDS and impaired glucose metabolism was observed.

CONCLUSIONS

OSA with objective, but not subjective, EDS is associated with an increased risk of disordered glucose metabolism and insulin resistance. Dysregulation of valine degradation and dysbiosis of B. thetaiotaomicron appear to link objective EDS and disordered glucose metabolism in OSA.

Prevalence of prediabetes according to sleep apnea status

AIM

The association between obstructive sleep apnea (OSA) and prediabetes using the STOP-Bang questionnaire remains unknown. We aimed to investigate the prevalence of prediabetes among people based on their sleep apnea status.

METHODS

This cross-sectional study included 10131 Korean adults without diabetes with information of STOP-Bang scores, drawn from the dataset of the Korea National Health and Nutrition Examination Survey 2019-2021. Prediabetes was defined in three subsets: only by fasting blood glucose (FBG) (FBG 100-125 mg/dL, HbA1c <5.7 %), only by HbA1c (FBG <100 mg/dL, HbA1c 5.7-6.4 %) or by both. We used multivariable logistic regression to assess the odds ratio (OR) and 95 % confidence intervals (CIs) for prediabetes.

RESULTS

A total of 3828 subjects reported a STOP-Bang score of ≥ 3, which shows increased risk of OSA. Multivariable-adjusted OR (95 % CI) showed that a STOP-Bang score ≥ 3 was associated with prediabetes meeting both FBG and HbA1c criteria (OR 1.06; 95 % CI 1.01-1.12). This association was statistically significant among women, particularly postmenopausal women (OR 1.20, 95 % CI 1.10-1.30; OR 1.21, 95 % CI 1.11-1.32, respectively).

CONCLUSION

In Korean general population, a significant correlation between higher OSA risk and prediabetes was observed, especially in postmenopausal women.

Bidirectional interplay of sleep apnea syndrome and cardio-vascular disorders in diabetes

Although often overlooked sleep apnea has emerged as a significant public health concern. Obstructive sleep apnea (OSA) and diabetes commonly co-exist with a vicious cycle worsening the incidence and severity of both conditions. OSA has many implications including cardiometabolic disorders and impaired cardiovascular (CV) prognosis. OSA combined with diabetes generates a cumulative effect on CV outcomes. The association of OSA with several comorbidities including CV disease and heart failure is bi-directional meaning that some of them are likely to contribute to OSA. In patients with diabetes, OSA treatment should be integrated in a holistic strategy of prevention of CV and microvascular complications. This article provides some clues to advance the understanding of the interplay between OSA and CV disorders in diabetes and to consider the role of some CV risk markers like cardiac autonomic neuropathy and artery stiffness and of novel metrics for hypoxic-related events in CV risk stratification, and offers a discussion on the effects of medical approaches including weight loss strategies, GLP1-receptor agonists and sodium-glucose cotransporter 2 inhibitors. It provides a guidance to improve screening and diagnosis of OSA, and adherence to OSA treatment in patients with diabetes.

L-type calcium channel blockade worsens glucose tolerance and β-cell function in C57BL6/J mice exposed to intermittent hypoxia

Intermittent hypoxemia (IH), a pathophysiologic consequence of obstructive sleep apnea (OSA), adversely affects insulin sensitivity, insulin secretion, and glucose tolerance. Nifedipine, an L-type calcium channel blocker frequently used for the treatment of hypertension, can also impair insulin sensitivity and secretion. However, the cumulative and interactive repercussions of IH and nifedipine on glucose homeostasis have not been previously investigated. Adult male C57BL6/J mice were exposed to either nifedipine or vehicle concurrently with IH or intermittent air (IA) over 5 days. IH exposure entailed cycling fractional-inspired oxygen levels between 0.21 and 0.055 at a rate of 60 events/h. Nifedipine (20 mg/kg/day) or vehicle was administered via subcutaneous osmotic pumps resulting in four groups of mice: IA-vehicle (control), IA-nifedipine, IH-vehicle, and IH-nifedipine. Compared with IA (control), IH increased fasting glucose (mean Δ: 33.0 mg/dL; P < 0.001) and insulin (mean Δ: 0.53 ng/mL; P < 0.001) with nifedipine having no independent effect. Furthermore, glucose tolerance was worse with nifedipine alone, and IH further exacerbated the impairment in glucose disposal (P = 0.013 for interaction). Nifedipine also decreased glucose-stimulated insulin secretion and the insulinogenic index, with addition of IH attenuating those measures further. There were no discernible alterations in insulin biosynthesis/processing, insulin content, or islet morphology. These findings underscore the detrimental impact of IH on insulin sensitivity and glucose tolerance while highlighting that nifedipine exacerbates these disturbances through impaired β-cell function. Consequently, cautious use of L-type calcium channel blockers is warranted in patients with OSA, particularly in those at risk for type 2 diabetes.NEW & NOTEWORTHY The results of this study demonstrate the interaction between intermittent hypoxemia (IH) and nifedipine in a murine model. IH raises fasting glucose and insulin levels, with nifedipine exacerbating these disturbances. Glucose tolerance worsens when nifedipine is administered alone, and IH magnifies the impairment in glucose disposal. These findings raise the possibility of potential deleterious effects of L-type calcium channel blockers in patients with obstructive sleep apnea (OSA).

Different expression of circulating microRNA profile in tibetan OSAHS with metabolic syndrome patients

Recent empirical investigations reinforce the understanding of a profound interconnection between metabolic functions and Obstructive Sleep Apnea-hypopnea Syndrome (OSAHS). This study identifies distinctive miRNA signatures in OSAHS with Metabolic Syndrome (Mets) patients from healthy subjects, that could serve as diagnostic biomarkers or describe differential molecular mechanisms with potential therapeutic implications. In this study, OSAHS with MetS patients showed significantly higher Apnea Hyponea Index(AHI), but lower oxygen desaturation index(ODI 4/h) and minimum pulse oxygen saturation(SpO2). A total of 33 differentially expressed miRNAs by Limma method, and 31 differentially expressed miRNAs by DEseq2 method were screened. In addition, GO enrichment analysis of target genes associated with differentially expressed miRNAs revealed significant enrichment in metabolic processes, suggesting that the differential expression of OSAHS-induced miRNAs may contribute to the progression of metabolic disorders through the regulation of metabolic pathways. Furthermore, KEGG pathway enrichment analysis revealed significant enrichment in the p53 signaling pathway and several other pathways. Notably, the Wnt signaling pathway, PI3K-Akt signaling pathway, cAMP signaling pathway, and AMPK signaling pathway are implicated in the metabolic processes of glucose dysregulation and lipid homeostasis, as well as the pathogenesis of hypertension associated with OSAHS. We identified IKBKB, PIK3R1, and MAP2K1 as the target genes most associated with Mets pathogenesis in OSAHS, regulated by miR-503-5p, miR-497-5p, and miR-497-5p, respectively. Additionally, the target genes of differentially expressed miRNAs between Tibetan OSAHS patients with MetS and healthy individuals are regulated by transcription factors such as NR2C1, STAT3, STAT5a, HIF1a, ETV4, NANOG, RELA, SP1, E2F1, NFKB1, AR, and MYC. In conlusion, we found differentially expressed miRNAs in Tibetan OSAHS patients with Metabolic Syndrome for the first time. Enrichment analysis results suggest that differentially expressed miRNAs may involved in the development of OSAHS-related metabolic disorders by regulating metabolic pathways. We also revealed that IKBKB, PIK3R1, and MAP2K1 are mostly associated with metabolic disorder in OSAHS, and miR-503-5p and miR-497-5p may regulate the development of MetS associated with OSAHS by modulating IKBKB, PIK3R1, and MAP2K1.

Associations of fat, bone, and muscle indices with disease severity in patients with obstructive sleep apnea hypopnea syndrome

PURPOSE

To investigate the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) severity and fat, bone, and muscle indices.

METHODS

This study included 102 patients with OSAHS and retrospectively reviewed their physical examination data. All patients underwent polysomnography, body composition analysis, dual-energy X-ray absorptiometry, computed tomography (CT) and blood test. Correlation and multiple linear regression analyses were performed using SPSS 22.0.

RESULTS

Among the fat indices, fat mass (FM) (r = 0.27-0.43), body fat percentage (BFP) (r = 0. 25-0.35), visceral fat area (VFA) (r = 0.28-0.40) and trunk fat mass (TFM) (r = 0.26-0.34) were positively correlated with hypopnea index (HI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and percent of time spent with oxygen saturation below 90% (T90%), respectively, and negatively correlated with mean pulse oxygen saturation (SpO2) (r= -0.28--0.41). For bone indexes, T8, T9, T11, L1-CT value, mean vertebral CT value and 25-Hydroxyvitamin D3 were positively correlated with mean SpO2 (r = 0.23-0.32), respectively. For muscle indexes, pectoralis muscle density (PMD) was negatively correlated with HI, AHI, and ODI (r= -0.20--0.36) and positively correlated with mean SpO2 (r = 0.26). In separate models predicting sleep measures, AHI increased by 0.36, 0.29, 0.34 and 0.25 events/h per unit increase in FM, BFP, VFA, and triglyceride (TG), respectively. AHI decreased by 0.27 per unit increase in PMD. T90% increased with FM, BFP, VFA, WHR, TG and total cholesterol (TC), but decreased with appendicular skeletal muscle mass (ASM) and PMD respectively.

CONCLUSION

Higher fat levels and lower vertebral CT values, muscle mass and density correlated with a higher degree of OSAHS severity. Intermittent hypoxia may affect fat, bone, and muscle metabolism in patients with OSAHS.

Postnatal Growth Trajectories and Risk of Obstructive Sleep Apnea in Middle Age: A Cohort Study

STUDY OBJECTIVES

Rapid growth in childhood predisposes to obesity and cardiometabolic diseases in adulthood. While obstructive sleep apnea (OSA) is bidirectionally linked to obesity, its developmental origins are sparsely studied. We examined associations between postnatal growth and the risk of OSA in adulthood.

METHODS

We included adults whose childhood anthropometric data was collected in the New Delhi Birth Cohort study. The risk of OSA was defined by the Berlin Questionnaire (BQ) with and without the obesity criterion. Using logistic regression, we studied associations of OSA risk with conditional growth parameters, which are statistically independent measures of gain in height, weight, and body mass index (BMI), during infancy (0-2 years), early childhood (2-5 years), and late childhood (5-11 years).

RESULTS

Among 521 subjects (58.9% males) with a mean (SD) age of 40.9 (1.7) years, 30.9% had a high risk of OSA. On multivariate analysis, a high risk of OSA was associated with a higher conditional BMI in infancy (odds ratio: 1.25; 95% confidence interval: 1.00-1.57; p = 0.048) and early childhood (1.35; 1.07-1.69; p = 0.011). Higher risk of OSA was associated with greater conditional weight in early childhood (1.34; 1.06-1.68; p = 0.013). Using the modified BQ definition without obesity, adult risk of OSA was significantly associated with a higher adult BMI instead of childhood conditional BMIs.

CONCLUSIONS

Greater gain in conditional BMI or weight in early childhood is associated with a high risk of OSA in middle age, which is mediated by a higher attained adult BMI.

Obstructive Sleep Apnoea and Type 1 Diabetes Mellitus: A Neglected Relationship?

Obstructive sleep apnoea (OSA) is regarded as a major health condition, progressively affecting an increased number of people around the world. The interplay between OSA and type 2 diabetes mellitus (T2DM) has been extensively studied. However, little is known about the relationship between OSA and type 1 diabetes mellitus (T1DM). This review provides insight into the prevalence of OSA in T1DM and its relationship with diabetic complications. Studies have hitherto yielded contradictory results on the occurrence of OSA in T1DM. Indeed, the risk of OSA in T1DM has ranged from 1 in 10 to more than 1 in 2 T1DM subjects. This high occurrence was confirmed by objective polysomnography as well as widely used subjective questionnaires. Multiple studies revealed the important correlation between OSA and diabetes complications. Both microvascular (nephropathy, neuropathy and retinopathy) and macrovascular complications appear to be associated with OSA occurrence, although some associations were not significant due to inadequate data. In conclusion, T1DM subjects carry a higher risk of undiagnosed OSA. Additional studies are needed to clarify the exact correlation between the two conditions.

Twistable and Stretchable Nasal Patch for Monitoring Sleep-Related Breathing Disorders Based on a Stacking Ensemble Learning Model

Obstructive sleep apnea syndrome disrupts sleep, destroys the homeostasis of biological systems such as metabolism and the immune system, and reduces learning ability and memory. The existing polysomnography used to measure sleep disorders is executed in an unfamiliar environment, which may result in sleep patterns that are different from usual, reducing accuracy. This study reports a machine learning-based personalized twistable patch system that can simply measure obstructive sleep apnea syndrome in daily life. The stretchable patch attaches directly to the nose in an integrated form factor, detecting sleep-disordered breathing by simultaneously sensing microscopic vibrations and airflow in the nasal cavity and paranasal sinuses. The highly sensitive multichannel patch, which can detect airflow at the level of 0.1 m/s, has flexibility via a unique slit pattern and fabric layer. It has linearity with an R2 of 0.992 in the case of the amount of change according to its curvature. The stacking ensemble learning model predicted the degree of sleep-disordered breathing with an accuracy of 92.9%. The approach demonstrates high sleep disorder detection capacity and proactive visual notification. It is expected to help as a diagnostic platform for the early detection of chronic diseases such as cerebrovascular disease and diabetes.

Obstructive sleep apnea mediates genetic risk of Diabetes Mellitus: The Hispanic Community Health Study/Study of Latinos

Objective

We sought to evaluate whether obstructive sleep apnea (OSA), and other sleep disorders, increase genetic risk of developing diabetes mellitus (DM).

Research Design and Methods

Using GWAS summary statistics from the DIAGRAM consortium and Million Veteran Program, we developed multi-ancestry Type 2 Diabetes (T2D) polygenic risk scores (T2D-PRSs) useful in admixed Hispanic/Latino individuals. We estimated the association of the T2D-PRS with cross-sectional and incident DM in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We conducted a mediation analysis with T2D-PRSs as an exposure, incident DM as an outcome, and OSA as a mediator. Additionally, we performed Mendelian randomization (MR) analysis to assess the causal relationship between T2D and OSA.

Results

Of 12,342 HCHS/SOL participants, at baseline, 48.4% were normoglycemic, 36.6% were hyperglycemic, and 15% had diabetes, and 50.9% identified as female. Mean age was 41.5, and mean BMI was 29.4. T2D-PRSs was strongly associated with baseline DM and with incident DM. At baseline, a 1 SD increase in the primary T2D-PRS had DM adjusted odds ratio (OR) = 2.67, 95% CI [2.40; 2.97] and a higher incident DM rate (incident rate ratio (IRR) = 2.02, 95% CI [1.75; 2.33]). In a stratified analysis based on OSA severity categories the associations were stronger in individuals with mild OSA compared to those with moderate to severe OSA. Mediation analysis suggested that OSA mediates the T2D-PRS association with DM. In two-sample MR analysis, T2D-PRS had a causal effect on OSA, OR = 1.03, 95% CI [1.01; 1.05], and OSA had a causal effect on T2D, with OR = 2.34, 95% CI [1.59; 3.44].

Conclusions

OSA likely mediates genetic effects on T2D.

A systematic review of the methodology for examining the relationship between obstructive sleep apnea and type two diabetes mellitus

Background

The association between obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) has been explored in various studies, revealing inconsistent correlations that impact therapeutic effectiveness. This heterogeneity in findings requires further exploration to understand what may be driving this. Therefore, this study focuses on systematically reviewing the data, classification of variables, and analytical approach to understand if and how this may be contributing to the mixed findings. This review aims to provide insights that can enhance the generalisability of future research findings.

Methods

A comprehensive electronic search was conducted, including EMBASE, MEDLINE, PsycINFO, CINAHL, Web of Science Core Collection, Scopus and specialised sleep journals. The included studies were observational studies published in English from 2011 onwards, involving adults above 18 years with OSA and T2DM or prediabetes, and included a control group. Exclusions were pregnant women, interventional studies, randomised trials, systematic reviews, conference abstracts, case studies and studies without a control group or only with descriptive analysis.

Results

We reviewed 23 studies that met the inclusion criteria. Among cohort studies, 54% did not report attrition rates, and 52% did not detail methods for handling missing data in all studies. Nine studies (39%) predominantly included male participants. Objective measures were prevalent in assessing OSA, with 11 using home portable sleep monitors and four employing clinic polysomnography, though only three validated home sleep monitors. The apnea-hypopnea index was commonly used to define OSA severity, with six studies adapting the American Academy of Sleep Medicine criteria. Two studies utilised validated self-report questionnaires for OSA symptoms. T2DM diagnosis methods varied, with 17 studies using blood samples, two relying only on self-reporting, and four confirmed diagnosis via medical records.

Conclusions

The variability in sample characteristics, data quality, and variable coding may contribute to the mixed finding. This review identifies gaps in using the standardised measures, reporting attrition rates, handling missing data, and including both sexes. Addressing these issues is crucial to enhancing future research generalisability. Standardising diagnostic criteria, considering clinical and sociodemographic factors, and ensuring inclusivity in study populations are essential for advancing understanding and treatment strategies for OSA and T2DM.

Protocol registration

https://www.crd.york.ac.uk/prospero, identifier CRD42023397547.

Tet1-mediated 5hmC regulates hippocampal neuroinflammation via wnt signaling as a novel mechanism in obstructive sleep apnoea leads to cognitive deficit

BACKGROUND

Obstructive sleep apnoea (OSA) is a sleep-disordered breathing characterized by intermittent hypoxia (IH) that may cause cognitive dysfunction. However, the impact of IH on molecular processes involved in cognitive function remains unclear.

METHODS

C57BL / 6 J mice were exposed to either normoxia (control) or IH for 6 weeks. DNA hydroxymethylation was quantified by hydroxymethylated DNA immunoprecipitation (hMeDIP) sequencing. ten-eleven translocation 1 (Tet1) was knocked down by lentivirus. Specifically, cognitive function was assessed by behavioral experiments, pathological features were assessed by HE staining, the hippocampal DNA hydroxymethylation was examined by DNA dot blot and immunohistochemical staining, while the Wnt signaling pathway and its downstream effects were studied using qRT-PCR, immunofluorescence staining, and Luminex liquid suspension chip analysis.

RESULTS

IH mice showed pathological changes and cognitive dysfunction in the hippocampus. Compared with the control group, IH mice exhibited global DNA hydroxylmethylation in the hippocampus, and the expression of three hydroxylmethylases increased significantly. The Wnt signaling pathway was activated, and the mRNA and 5hmC levels of Wnt3a, Ccnd2, and Prickle2 were significantly up-regulated. Further caused downstream neurogenesis abnormalities and neuroinflammatory activation, manifested as increased expression of IBA1 (a marker of microglia), GFAP (a marker of astrocytes), and DCX (a marker of immature neurons), as well as a range of inflammatory cytokines (e.g. TNFa, IL3, IL9, and IL17A). After Tet1 knocked down, the above indicators return to normal.

CONCLUSION

Activation of Wnt signaling pathway by hippocampal Tet1 is associated with cognitive dysfunction induced by IH.

Obstructive sleep apnea risk among adults with type 2 diabetes mellitus in an urban primary care setting of Mangalore, India

Background

Obstructive sleep apnea (OSA) is an under-evaluated and under-treated problem, particularly among individuals with type 2 diabetes mellitus (T2DM). Therefore, in this study, we aim to determine the risk of OSA among adults with T2DM residing in an urban area of Mangalore and to elucidate the determinants of OSA among the study participants.

Materials and Methods

A cross-sectional study was conducted for a period of 2 months among adult patients (≥ 18 years) with T2DM seeking health care at a primary care setting located in an urban area of Mangalore. Face-to-face interviews were conducted using a semi-structured proforma. STOP-BANG questionnaire was used to assess the risk of OSA among the study participants. The measurements, such as height, weight, and neck circumference, were conducted using standard techniques.

Results

The mean age of the study participants was 58.12 ± 11.60 years. The majority, (58.30%), were males, and 45.0% reported a family history of T2DM. A total of 108 (60.0%) experienced loud snoring while asleep, while 149 (82.80%) experienced tiredness during daytime. The mean body mass index (BMI) was 24.64 ± 4.9 kg/m2, while a neck circumference of >40 cms was found in 28.90%. A total of 69 (38.30%) had a high risk of OSA with a STOP-BANG score ranging from 5 to 8, while 71 (39.40%) had a score ranging from 3 to 4 (intermediate risk). The statistically significant associations were found between age >50 years, male gender, and diabetes for ≥ 7 years and high risk of OSA (P < 0.001).

Conclusion

More than a third of the study participants had a high risk of OSA. Age > 50 years, male gender, and diabetes for ≥7 years were the factors associated with OSA.

The effect of PAP on UACR and metabolic indexes in patients with MS and OSAHS

PURPOSE

To investigate the effects of positive airway pressure (PAP) device on urinary albumin to creatinine ratio (UACR) and metabolic indexes in patients with metabolic syndrome (MS) and obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODS

This study is a retrospective cohort study. Grouped according to whether to use PAP treatment, there were 25 cases in the PAP group and 44 cases in the no OSAHS treatment group. The PAP group received positive airway pressure device and routine treatment of MS. The no OSAHS treatment group received routine treatment of OSAHS and MS. The treatment period is 3 months.

RESULTS

1. The PAP group demonstrated significant reductions in Body Mass Index (BMI), Waist circumference (WC), Neck circumference (NC), Visceral fat area (VFA), Fasting C peptide (FCP), high-sensitivity C-reactive protein (hs-CRP), and UACR compared to the no OSAHS treatment group, with significant differences (P all <0.05). Among them, the UACR in the PAP group decreased significantly (from 86.05(52.55,131.61)mg/g to 16.76(8.70,25.12)mg/g, P<0.001). 2. Linear regression analysis using the decrease in UACR values as the dependent variable demonstrated a positive linear relationship with the decrease in BMI, VFA, fasting insulin (FINS), and homeostasis model assessment of insulin resistance (HOMA-IR). Furthermore, multiple linear regression analysis indicated that the decrease in VFA (B=0.537 [95% confidence interval, 0.084 to 0.989]; P = 0.021) and HOMA-IR (B=1.000 [95% confidence interval, 0.082 to 1.917]; P = 0.033) values independently correlated with decrease in UACR values.

CONCLUSIONS

PAP treatment can reduce UACR in patients with MS and OSAHS, and has the effect of improving metabolic disorders. The decrease of UACR in patients may be related to the decrease of visceral fat and the improvement of insulin resistance.

[Relationship between obstructive sleep apnea and type 2 diabetes mellitus]

INTRODUCTION

The association between obstructive sleep apnea (OSA) and glucose metabolism remains controversial. This study investigates the relationship between OSA and incident type 2 diabetes (DM) and prediabetes (preDM), as well as the effect of long-term CPAP (continuous positive airway pressure) treatment.

METHODS

Follow-up study in a retrospective clinical cohort of patients with OSA and randomly selected controls. Data on incident DM and preDM as well as CPAP were obtained from hospital records. The relationship between baseline OSA and incident DM was examined using COX regression models.

RESULTS

Three hundred and fifty-six patients, 169 with OSA and 187 controls were followed for a median of 98 months; 47 patients (13.2%) developed DM and 43 (12.1%) developed preDM. The 5-year cumulative incidence of DM was 10.7% (6.5-13.9%). 87% of subjects with preDM in the baseline sample progressed to incident DM. It is shown that body mass index (BMI), nocturnal hypoxia and apnea hypopnea index (AHI) are risk factors for the development of DM and that CPAP reduces this risk.

CONCLUSIONS

Patients with OSA have a higher risk of developing DM. The risk factors involved are BMI, nocturnal hypoxia and AHI. Regular long-term CPAP use was associated with a decreased risk.

Implications of depressive mood in OSAHS patients: insights from event-related potential

BACKGROUND

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a chronic breathing disorder characterized by recurrent upper airway obstruction during sleep. Although previous studies have shown a link between OSAHS and depressive mood, the neurobiological mechanisms underlying mood disorders in OSAHS patients remain poorly understood. This study aims to investigate the emotion processing mechanism in OSAHS patients with depressive mood using event-related potentials (ERPs).

METHODS

Seventy-four OSAHS patients were divided into the depressive mood and non-depressive mood groups according to their Self-rating Depression Scale (SDS) scores. Patients underwent overnight polysomnography and completed various cognitive and emotional questionnaires. The patients were shown facial images displaying positive, neutral, and negative emotions and tasked to identify the emotion category, while their visual evoked potential was simultaneously recorded.

RESULTS

The two groups did not differ significantly in age, BMI, and years of education, but showed significant differences in their slow wave sleep ratio (P = 0.039), ESS (P = 0.006), MMSE (P < 0.001), and MOCA scores (P = 0.043). No significant difference was found in accuracy and response time on emotional face recognition between the two groups. N170 latency in the depressive group was significantly longer than the non-depressive group (P = 0.014 and 0.007) at the bilateral parieto-occipital lobe, while no significant difference in N170 amplitude was found. No significant difference in P300 amplitude or latency between the two groups. Furthermore, N170 amplitude at PO7 was positively correlated with the arousal index and negatively with MOCA scores (both P < 0.01).

CONCLUSION

OSAHS patients with depressive mood exhibit increased N170 latency and impaired facial emotion recognition ability. Special attention towards the depressive mood among OSAHS patients is warranted for its implications for patient care.

Sleep Characteristics are Associated with Risk of Treated Diabetes Among Postmenopausal Women

OBJECTIVE

The purpose of this study was to determine whether sleep characteristics are associated with incidence of treated diabetes in postmenopausal individuals.

METHODS

Postmenopausal participants ages 50-79 years reported sleep duration, sleep-disordered breathing, or insomnia at baseline and again in a subsample 3 years later. The primary outcome was self-reported new diagnosis of diabetes treated with oral drugs or insulin at any time after baseline. Multivariable Cox proportional hazards models were used.

RESULTS

In 135,964 participants followed for 18.1 (± 6.3) years, there was a nonlinear association between sleep duration and risk of treated diabetes. Participants sleeping ≤5 hours at baseline had a 21% increased risk of diabetes compared with those sleeping 7 hours (adjusted hazard ratio [aHR] 1.21; 95% confidence interval [CI], 1.00-1.47). Those who slept for ≥9 hours had a nonsignificant 6% increased risk of diabetes compared with those sleeping 7 hours (aHR 1.06; 95% CI, 0.97-1.16). Participants whose sleep duration had decreased at 3 years had a 9% (aHR 1.09; 95% CI, 1.02-1.16) higher risk of diabetes than participants with unchanged sleep duration. Participants who reported increased sleep duration at 3 years had a risk of diabetes (HR 1.01; 95% CI, 0.95-1.08) similar to those with no sleep duration change. Participants at high risk of sleep-disordered breathing at baseline had a 31% higher risk of diabetes than those without (aHR 1.31; 95% CI, 1.26-1.37). No association was found between self-reported insomnia score and diabetes risk.

CONCLUSIONS

Sleep-disordered breathing and short or long sleep duration were associated with higher diabetes risk in a postmenopausal population.

Chronic intermittent hypoxia-induced oxidative stress activates TRB3 and phosphorylated JNK to mediate insulin resistance and cell apoptosis in the pancreas

This study explores the potential mechanisms of obstructive sleep apnoea (OSA) complicates type 2 diabetes mellitus (T2DM) by which chronic intermittent hypoxia (CIH) induces insulin resistance and cell apoptosis in the pancreas through oxidative stress. Four- and eight-week CIH rat models were established, and Tempol (100 mg/kg/d), was used as an oxidative stress inhibitor. This study included five groups: 4-week CIH, 4-week CIH-Tempol, 8-week CIH, 8-week CIH-Tempol and normal control (NC) groups. Fasting blood glucose and insulin levels were measured in the serum. The expression levels of 8-hidroxy-2-deoxyguanosine (8-OHdG), tribbles homologue 3 (TRB3), c-Jun N-terminal kinase (JNK), phosphorylated JNK (p-JNK), insulin receptor substrate-1 (IRS-1), phosphorylated IRS-1 (Ser307) (p-IRS-1ser307 ), protein kinase B (AKT), phosphorylated AKT (Ser473) (p-AKTser473 ), B cell lymphoma protein-2 (Bcl-2), cleaved-caspase-3 (Cl-caspase-3), and the islet cell apoptosis were detected in the pancreas. CIH induced oxidative stress in the pancreas. Compared with that in the NC group and CIH-Tempol groups individually, the homeostasis model assessment of insulin resistance (HOMA-IR) and apoptosis of islet cells was increased in the CIH groups. CIH-induced oxidative stress increased the expression of p-IRS-1Ser307 and decreased the expression of p-AKTSer473 . The expression levels of TRB3 and p-JNK were higher in the CIH groups than in both the CIH-Tempol and NC groups. Meanwhile, the expressions of Cl-caspase-3 and Bcl-2 were upregulated and downregulated, respectively, in the CIH groups. Hence, the present study demonstrated that CIH-induced oxidative stress might not only induce insulin resistance but also islet cell apoptosis in the pancreas through TRB3 and p-JNK.

Childhood maltreatment and sleep apnea: Findings from a cross-sectional general population study

OBJECTIVE

Cumulative evidence indicates that childhood maltreatment (CM) is associated with sleep disturbances possibly suggesting sleep apnea. However, the relation between CM and objective measures of sleep apnea as determined by polysomnography (PSG) has not yet been assessed.

METHODS

Using a cross-sectional design and based on PSG measurements from N = 962 subjects from the SHIP-Trend general population study, we used linear regression models to investigate the relationship between apnea-hypopnea (AHI) and oxygen desaturation index (ODI) and Epworth sleepiness scale (ESS) metrics and the Childhood Trauma Questionnaire (CTQ). All significant models were additionally adjusted for obesity, depression, metabolic syndrome, risky health behaviors, and socioeconomic factors.

RESULTS

While both AHI and ESS were positively associated with the CTQ sum score, ODI was not. Investigating the CTQ subscales, ESS was associated with emotional abuse and emotional neglect; AHI was associated with physical and sexual abuse as well as physical neglect. For both the sum score and the subscales of the CTQ, ESS effects were partially mediated by depressive symptoms, while AHI effects were mediated by obesity, risky health behaviors, and metabolic syndrome.

CONCLUSION

The findings of this general population study suggest an association between CM, particularly physical neglect, and objective as well as subjective indicators of sleep apnea, which were partially mediated by depressive symptoms and obesity.

Sleep disorders and associated factors among medical students in the Middle East and North Africa: a systematic review and meta-analysis

Sleep disturbances like poor and insufficient sleep are common among medical students in the Middle East and North Africa (MENA) countries; however, the extent of medically defined sleep disorders (SDs) remains unclear. This meta-analysis determines SD prevalence and identifies associated factors among medical students in the MENA. PubMed, Web of Science, Google Scholar, and reference lists of included studies were searched (latest search: June 2022). Meta-analyses included 22 studies and were performed using random-effect models. Included studies used self-reported screening tools for assessing SDs and then estimated the proportion of participants at high risk of developing a SD. Central disorders of hypersomnolence were the most prevalent SD [prevalencepooled range: 30.9% (Jordan) to 62.5% (Saudi Arabia)], followed by insomnia disorders [prevalencepooled range: 30.4% (Jordan) to 59.1% (Morocco)], circadian rhythm sleep-wake disorders [prevalencepooled range: 13.5% (Jordan) to 22.4% (Saudi Arabia)], sleep-related breathing disorders [prevalencepooled range: 12.2% (Jordan) to 22.5% (Pakistan)], sleep-related movement disorders [prevalencepooled range: 5.9% (Egypt) to 30.6% (Saudi Arabia)], and parasomnias [prevalencepooled range: 5.6% (Jordan) to 17.4% (Saudi Arabia)]. Female sex, studying in the latter academic years, having anxiety, excessive internet use, and poor academic performance were significantly associated with SDs. SDs are prevalent among MENA medical students. Implementing student-centered interventions targeting high risk groups in medical schools should be considered to improve students' health and wellbeing.

Approach the Patient With Obstructive Sleep Apnea and Obesity

Obstructive sleep apnea (OSA) and obesity are highly prevalent and bidirectionally associated. OSA is underrecognized, however, particularly in women. By mechanisms that overlap with those of obesity, OSA increases the risk of developing, or having poor outcomes from, comorbid chronic disorders and impairs quality of life. Using 2 illustrative cases, we discuss the relationships between OSA and obesity with type 2 diabetes, dyslipidemia, cardiovascular disease, cognitive disturbance, mood disorders, lower urinary tract symptoms, sexual function, and reproductive disorders. The differences in OSA between men and women, the phenotypic variability of OSA, and comorbid sleep disorders are highlighted. When the probability of OSA is high due to consistent symptoms, comorbidities, or both, a diagnostic sleep study is advisable. Continuous positive airway pressure or mandibular advancement splints improve symptoms. Benefits for comorbidities are variable depending on nightly duration of use. By contrast, weight loss and optimization of lifestyle behaviors are consistently beneficial.

A Narrative Review of Self-Reported Scales to Evaluate Depression and Anxiety Symptoms in Adult Obstructive Sleep Apnea Patients

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent chronic condition that has been associated with mental disorders like depression and anxiety. This study intends to provide a practical overview of the most relevant self-reported and self-rating scales that assess depression and anxiety in OSA patients. Materials and Methods: A search for articles was performed using PubMed, Google Scholar, and Semantic Scholar using a combination of words for obstructive sleep apnea, depression, anxiety, and scales. The tools were ordered by type (screening and rating) and arranged chronologically according to the year of publication. Results: Three scales were identified for assessing depression, which were the Center for Epidemiologic Studies Depression Scale (CES-D), the Hospital Anxiety and Depression Scale (HADS-D), and the Patient Health Questionnaire-9 (PHQ-9). For rating depression, two scales were discussed: the Zung Self-Rating Depression Scale (SDS) and the Beck Depression Inventory (BDI), which has three versions (the BDI, the BDI-II, and the Fast Screen (BDI-FS)). For assessing anxiety, the Generalized Anxiety Disorder-7 (GAD-7) scale was identified. Two scales were reviewed for rating anxiety: the State-Trait Anxiety Inventory (STAI) and the Beck Anxiety Inventory (BAI). Each scale is accompanied by a brief description of its practicality and psychometric qualities and an analysis of its strengths and limitations. Conclusions: The findings of this review will contribute to the understanding of the importance of assessing mental health comorbidities in the context of OSA, ultimately guiding clinical practice and future research in this area.

[Diabetes and obstructive sleep apnoea: A case-control study]

INTRODUCTION

Obstructive sleep apnoea (OSA) and diabetes mellitus (DM) are very prevalent diseases frequently associated. Their coexistence is independently associated with an increased prevalence of cardiovascular comorbidities. As this association is underdiagnosed, it is necessary to optimise clinical suspicion by studying independent predictors of DM or prediabetes (preDM) in patients with OSA.

METHOD

A simple randomised case-control study, matched for sex, body mass index (BMI) and age, aimed to study the association of OSA with DM and preDM and to identify independent predictors for both diseases in people with OSA.

RESULTS

We included 208 cases with OSA and 208 controls without OSA. In the former, 18.8% had DM compared to only 10.1% in the latter (P=.00). Prevalence of preDM was 41.8% vs. 10.6%, respectively (P=.00). One hundred and twenty-four cases (59.6%) reported excessive daytime sleepiness (EDS) (Epworth scale, 10.5±3.1) vs. 24.5% of the control group (Epworth scale, 6.6±2.9). Apnoea-hypopnoea index (AHI) and O2 desaturation indices (IDO, CT90 and CT80) were significantly higher in the case group. The risk of MD was related to age, nocturnal hypoxaemia and EDS. The risk of pre-MD was related to BMI and AHI.

CONCLUSIONS

OSA is associated with DM and preDM. Age, nocturnal hypoxaemia and EDS are predictors of DM. BMI and AHI are predictors of pre-MD.

Sleep and cardiovascular disease

This review centres around the recent evidence in examining the intersection of sleep and cardiovascular disease (CVD). Sleep in this review will be further subdivided to consider both sleep quantity and quality along and will also consider some of the more common sleep disorders, such as insomnia and obstructive sleep apnoea, in the context of CVD. Sleep disorders have been further explored in several specific populations which are both at risk of sleep disorders and CVD. Secondly, the review will present some of the risk factors for CVD that are affected by sleep and sleep disorders which include hypertension, diabetes, and obesity. It will also examine the potential underlying mechanisms including inflammation, appetite control, endocrine, and genetic processes that are affected by sleep and sleep disorders leading to increased risk of CVD development. In addition, we will consider the observed bi-directional relationships between sleep and cardiovascular risk factors. For example, obesity, a risk factor for CVD can be affected by sleep, but in turn can increase the risk of certain sleep disorder development which disrupts sleep, leading to further risk of obesity development and increased CVD risk. Finally, the review will explore emerging evidence around lifestyle interventions that have included a sleep component and how it impacts the management of CVD risk factor. The need for increased awareness of the health effects of poor sleep and sleep disorders will be discussed alongside the need for policy intervention to improve sleep to facilitate better health and well-being.

The role of microRNAs in pathophysiology and diagnostics of metabolic complications in obstructive sleep apnea patients

Obstructive sleep apnea (OSA) is one of the most common sleep disorders, which is characterized by recurrent apneas and/or hypopneas occurring during sleep due to upper airway obstruction. Among a variety of health consequences, OSA patients are particularly susceptible to developing metabolic complications, such as metabolic syndrome and diabetes mellitus type 2. MicroRNAs (miRNAs) as epigenetic modulators are promising particles in both understanding the pathophysiology of OSA and the prediction of OSA complications. This review describes the role of miRNAs in the development of OSA-associated metabolic complications. Moreover, it summarizes the usefulness of miRNAs as biomarkers in predicting the aforementioned OSA complications.

Impact of CPAP Therapy Adherence on Global Cognition in Patients with Moderate to Severe Obstructive Sleep Apnea: A One-Year Follow-Up

Background: Obstructive sleep apnea increases (OSA) cognitive impairment risk. The objective of this study was to determine the impact of continuous positive airway pressure (CPAP) adherence on global cognition using the Montreal Cognitive Assessment questionnaire (MoCA). Materials and Methods: Thirty-four new patients diagnosed with moderate or severe OSA (apnea-hypopnea index AHI ≥ 15 events/h) from the CPAP group were compared with thirty-one moderate to severe OSA patients from the no-CPAP group. In addition, all patients completed the MoCA test, a patient health questionnaire (PHQ-9) for depressive symptoms, and a generalized anxiety questionnaire (GAD-7) for anxiety symptoms, at baseline, after 6 months, and after 1 year. Results: At baseline, there were no significant differences between the two groups regarding total MoCA scores, 20.9 ± 3.5 CPAP group to 19.7 ± 2.9 no-CPAP group (p = 0.159), PHQ-9 (p = 0.651), and GAD-7 (p = 0.691). After one year, improvement was observed for a total MoCA score of 22.7 ± 3.5 (p < 0.001) for the CPAP group, and significant variance of score between groups was more accentuated for delayed recall and attention (p < 0.001) sub-topic. Moreover, PHQ-9, GAD-7 scores, and the Epworth Sleepiness Scale (ESS) decreased significantly (p < 0.001) after CPAP therapy. The MoCA score was significantly correlated with years of education (r = 0.74, p < 0.001) and had a negative correlation with body mass index (BMI) (r = -0.34), ESS (r = -0.30) and PHQ-9 (r = -0.34). Conclusions: One year of CPAP adherence improved global cognition associated with OSA.

Sleep disturbances, glycaemic control, stress, and coping among diabetic patients: A structural equation modelling approach

BACKGROUND

Sleep disturbances are more prevalent in diabetic patients than in the general population and may consequently be comorbid with hyperglycaemia.

OBJECTIVE

The two study aims were to (1) verify the factors associated with sleep disturbances and glycaemic control and (2) further understand the mediation effects of coping and social support in the relationship among stress, sleep disturbances, and glycaemic control.

METHODS

A cross-sectional study design was used. Data were collected at two metabolic clinics in southern Taiwan. The study recruited 210 patients with type II diabetes mellitus who were aged 20 years or above. Demographic information and data on stress, coping, social support, sleep disturbances, and glycaemic control were collected. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and PSQI scores >5 were considered to indicate sleep disturbances. Structural equation modelling (SEM) approaches were employed to analyse the path association for sleep disturbances in diabetic patients.

RESULTS

The mean age of the 210 participants was 61.43 (standard deviation, SD 11.41) years old, and 71.9 % reported sleep disturbances. The final path model had acceptable model fit indices. Stress perception was divided into stress perceived positively and negatively. Stress perceived positively was associated with coping (β = 0.46, p < .01) and social support (β = 0.31, p < .01), whereas stress perceived negatively was significantly associated with sleep disturbances (β = 0.40, p < .001).

CONCLUSIONS

The study shows that sleep quality is essential to glycaemic control, and stress perceived negatively might play a critical role to sleep quality.

Causal associations of sleep apnea and snoring with type 2 diabetes and glycemic traits and the role of BMI

OBJECTIVE

Sleep apnea and snoring have been associated with type 2 diabetes, with BMI playing a role in the pathway, but the directions of causality are unclear. This study examined the causal associations of sleep apnea and snoring with type 2 diabetes while assessing the role of BMI using multiple genetic methods.

METHODS

Five genetic methods were used: two-sample; bidirectional univariable Mendelian randomization (MR) inverse variance-weighted (MR-IVW); multivariable MR-IVW; network MR; and latent causal variable method.

RESULTS

Compared with univariable MR-IVW, the odds ratio (95% CI) of type 2 diabetes for genetically predicted sleep apnea and snoring using the largest genome-wide association study decreased dramatically, from 1.61 (95% CI: 1.16-2.23) to 1.08 (95% CI: 0.59-1.97) and from 1.98 (95% CI: 1.25-3.13) to 1.09 (95% CI: 0.64-1.86) after adjustment for BMI. Network MR showed that BMI accounts for 67% and 62% of the total effect of sleep apnea and snoring on type 2 diabetes, respectively. The latent causal variable suggested that sleep apnea and snoring have no direct causal effect on type 2 diabetes.

CONCLUSIONS

These results first suggest that the associations of sleep apnea and snoring with type 2 diabetes were mainly driven by BMI. The possible indirect effects of sleep apnea and snoring on type 2 diabetes through BMI cannot be ruled out.

Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study

This study aimed to obtain a comprehensive view of the risk of developing diabetes in patients with obstructive sleep apnea (OSA) and to compare this risk between patients receiving continuous positive airway pressure (CPAP) therapy versus upper airway surgery (UAS). We used local and the global-scale federated data research network TriNetX to obtain access to electronic medical records, including those for patients diagnosed with OSA, from health-care organizations (HCOs) worldwide. Using propensity score matching and the score-matched analyses of data for 5 years of follow-up, we found that patients who had undergone UAS had a lower risk of developing diabetes than those who used CPAP (risk ratio 0.415, 95% confidence interval (CI) 0.349-0.493). The risk for newly diagnosed diabetes patients showed a similar pattern (hazard ratio 0.382; 95% CI 0.317-0.459). Both therapies seem to protect against diabetes (Risk 0.081 after UAS vs. 0.195 after CPAP). Analysis of the large data sets collected from HCOs in Europe and globally lead us to conclude that, in patients with OSA, UAS can prevent the development of diabetes better than CPAP.

Shorter respiratory event duration is related to prevalence of type 2 diabetes

BACKGROUND

Obstructive sleep apnea (OSA) is a heterogeneous sleep disorder often comorbid with metabolic diseases, and type 2 diabetes (T2DM) is one of them. Although apnea hypopnea index (AHI) is currently the diagnostic criteria for OSA severity, a controversial relationship between AHI and T2DM has been found. On the other hand, the duration of apnea-hypopnea events has been shown to be a useful metric for predicting mortality. This study aimed to test whether average respiratory event duration was associated with prevalence of T2DM.

METHODS

Patients referred to the sleep clinic were recruited in the study. Baseline clinical characteristics and polysomnography parameters including average respiratory event duration were collected. The association of average respiratory event duration with the prevalence of T2DM was evaluated by univariate and multivariate logistic regression analyses.

RESULTS

A total of 260 participants were enrolled, and 92 (35.4%) had T2DM. Univariate analysis revealed that age, body mass index (BMI), total sleep time, sleep efficiency, history of hypertension, and shorter average respiratory event duration were associated with T2DM. In multivariate analysis, only age and BMI remained significant. While average respiratory event duration was insignificant in multivariate analysis, subtype event analysis showed that shorter average apnea duration was both significant in univariate (OR, 0.95; 95% CI, 0.92-0.98) and multivariate analyses (OR, 0.95; 95% CI, 0.91-0.99). Neither average hypopnea duration nor AHI was associated with T2DM. Significant association (OR, 1.19; 95% CI, 1.12-1.25) was observed between shorter average apnea duration and lower respiratory arousal threshold after multivariate adjustment. However, causal mediation analysis revealed no mediating effect of arousal threshold on average apnea duration and T2DM.

CONCLUSION

The average apnea duration may be a useful metric in the diagnosis of OSA comorbidity. Shorter average apnea duration indicating poor sleep quality and augmented autonomic nervous system responses might be the potential pathological mechanisms leading to T2DM.

PREDICTING PROGRESSION TYPE 2 DIABETES MELLITUS: A 3-YEAR FOLLOW-UP STUDY EXAMINING RISK FACTORS FOR TYPE 2 DIABETES IN PATIENTS WITH PREDIABETES

OBJECTIVE

Aim: To study the risk factors in patients with prediabetes that can lead to the progression of impaired glucose tolerance in the form of type 2 diabetes mellitus.

PATIENTS AND METHODS

Materials and methods: The selection of patients for this study was carried out on an outpatient basis at the Department of Therapy and Family Medicine, Uzhhorod National University. Patients with prediabetes were identified based on the American Diabetes Association criteria. Informed consent was obtained from all patients before the start of the study. Patients were randomly assigned to one of two groups: Group 1 (n=37) that received typical treatment according to the recommendations of the American Diabetes Association and the control Group 2 (n=42). At the 3rd year of the study, we determined the body mass index, glucose levels and glycated hemoglobin levels of the patients, also their medical documentation was analyzed and patients were interviewed about concomitant diseases.

RESULTS

Results: Analyzing the 3-year follow-up of patients with prediabetes, cases of type 2 diabetes mellitus were detected in both groups, but there is no statistically significant difference when comparing the indicators between the groups (p>0.05).

CONCLUSION

Conclusions: In our study, we analyzed the risk factors in patients with prediabetes that can lead to type 2 diabetes. During a 3-year follow-up, we identified cases of type 2 diabetes mellitus.

CPAP Therapy on Depressive and Anxiety Symptoms in Patients with Moderate to Severe Obstructive Sleep Apnea Syndrome

Backgrounds and Objectives: There is a link between sleep apnea syndrome (OSA) and depressive and anxiety symptoms, but the underlying mechanisms are not fully understood. The study aimed to determine the prevalence of these symptoms in patients with OSA and to evaluate the impact of continuous positive airway pressure (CPAP) on depression and anxiety scores. Materials and Methods: Ninety-nine consecutive new patients diagnosed with moderate or severe (apnea-hypopnea index AHI ≥ 15 events/h) OSA were accepted for the CPAP therapy. Patients completed a patient health questionnaire (PHQ-9) for depressive symptoms and a generalized anxiety questionnaire (GAD-7) for anxiety symptoms before the CPAP treatment, after 6 months, and after 1 year of CPAP therapy with compliance. For both scores (PHQ-9 and GAD-7), a cut point ≥10 was used to indicate the presence of clinically depressive and anxiety symptoms. Results: Forty-eight individuals (48.48%) had PHQ-9 scores above the cut-off point ≥ 10, and twenty-seven participants (27.27%) had GAD-7 scores above the cut-off point ≥10. A significant correlation has been shown between PHQ-9 score and BMI (p < 0.0001), AHI (p < 0.0001), ODI (p < 0.001), ESS (p < 0.001), GAD-7 score (p < 0.0001), and [t90] (p < 0.0001), while GAD-7 was correlated with AHI (p < 0.030), ODI (p < 0.006), and [t90] (p < 0.001). The PHQ-9 and GAD-7 scores decreased significantly after 6 months of CPAP therapy in all groups and after 1 year of CPAP use. Conclusions: OSA patients should be screened for depression and anxiety. Furthermore, CPAP should be the first choice of treatment before starting other treatments for depression and anxiety symptoms.