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Gouveri E, Steiropoulos P, Papanas N. Does Obstructive Sleep Apnoea Syndrome Influence the Development and Treatment of Diabetic Foot? A Brief Narrative Review. INT J LOW EXTR WOUND 2025; 24:294-298. [PMID: 35833320 DOI: 10.1177/15347346221113992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Both obstructive sleep apnoea syndrome (OSAS) and diabetes mellitus (DM) are common conditions that often coexist and share many similar risk factors. Diabetic foot is a common complication of DM, which may lead to lower-limb amputation. OSAS is considered a risk factor for type 2 DM (T2DM). There is also evidence that OSAS may be linked with the development, as well as the healing of diabetic foot. Multiple mechanisms triggered by sleep fragmentation and intermittent hypoxaemia in OSAS could contribute to the development of diabetic foot ulcers (DFUs). More interestingly, emerging evidence implies a favourable impact of continuous positive airway pressure (CPAP) treatment on DFU healing. Healing DFUs and minimising recurrence rates remains a challenge for health care professionals. In this context, management of OSAS might prove a useful therapeutic adjunct for DFUS. However, data is still limited and randomised controlled trials are needed to further explore this interesting potential.
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Affiliation(s)
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Cheng F, Yang K, Wang Y, Yang F, Niu X, Li W. Therapeutic potential of GLP-1RAs in sleep apnea with genetic associations to type 2 diabetes. Diabetol Metab Syndr 2025; 17:141. [PMID: 40296043 PMCID: PMC12036185 DOI: 10.1186/s13098-025-01699-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Accepted: 04/11/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Some observational studies found that there is an epidemiological association between type 2 diabetes (T2D) and sleep apnea (SA) and glucose-lowering drugs may lower SA risk. However, the causative relationship among them remains unclear. METHODS Linkage Disequilibrium Score Regression (LDSC) was utilized to assess the genetic correlation between T2D and SA. Mendelian Randomization (MR) was applied, primarily using the inverse variance weighted (IVW) method, to evaluate the causal relationship between T2D and SA. Additionally, we performed Drug-target MR analysis to evaluate the impact of Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) on SA. We used two kinds of genetic instruments to proxy the exposure of GLP-1RAs, including expression quantitative trait loci of drugs target genes, and genetic variants within drugs target genes associated with glycated hemoglobin A1c(HbA1c) from genome wide association study. Summary-data-based MR (SMR) and IVW were used to calculate the effect estimates. A two-step MR analysis was further employed to explore potential mediating factors in the T2D-SA relationship. RESULTS A genetic correlation and bidirectional causal association were found between T2D and SA. GLP-1RAs-mediated reductions in HbA1c levels showed associations with decreased SA risk in two independent datasets: (odds ratio (OR)1 = 0.48 [95% confidence interval (CI) 0.28-0.83], P1 = 9.21 × 10-3; OR2 = 0.21 [95% CI 0.05-0.92], P2 = 3.89 × 10-2); a higher expression of GLP-1R was associated with a decreased risk of SA (OR1 = 0.98 [95% CI 0.96-1.00], P1 = 4.55 × 10-2; OR2 = 0.95 [95% CI 0.92-0.99], P2 = 1.71 × 10-2). Body mass index (BMI) and current tobacco smoking mediated 20.28% and 6.65%, respectively, of the total effect of GLP-1RAs on SA risk. CONCLUSION This study suggested a bidirectional causal relationship between T2D and SA, with GLP-1-RAs potentially serving as a therapeutic target for SA. The reduction of SA risk by GLP-1RAs may be partially mediated by decreases in BMI and current tobacco smoking.
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Affiliation(s)
- Fang Cheng
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Kang Yang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Yaoling Wang
- Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Fan Yang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Xinyu Niu
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Wei Li
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China.
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277, Jiefang Avenue, Wuhan, 430022, Hubei Province, China.
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Bloomquist RF, Bloomquist DT, Gardner TW. Current Treatment Options for Diabetic Retinal Disease. Diabetes Technol Ther 2025; 27:248-260. [PMID: 39723931 DOI: 10.1089/dia.2024.0548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2024]
Abstract
The global incidence of diabetes is rising steadily and with it the number of people living with diabetic retinal disease (DRD) is increasing. Like diabetes, DRD can be treated but not cured. In response, therapies to address DRD include targeted ocular and systemic medications. This review discusses diabetes and DRD in terms of current screening recommendations, treatments, and considerations related to those therapies and future drug targets and trials on the horizon. This discourse is targeted at all members of the diabetes care team, including primary care providers, optometrists, and ophthalmologists. The dynamic landscape of diabetic retinopathy treatment is promising for the prevention and improvement of visually significant disease.
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Affiliation(s)
- Ryan F Bloomquist
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Doan Tam Bloomquist
- Department of Ophthalmology, Charlie Norwood Veterans Affairs Hospital, Augusta, Georgia, USA
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
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Dhiman P, Singh P, Arora S, Kashyap A, Jain P, Singh M, Singh J, Singh A, Suhani F, Singh A, Goyal MK, Vuthaluru AR. A Comprehensive Analysis of Clinical, Biochemical, and Polysomnographic Characteristics in Patients With Type 2 Diabetes Mellitus With and Without Obstructive Sleep Apnea. Cureus 2024; 16:e59734. [PMID: 38841011 PMCID: PMC11151989 DOI: 10.7759/cureus.59734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) has been a significant contributor to mortality all across the globe. The most attributing factors to pathogenesis are metabolic syndrome, obesity, diabetes, and so on, but the indicators of its early detection are still elusive. OBJECTIVE The study aimed to compare the clinical, biochemical, and polysomnographic characteristics of type 2 diabetes patients with and without OSA. DESIGN AND METHODS This cross-sectional study was conducted at the Department of Medicine and Endocrinology Unit of Dayanand Medical College and Hospital, Ludhiana. A total of 584 patients with type 2 diabetes were assessed using the Berlin questionnaire, with 302 fulfilling the criteria for a high risk of OSA. Out of 302 patients who met the criteria for the high-risk category, 110 patients underwent a sleep study. RESULTS Three hundred and two patients satisfying the inclusion and exclusion criteria were enrolled in the study. A total of 110 patients underwent a sleep study, of which 68 (61.8%) had evidence of OSA. The waist-to-hip ratio was considerably higher in the OSA patients than in the non-OSA group (1.09 vs 0.930, p = 0.001). HbA1c >7% was found in 58.8% of OSA patients contrary to 38.1% of non-OSA patients. Fasting plasma glucose levels (>126 mg/dl) were identified in a substantially larger proportion of OSA patients than the non-OSA patients (64.7% vs 45.2%, p = 0.04). Similarly, peripheral neuropathy was found more commonly in the OSA patients than in the non-OSA patients (47% vs. 26.1%, p = 0.02). Prevalence of retinopathy, nephropathy, coronary artery disease, stroke, heart failure, and peripheral vascular disease did not differ significantly between the two groups. CONCLUSIONS OSA frequently occurs among individuals diagnosed with type 2 diabetes mellitus. The prompt identification of OSA within this demographic is imperative to pinpoint those at an elevated risk of succumbing to conditions such as peripheral neuropathy, the exacerbation of glycemic control, and the onset of unmanaged hypertension. Moreover, there exists a positive correlation between the waist-to-hip ratio and the prevalence of OSA in persons with type 2 diabetes mellitus, highlighting the critical role of waist-to-hip ratio assessments in this patient population.
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Affiliation(s)
- Pulkit Dhiman
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Parminder Singh
- Endocrinology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Saurabh Arora
- Endocrinology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Anil Kashyap
- Pulmonology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Prannav Jain
- Medicine and Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Manavjot Singh
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Jaskaran Singh
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Akashdeep Singh
- Pulmonary Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Fnu Suhani
- Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Anmol Singh
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
- Internal Medicine, Global Heart & Super Speciality Hospital, Ludhiana, IND
| | - Manjeet K Goyal
- Gastroenterology and Hepatology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ashita R Vuthaluru
- Anesthesia and Critical Care, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, IND
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Catikkas NM, Tunc M, Soysal P. The prevalence of excessive daytime sleepiness and associated factors in older diabetic patients. Aging Clin Exp Res 2023; 35:3205-3214. [PMID: 38064108 DOI: 10.1007/s40520-023-02602-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/20/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVES Sleep disorders are a frequent health problem in older patients with diabetes mellitus (DM). There has been no study investigating the factors associated with excessive daytime sleepiness (EDS) in older diabetic patients. We aimed to investigate the prevalence and associated factors of EDS. METHODS We performed a retrospective cross-sectional study in older diabetic patients. The Epworth Sleepiness Scale score of ≥ 11 points indicated EDS. All patients underwent comprehensive geriatric assessment including demographic characteristics, blood pressures, comorbid diseases, cognitive and nutritional states, basic and instrumental daily living activity indexes, lower urinary tract symptoms, and laboratory values. RESULTS Of 227 patients, 73.1% were females, with a mean age of 78.8 ± 6.5. The prevalence of EDS was 19.8%. Patients with EDS were mostly males with dementia and used significantly more medication with more anticholinergic drug burden, falls, urge incontinence, and nocturia (p < 0.05). They had higher SARC-F and lower Barthel index, Lawton-Brodie, Tinetti, MMSE scores, and high-density lipoprotein than the patients without EDS (p < 0.05). After adjusting for age, sex, and dementia, all parameters that were significant in univariate analysis remained associated with EDS, except for falls, and MMSE scores. CONCLUSION The EDS was found in one in five older diabetic patients. There was a significant relationship between EDS and drug use, anticholinergic drug burden, impaired excretory functions, sarcopenia, decreased functional capacity, falls, gait-balance disorder, and cognitive dysfunction. The recognization of EDS and the implementation of interventions may be helpful in the management of geriatric syndromes.
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Affiliation(s)
- Nezahat Muge Catikkas
- Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and, Research Hospital, Department of Internal Medicine, Division of Geriatrics, University of Health Sciences Istanbul, 34785, Sancaktepe, Istanbul, Turkey
| | - Muhammed Tunc
- Faculty of Medicine, Department of Internal Medicine, Bezmialem Vakif University, 34093, Fatih, Istanbul, Turkey
| | - Pinar Soysal
- Faculty of Medicine, Department of Geriatric Medicine, Bezmialem Vakif University, 34093, Fatih, Istanbul, Turkey.
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Sircu V, Colesnic SI, Covantsev S, Corlateanu O, Sukhotko A, Popovici C, Corlateanu A. The Burden of Comorbidities in Obstructive Sleep Apnea and the Pathophysiologic Mechanisms and Effects of CPAP. Clocks Sleep 2023; 5:333-349. [PMID: 37366660 PMCID: PMC10297352 DOI: 10.3390/clockssleep5020025] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Micro-arousals and the repeated desaturation of oxyhemoglobin, which are typical in obstructive sleep apnea syndrome (OSAS), have adverse effects on the health of patients, leading to a wide range of complications such as cardiovascular (arterial hypertension, pulmonary hypertension, chronic heart failure, arrhythmias, myocardial infarction), cerebrovascular (strokes), metabolic (insulin resistance, obesity, diabetes mellitus, metabolic syndrome), gastrointestinal (non-alcoholic liver disease), urinary (chronic renal failure), and neuropsychiatric complications as well as a wide range of malignancies. These, in turn, have multilateral effects on familial, occupational, and social life, as well as increasing the risks of road traffic accidents and accidents at the workplace. Awareness, timely screening, and the prevention of complications play important roles in diagnosing and treating comorbid conditions. This review focuses on comorbidities in OSAS and the effect of Continuous Positive Airway Pressure (CPAP) therapy on their prognoses.
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Affiliation(s)
- Victoria Sircu
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova; (V.S.); (S.-I.C.); (C.P.)
| | - Silvia-Iaroslava Colesnic
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova; (V.S.); (S.-I.C.); (C.P.)
| | - Serghei Covantsev
- Department of Clinical Research and Development, Botkin Hospital, 125284 Moscow, Russia;
- Department of Emergency Medicine № 76, Botkin Hospital, 125284 Moscow, Russia
| | - Olga Corlateanu
- Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova;
| | - Anna Sukhotko
- Department of General Oncology № 71, Botkin Hospital, 125284 Moscow, Russia;
| | - Cristian Popovici
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova; (V.S.); (S.-I.C.); (C.P.)
| | - Alexandru Corlateanu
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova; (V.S.); (S.-I.C.); (C.P.)
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7
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Lu N, Yin F. Relationship Between Hyperuricemia-Waist Phenotype and Obstructive Sleep Apnea in Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2023; 16:1505-1513. [PMID: 37252008 PMCID: PMC10224684 DOI: 10.2147/dmso.s408637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
Objective This study aimed to propose the hyperuricemia-waist (HUAW) phenotype and investigate the relationship between the HUAW phenotype and obstructive sleep apnea (OSA) in type 2 diabetes mellitus (T2DM). Methods We enrolled 255 patients with T2DM (165 male and 90 female) from the First Hospital of Qinhuangdao. The sleep test was performed, and serum uric acid (UA) levels and waist circumference (WC) were calculated. The HUAW phenotype was defined as serum UA concentrations ≥420 μmol/L and WC ≥90 cm (male) and ≥85 cm (female). The participants were categorized into four phenotype groups based on the mentioned cutoffs: normal WC and normal UA concentrations (group A); normal WC and elevated UA concentrations (group B); enlarged WC and normal UA concentrations (group C); and enlarged WC and elevated UA concentrations (group D). Among these participants, 17.6% were characterized by the HUAW phenotype, 80.0% had OSA, and 47.0% had moderate-to-severe OSA. The prevalence of OSA was 43.4%, 71.4%, 89.7%, and 97.8% in groups A, B, C, and D, respectively. The prevalence of moderate-to-severe OSA was 7.5%, 28.6%, 56.9%, and 72.7% in groups A, B, C, and D, respectively. After adjusting for age, sex, duration of diabetes, glycosylated hemoglobin A1c, smoking, and drinking, the HUAW phenotype was found to be significantly associated with OSA and moderate-to-severe OSA. Conclusion The present study proposed the HUAW phenotype and demonstrated that in T2DM, the HUAW phenotype was associated with OSA, especially with moderate-to-severe OSA. Unlike T2DM without the HUAW phenotype, T2DM with the HUAW phenotype showed a significantly higher prevalence of OSA, especially moderate-to-severe OSA. Thus, early sleep studies should be routinely examined in individuals with T2DM who display the HUAW phenotype.
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Affiliation(s)
- Na Lu
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Fuzai Yin
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People’s Republic of China
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Niu Y, Cai H, Zhou W, Xu H, Dong X, Zhang S, Lan J, Guo L. Research trends in hypertension associated with obstructive sleep apnea: a bibliometric analysis. Sleep Breath 2023; 27:411-419. [PMID: 35579792 DOI: 10.1007/s11325-022-02637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to systematically analyze the studies of hypertension associated with obstructive sleep apnea to assess the current status and hot spots in this field. METHODS We searched the Web of Science Core Collection for publications related to hypertension associated with obstructive sleep apnea published before July 3, 2021. Bibliometric analyses and science mappings were carried out using the CiteSpace 5.8.R1 and Microsoft Office Excel 2019. CiteSpace 5.8.R1 was used to visualize the distribution of research fields, analyze co-occurring keywords and burst terms to detect trends and frontiers, and identify leading collaborations among countries, authors, and institutions. Microsoft Office Excel 2019 was used to make bar graphs, histograms and line graphs. RESULTS According to the search strategy, a total of 7263 published articles and reviews were retrieved. The research on hypertension associated with obstructive sleep apnea has been developing quickly at present. Sleep and Breathing was the most productive journal. The USA was a major producing country and Harvard Medical School was the most productive institution in this field. In the field of hypertension associated with obstructive sleep apnea, the main research hotspots were continuous positive airway pressure, cardiovascular disease, and obesity. CONCLUSIONS The present study provides a new perspective for the study of hypertension associated with obstructive sleep apnea and valuable information for researchers to find potential partners and cooperative institutions, hot issues and research frontiers.
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Affiliation(s)
- Yirou Niu
- School of Nursing, Jilin University, 965 Xinjiang Street, Chaoyang District, Changchun, 130021, Jilin Province, China
| | - Hongwei Cai
- Yantai Affiliated Hospital of Binzhou Medical University, 717 Jinbu Street, Mouping District, Yantai, 264100, Shandong, China
| | - Wei Zhou
- Bethune First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, Jilin Province, China
| | - Haiyan Xu
- School of Nursing, Jilin University, 965 Xinjiang Street, Chaoyang District, Changchun, 130021, Jilin Province, China
| | - Xiaodan Dong
- School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin Province, China
| | - Shuang Zhang
- School of Nursing, Jilin University, 965 Xinjiang Street, Chaoyang District, Changchun, 130021, Jilin Province, China
| | - Jiaxin Lan
- School of Nursing, Jilin University, 965 Xinjiang Street, Chaoyang District, Changchun, 130021, Jilin Province, China
| | - Lirong Guo
- School of Nursing, Jilin University, 965 Xinjiang Street, Chaoyang District, Changchun, 130021, Jilin Province, China.
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Wium-Andersen IK, Jørgensen TSH, Jørgensen MB, Osler M, Wium-Andersen MK. Diabetes, sleep disorders and risk of depression - A Danish register-based cohort study. J Diabetes Complications 2022; 36:108266. [PMID: 35932548 DOI: 10.1016/j.jdiacomp.2022.108266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
AIMS We examined the influence of comorbid sleep disorder on the association between type 2 diabetes (T2D) and risk of incident depression. METHODS The study population (N = 232,489) was based on all individuals registered aged ≥40 years with a T2D diagnosis between January 1, 2000 to December 31, 2012 in the Danish National Diabetes Register and a matched reference population. The risk of incident depression (diagnosis or anti-depressant medication) following T2D and possible effect modification of comorbid sleep disorder was estimated using adjusted Cox proportional hazards regression. Sleep disorder was defined as a diagnosis of insomnia, hypersomnia or sleep-wake schedule disorders or use of sleep medication (z-drugs or melatonin) in the Danish National Patient Registry or the Danish National Prescription Registry. RESULTS At study entry, 15.3 % of the participants had a sleep disorder. During follow-up, 2.6 % were diagnosed with depression and 32.1 % received antidepressant medication. The unadjusted hazard ratio (HR) for depression was 1.54 (95%CI 1.52-1.56) for patients with diabetes, which attenuated to 1.50 (1.48-1.52) after adjustment for sleep disorders, which further attenuated to 1.27 (1.26-1.29) in the model further adjusted for psychiatric and somatic comorbidities. The analyses of T2D and sleep disorder as independent and combined variables compared with none of the conditions on risk of depression, showed a HR of 1.27 (95 % CI 1.19-1.35) for T2D without sleep disorder, 1.46 (95 % CI 1.33-1.59) for sleep disorders without T2D, and 1.49 (95%CI 1.37-1.63) for both conditions. CONCLUSIONS T2D and sleep disorders were independently associated with subsequent risk of depression and individuals with both conditions experienced the greatest relative risk. Sleep disorders neither explained nor amplified the relation between diabetes and depression.
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Affiliation(s)
| | - Terese Sara Høj Jørgensen
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farigmagsgade 5, 1014 Copenhagen K, Denmark
| | | | - Merete Osler
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farigmagsgade 5, 1014 Copenhagen K, Denmark
| | - Marie Kim Wium-Andersen
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
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Sultana R, Sissoho F, Kaushik VP, Raji MA. The Case for Early Use of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Patients with Comorbid Diabetes and Metabolic Syndrome. Life (Basel) 2022; 12:1222. [PMID: 36013401 PMCID: PMC9410036 DOI: 10.3390/life12081222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023] Open
Abstract
Patients with obstructive sleep apnea (OSA) have high rates of co-occurring type 2 diabetes, hypertension, obesity, stroke, congestive heart failure, and accelerated atherosclerotic cardiovascular diseases. These conditions frequently require multiple medications, raising the risk of polypharmacy, adverse drug-drug and drug-disease interactions, decreased quality of life, and increased healthcare cost in these patients. The current review of extant literature presents evidence supporting glucagon-like peptide-1 receptor agonists (GLP-1RA) as one pharmacologic intervention that provides a "one-stop shop" for OSA patients because of the multiple effects GLP-1RA has on comorbidities (e.g., hypertension, diabetes, obesity, metabolic syndrome, and atherosclerotic cardiovascular diseases) that commonly co-occur with OSA. Examples of glucagon-like peptide-1 receptor agonists approved by the FDA for diabetes (some of which are also approved for obesity) are liraglutide, exenatide, lixisenatide, dulaglutide, semaglutide, and albiglutide. Prescribing of GLP-1RAs to address these multiple co-occurring conditions has enormous potential to reduce polypharmacy, cost, and adverse drug events, and to improve quality of life for patients living with OSA and diabetes. We thus strongly advocate for increased and early use of GLP-1RA in OSA patients with co-occurring diabetes and other cardiometabolic conditions common in OSA.
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Affiliation(s)
- Rizwana Sultana
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Fatoumatta Sissoho
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Vinod P. Kaushik
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Mukaila A. Raji
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
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Kaba Q, Tai F, Al-Awadi A, Somani S. Examining the Relationship Between Diabetic Macular Edema, and Obstructive Sleep Apnea. Clin Ophthalmol 2022; 16:1215-1223. [PMID: 35480621 PMCID: PMC9037844 DOI: 10.2147/opth.s354087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose This prospective cohort study examined the relationship between diabetic macular edema (DME), diabetic retinopathy (DR) and obstructive sleep apnea (OSA) in patients after 1 year of treatment with anti-VEGF injection and/or continuous positive airway pressure (CPAP). Patients and Methods The study included adults with type 1 or 2 diabetes mellitus with diabetic retinopathy. Polysomnography metrics were measured at baseline. Ophthalmologic metrics were measured at baseline, six-month (6m) and twelve-month (12m) follow-up. All DME+ patients received standard care, and all OSA+ patients were advised continuous positive airway pressure (CPAP). Logistic regression between DR severity and OSA severity was performed. Analysis of variance (ANOVA) was performed between subgroups. Results Seventy-four eyes of 49 patients with DR were included. Prevalence of OSA was significantly higher in the DME+ group (70.7%) than DME- group (42.4%, p < 0.05). A significantly lower average minimum SaO2 was noted in OSA+DME+ (81.74%) than OSA+DME- eyes (88.23%, p < 0.05). Logistic regression analysis of ophthalmological and sleep metrics showed no correlation between DR and OSA severity. CPAP adherence was 20% (6/30) in the OSA+DME+ cohort and 36% (5/14) in the OSA+DME- cohort. At 12m, CPAP-adherent OSA+DME+ showed significantly lower DR severity score (1.00 ± 0.0) than CPAP non-adherent OSA+DME+ (1.36 ± 0.80, p = 0.042). No significant patterns were noted for visual acuity and mean central retinal thickness. Conclusion DME is associated with the presence of OSA. Minimum SaO2 is a significant OSA clinical variable for DME. DR severity is not associated with OSA severity. CPAP coupled with intravitreal anti-VEGF therapy may be helpful for reducing DR severity in DME+ eyes. Presence of OSA may diminish intravitreal anti-VEGF efficacy on anatomical (mean CRT) and functional (VA) outcomes of DME.
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Affiliation(s)
- Qayim Kaba
- Cardiff University School of Medicine, Cardiff, UK
| | - Felicia Tai
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmad Al-Awadi
- Mayo Clinic School of Graduate Medical Education, Jacksonville, FL, USA
| | - Sohel Somani
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Uptown Eye Specialists, Brampton, Ontario, Canada
- William Osler Health Centre, Brampton, Ontario, Canada
- Correspondence: Sohel Somani, Uptown Eye Specialists, 401-7900 Hurontario Street, Brampton, ON, L6Y 0P6, Canada, Email
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Dash S, Thakur A. To assess the risk of obstructive sleep apnea in type 2 diabetes mellitus patients in a tertiary care center in Eastern India. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_54_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Wei DYW, Chew M, Sabanayagam C. Obstructive Sleep Apnoea, Other Sleep Parameters and Diabetic Retinopathy. Curr Diab Rep 2021; 21:58. [PMID: 34902078 DOI: 10.1007/s11892-021-01425-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To summarise the association between obstructive sleep apnoea and diabetic retinopathy and diabetic macular oedema. To examine the effects of other sleep parameters on diabetic retinopathy and diabetic macular oedema. To discuss the pathophysiology of diabetic eye changes and how it is related to obstructive sleep apnoea. RECENT FINDINGS Conflicting data exists in terms of the association of diabetic eye changes with sleep apnoea and/or other sleep parameters. Various cross-sectional studies show PDR to be associated with the prevalence of OSA. Patients who underwent continuous positive airway pressure (CPAP) treatment were significantly less likely to develop pre/proliferative DR. Secondary sleep parameters generally are not associated with DR except for long duration of sleep. Differences in reporting could be due to the different thresholds set to define OSA/ODI and severity of DR/DME, in addition to factors used in multivariate analysis. There is a need for further studies with long-term follow-up and to assess the impact of CPAP on the development and progression of diabetic eye change(s).
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Affiliation(s)
- Dayna Yong Wei Wei
- Department of Ophthalmology, National University Hospital, National University Health System, Singapore, Singapore
| | - Merwyn Chew
- Department of Ophthalmology, JurongHealth, National University Health System, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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Singh A, Chaudhary SC, Gupta KK, Sawlani KK, Singh A, Singh AB, Verma AK. Prevalence of obstructive sleep apnea in diabetic patients. Ann Afr Med 2021; 20:206-211. [PMID: 34558450 PMCID: PMC8477286 DOI: 10.4103/aam.aam_43_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Obstructive sleep apnea (OSA)-related hypoxemia stimulates release of acute-phase proteins and reactive oxygen species that exacerbate insulin resistance and lipolysis and cause an augmented prothrombotic and proinflammatory state which can leads to premature death. Aims This study aims to study the prevalence of OSA in diabetic patients. Setting and Design It was a cross-sectional study, done over a period of 1 year in a tertiary care hospital. Materials and Methods A total of 149 type 2 diabetic patients were enrolled after taking written consent. All patients were subjected to STOP BANG questionnaire and patients falling in intermediate-high risk (score 3-8), were taken for overnight polysomnography to confirm the diagnosis of OSA (apnea hypopnea index ≥ 5). Statistical Analysis Used Statistical Package for Social Sciences (SPSS) Version 21.0 statistical analysis software. Results Fifty-five percent of our diabetic population were having OSA. The age of patients enrolled in the study ranged between 30 and 86 years and prevalence increases with an increase in age groups. Majority (61.7%) of our cases were males. Incremental trend in weight, body mass index (BMI), neck circumference, and waist circumference of OSA cases were found with increasing in severity of OSA. Mean levels of raised blood sugar and HbA1c were higher in severe OSA cases. Conclusions OSA has a high prevalence in patients with type 2 diabetes mellitus. Patients with type 2 diabetes should be screened for OSA, even in the absence of symptoms, especially in individuals with higher waist circumference and BMI.
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Affiliation(s)
- Ankita Singh
- Department of Medicine, KGMU, Lucknow, Uttar Pradesh, India
| | | | | | | | - Abhishek Singh
- Department of Medicine, KGMU, Lucknow, Uttar Pradesh, India
| | | | - Ajay K Verma
- Department of Respiratory Medicine, KGMU, Lucknow, Uttar Pradesh, India
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15
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Korompili G, Amfilochiou A, Kokkalas L, Mitilineos SA, Tatlas NA, Kouvaras M, Kastanakis E, Maniou C, Potirakis SM. PSG-Audio, a scored polysomnography dataset with simultaneous audio recordings for sleep apnea studies. Sci Data 2021; 8:197. [PMID: 34344893 PMCID: PMC8333307 DOI: 10.1038/s41597-021-00977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/17/2021] [Indexed: 11/22/2022] Open
Abstract
The sleep apnea syndrome is a chronic condition that affects the quality of life and increases the risk of severe health conditions such as cardiovascular diseases. However, the prevalence of the syndrome in the general population is considered to be heavily underestimated due to the restricted number of people seeking diagnosis, with the leading cause for this being the inconvenience of the current reference standard for apnea diagnosis: Polysomnography. To enhance patients' awareness of the syndrome, a great endeavour is conducted in the literature. Various home-based apnea detection systems are being developed, profiting from information in a restricted set of polysomnography signals. In particular, breathing sound has been proven highly effective in detecting apneic events during sleep. The development of accurate systems requires multitudinous datasets of audio recordings and polysomnograms. In this work, we provide the first open access dataset, comprising 212 polysomnograms along with synchronized high-quality tracheal and ambient microphone recordings. We envision this dataset to be widely used for the development of home-based apnea detection techniques and frameworks.
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Affiliation(s)
- Georgia Korompili
- Department of Electrical and Electronic Engineering, University of West Attica, Attica, Greece
| | - Anastasia Amfilochiou
- Sleep Study Unit, Sismanoglio - Amalia Fleming General Hospital of Athens, Athens, Greece
| | - Lampros Kokkalas
- Department of Electrical and Electronic Engineering, University of West Attica, Attica, Greece
| | - Stelios A Mitilineos
- Department of Electrical and Electronic Engineering, University of West Attica, Attica, Greece
| | | | - Marios Kouvaras
- Department of Electrical and Electronic Engineering, University of West Attica, Attica, Greece
| | - Emmanouil Kastanakis
- Sleep Study Unit, Sismanoglio - Amalia Fleming General Hospital of Athens, Athens, Greece
| | - Chrysoula Maniou
- Sleep Study Unit, Sismanoglio - Amalia Fleming General Hospital of Athens, Athens, Greece
| | - Stelios M Potirakis
- Department of Electrical and Electronic Engineering, University of West Attica, Attica, Greece.
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Aurora RN, Punjabi NM. Postprandial hyperglycemia in type 2 diabetes and obstructive sleep apnea. Sleep Med 2021; 84:173-178. [PMID: 34153800 PMCID: PMC10955457 DOI: 10.1016/j.sleep.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Postprandial hyperglycemia is common in type 2 diabetes even in those with acceptable glycemic control and conveys an increased risk of cardiovascular morbidity and mortality. Although obstructive sleep apnea (OSA) has been associated with altered glucose metabolism, data regarding its association with postprandial hyperglycemia in type 2 diabetes are limited. Thus, the current study sought to characterize the association between OSA and postprandial hyperglycemia in adults with type 2 diabetes. METHODS A cross-sectional study of adults with type 2 diabetes was conducted. Home sleep testing was used to assess OSA severity as determined by the oxygen desaturation index (ODI). Self-monitoring of blood glucose (SMBG) was performed before and 2-h after breakfast, lunch, and dinner for three days. The association between OSA and glucose levels before and after each meal was examined using multivariable logistic regression. RESULTS The study sample consisted of 195 adults with 52% being men. OSA severity, as assessed by ODI quartiles, was associated with higher postprandial glucose values after dinner but not after breakfast or lunch. The adjusted odds ratios (95% confidence intervals) for a higher post-dinner glucose level for four ODI quartiles were 1.00 (Reference), 2.16 (0.96, 4.87), 2.23 (1.03, 4.83), and 2.58 (1.18, 5.94). Stratified analyses showed that this association was present in men but not women. CONCLUSIONS Increasing OSA severity is associated with postprandial hyperglycemia in type 2 diabetes and may contribute to impaired glycemic control. Future studies examining the impact of OSA treatment on glucose metabolism should consider meal-related glycemic excursions as a potential outcome.
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Affiliation(s)
- R Nisha Aurora
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Johns Hopkins University, School of Medicine, USA.
| | - Naresh M Punjabi
- Johns Hopkins University, School of Medicine, USA; University of Miami, School of Medicine, USA
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Possible Preventative/Rehabilitative Role of Gliflozins in OSA and T2DM. A Systematic Literature Review-Based Hypothesis. Adv Ther 2021; 38:4195-4214. [PMID: 34273093 PMCID: PMC8342338 DOI: 10.1007/s12325-021-01791-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea (OSA) is characterized by frequent apnoea episodes during sleep due to upper airway obstruction. The present review summarizes current knowledge on inter-relationships between OSA and type 2 diabetes mellitus (T2DM) and suggests the former as a possible target for sodium-glucose co-transporter-2 inhibitors (SGLT-2i). Based on pathophysiological mechanisms underlying OSA onset and renal SGLT-2 effects, we suggest that SGLT-2i indications might expand beyond current ones, including glucose, lipids, uric acid, blood pressure, and body weight control as well as chronic heart failure and kidney disease prevention.
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Chronic Intermittent Hypoxia Induces Early-Stage Metabolic Dysfunction Independently of Adipose Tissue Deregulation. Antioxidants (Basel) 2021; 10:antiox10081233. [PMID: 34439481 PMCID: PMC8388878 DOI: 10.3390/antiox10081233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/09/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
Several studies demonstrated a link between obstructive sleep apnea (OSA) and the development of insulin resistance. However, the main event triggering insulin resistance in OSA remains to be clarified. Herein, we investigated the effect of mild and severe chronic intermittent hypoxia (CIH) on whole-body metabolic deregulation and visceral adipose tissue dysfunction. Moreover, we studied the contribution of obesity to CIH-induced dysmetabolic states. Experiments were performed in male Wistar rats submitted to a control and high-fat (HF) diet. Two CIH protocols were tested: A mild CIH paradigm (5/6 hypoxic (5% O2) cycles/h, 10.5 h/day) during 35 days and a severe CIH paradigm (30 hypoxic (5% O2) cycles, 8 h/day) during 15 days. Fasting glycemia, insulinemia, insulin sensitivity, weight, and fat mass were assessed. Adipose tissue hypoxia, inflammation, angiogenesis, oxidative stress, and metabolism were investigated. Mild and severe CIH increased insulin levels and induced whole-body insulin resistance in control animals, effects not associated with weight gain. In control animals, CIH did not modify adipocytes perimeter as well as adipose tissue hypoxia, angiogenesis, inflammation or oxidative stress. In HF animals, severe CIH attenuated the increase in adipocytes perimeter, adipose tissue hypoxia, angiogenesis, and dysmetabolism. In conclusion, adipose tissue dysfunction is not the main trigger for initial dysmetabolism in CIH. CIH in an early stage might have a protective role against the deleterious effects of HF diet on adipose tissue metabolism.
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Shoukri AM. Correlation between nocturnal oxygen desaturation and glycemic control in diabetic patients with obstructive sleep apnea. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [DOI: 10.1186/s43168-021-00068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nocturnal hypoxia occurring in obstructive sleep apnea (OSA) is associated with different metabolic disturbances. The present study aims to correlate between nocturnal oxygen desaturation and levels of glycemic control in patients with type 2 diabetes mellitus (T2DM) and undiagnosed OSA.
Results
The present study included 107 patients with T2DM referred for assessment of sleep-related breathing disorder, there were 62 males (57.94%) and 45 females (42.05%), and their age ranged from 42 to 72 years with an average age of 61.29 ± 6.68 years. The patients were divided into 2 groups according to the results of overnight pulse oximetry (OPO) and apnea-hypopnea index (AHI) detected by polysomnography. Group 1 included 68 patients, they had moderate to severe OSA and significant nocturnal desaturation, and group 2 included 39 patients with no or mild OSA. The baseline characteristics of the two groups were not significantly different. Group 1 patients showed significantly higher mean Epworth score and more symptoms related to OSA. There was statistically significant difference between the values of ODI (24.88 ± 9.21 versus 8.94 ± 2.38), AHI (27.10 ± 7.68 versus 9.02 ± 3.90), and hemoglobin A1c levels (8.04 ± 0.64 versus 6.79 ± 0.38) between the two groups. A positive correlation was found between nocturnal oxygen desaturation and levels of HbA1c in group 1 patients reflecting worse glycemic control in patients with moderate to severe OSA.
Conclusion
Nocturnal oxygen desaturation occurring in obstructive sleep apnea is associated with poor glycemic control in patients with type 2 diabetes mellitus.
Trial registration
ClinicalTrials.gov, Protocol ID: OPO10-18. Trial registry number: NCT04711083. Date of registration: 14 January 2021, retrospectively registered.
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The impact of sleep disorders on microvascular complications in patients with type 2 diabetes (SLEEP T2D): the protocol of a cohort study and feasibility randomised control trial. Pilot Feasibility Stud 2021; 7:80. [PMID: 33752759 PMCID: PMC7982768 DOI: 10.1186/s40814-021-00817-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is very common in patients with type 2 diabetes (T2D). We and others have shown that OSA was associated with diabetes-related microvascular complications in patients with T2D in cross-sectional and longitudinal studies and that compliance with continuous positive airway pressure (CPAP) reduced the progression of microvascular complications. Hence, we hypothesised that adequate CPAP reduces the development of microvascular complication in patients with T2D. METHODS SLEEP T2D is a cohort study with embedded feasibility, open-label, parallel-arm, randomised control trial (RCT) over 2 years. The primary aim is the feasibility of conducting a definitive RCT assessing the impact of CPAP on chronic kidney disease and other microvascular complications in patients with T2D. The main parameters are to assess willingness of participants to be randomised, follow-up rates, CPAP adherence/compliance, to optimise the choice of outcome measures for a substantive trial, and to identify the parameters for sample size calculations. The secondary aims of the study are related to the impact of CPAP, sleep-related disorders, and sleep chronotype on a variety of diabetes-related end points. The study participants were recruited from the T2D services in multiple NHS trusts across England. The main exclusion criteria for the cohort study are as follows: T1D, eGFR < 15 mL/min/1.73 m2, known OSA, active malignancy or chronic kidney disease from reasons other than diabetes, pregnancy, professional drivers, and a history of falling asleep whilst driving within last 2 years. The main exclusion criteria from the RCT were as follows: Apnoea-Hypopnoea Index < 10 and Epworth Sleepiness Score ≥ 11. Study participants were extensively phenotyped clinically and biochemically. The OSA diagnosis was based on multichannel portable device (ApneaLink AirTM, Resmed). DISCUSSION The feasibility RCT will help us design the future RCT to assess the impact of CPAP on diabetes-related microvascular complications. The cohort study will generate preliminary data regarding the impact of sleep quality, duration, and chronotype on diabetes-related outcomes which could lead to further mechanistic and interventional studies. TRIAL REGISTRATION ISRCTN, ISRCTN12361838 . Registered 04 April 2018, Protocol version: v5.0 02.12.19.
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Pathology, Risk Factors, and Oxidative Damage Related to Type 2 Diabetes-Mediated Alzheimer's Disease and the Rescuing Effects of the Potent Antioxidant Anthocyanin. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:4051207. [PMID: 33728019 PMCID: PMC7936905 DOI: 10.1155/2021/4051207] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/27/2021] [Accepted: 02/18/2021] [Indexed: 02/07/2023]
Abstract
The pathology and neurodegeneration in type 2 diabetes- (T2D-) mediated Alzheimer's disease (AD) have been reported in several studies. Despite the lack of information regarding the basic underlying mechanisms involved in the development of T2D-mediated AD, some common features of the two conditions have been reported, such as brain atrophy, reduced cerebral glucose metabolism, and insulin resistance. T2D phenotypes such as glucose dyshomeostasis, insulin resistance, impaired insulin signaling, and systemic inflammatory cytokines have been shown to be involved in the progression of AD pathology by increasing amyloid-beta accumulation, tau hyperphosphorylation, and overall neuroinflammation. Similarly, oxidative stress, mitochondrial dysfunction, and the generation of advanced glycation end products (AGEs) and their receptor (RAGE) as a result of chronic hyperglycemia may serve as critical links between diabetes and AD. The natural dietary polyflavonoid anthocyanin enhances insulin sensitivity, attenuates insulin resistance at the level of the target tissues, inhibits free fatty acid oxidation, and abrogates the release of peripheral inflammatory cytokines in obese (prediabetic) individuals, which are responsible for insulin resistance, systemic hyperglycemia, systemic inflammation, brain metabolism dyshomeostasis, amyloid-beta accumulation, and neuroinflammatory responses. In this review, we have shown that obesity may induce T2D-mediated AD and assessed the recent therapeutic advances, especially the use of anthocyanin, against T2D-mediated AD pathology. Taken together, the findings of current studies may help elucidate a new approach for the prevention and treatment of T2D-mediated AD by using the polyflavonoid anthocyanin.
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Zhao X, Yu X, Xin S, Zhang W, Zhang X, Ji L. Correlation between OSAHS and Early Peripheral Atherosclerosis Indices in Patients with Type 2 Diabetes Mellitus in China: A Cross-Sectional Inpatient Study. J Diabetes Res 2021; 2021:6630020. [PMID: 33628835 PMCID: PMC7895581 DOI: 10.1155/2021/6630020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/10/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyze the differences of early atherosclerosis indices in type 2 diabetes mellitus (T2DM) patients with different degrees of obstructive sleep apnea-hypopnea syndrome (OSAHS) and explore the correlation between them, so as to provide a new clinical basis for the prevention and treatment of early atherosclerosis in patients with T2DM and OSAHS. Methods. A prospective study was conducted in 312 patients with T2DM and snoring who were hospitalized in the Department of Endocrinology, Peking University International Hospital from January 2017 to January 2020. According to the monitoring results, 312 patients were divided into 4 groups including the control group (208 cases), mild OSAHS group (18 cases), moderate OSAHS group (38 cases), and severe OSAHS group (48 cases). Multivariate logistic regression analysis was used to analyze the early atherosclerosis indices including brachial-ankle pulse wave velocity (PWV) and ankle-brachial index (ABI) in patients with T2DM coexistence with different degrees of OSAHS. Results. (1) As the degree of OSAHS increased, ABI decreased gradually and was lower than that in the control group, but PWV increased and was higher than that in the control group (p < 0.05, respectively). (2) The apnea-hypopnea index (AHI) positively correlated with PWV (r = 0.36, p < 0.05) and negatively correlated with ABI (r = -0.37, p < 0.05). (3) Multivariate logistic regression showed that after adjusting for age, gender, duration, BMI, blood pressure, blood glucose, blood lipid, and other factors, OSAHS was a risk factor of lower extremity arterial disease (LEAD) in patients with T2DM. With the increase of degree of OSAHS, the risk of lower extremity atherosclerosis gradually increased. Conclusion. OSAHS is an independent risk factor of LEAD in patients with T2DM, and with the increase of AHI, the ABI and PWV have changed, which provides a new clinical basis for the prevention and the treatment of early atherosclerosis in patients with T2DM and OSAHS.
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Affiliation(s)
- Xin Zhao
- Endocrinology Department, Peking University International Hospital, Beijing, China
| | - Xiaofeng Yu
- Endocrinology Department, Peking University International Hospital, Beijing, China
| | - Sixu Xin
- Endocrinology Department, Peking University International Hospital, Beijing, China
| | - Wei Zhang
- Sleep Center Department, Peking University International Hospital, Beijing, China
| | - Xiaomei Zhang
- Endocrinology Department, Peking University International Hospital, Beijing, China
| | - Linong Ji
- Endocrinology Department, cc, Beijing, China
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Higher Apnea-Hypopnea Index (AHI) and Oxygen Desaturation Index (ODI) Were Independently Associated with Increased Risks of Hypertension in Patients with T2DM: A Cross-Sectional Study. Int J Hypertens 2021; 2021:8887944. [PMID: 33552598 PMCID: PMC7846401 DOI: 10.1155/2021/8887944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/05/2021] [Indexed: 12/31/2022] Open
Abstract
Objective The current study aimed to explore the relationship between OSAS and hypertension and whether polysomnography (PSG) indices were independently associated with hypertension in patients with type 2 diabetes (T2DM). Methods This study recruited 316 T2DM patients. Multivariable logistic regression analyses were performed to determine the independent association of apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) with hypertension with adjustment for potential confounders. Results Among 316 patients, 130 (41.1%) and 204 (64.6%) had hypertension and OSAS, respectively. T2DM patients with hypertension showed significantly increased levels of AHI ((median (interquartile range)): 17.2 (5.7–34.9) vs. 5.7 (2.1–17.3) events/hour, p < 0.001), nonrapid eye movement AHI (NREM-AHI) (17.6 (5.5–36.5) vs. 5.2 (2.2–16.6) events/hour, p < 0.001), ODI (48.4 (21.9–78.0) vs. 22.6 (10.8–48.1) events/hour, p < 0.001), and severities of OSAS and decreased levels of lowest SaO2 ((mean ± standard deviation): 74.0 ± 10.4 vs. 77.3 ± 9.8, p = 0.004). Multivariable logistic regression analysis showed that higher levels of AHI, NREM-AHI, and ODI were significantly associated with increased risks of hypertension, and the adjusted odds ratios (ORs) with 95% CI were 1.026 (1.008–1.044, p = 0.004), 1.026 (1.009–1.044, p = 0.003), and 1.005 (1.001–1.010, p = 0.040), respectively. Compared with non-OSAS, severe OSAS was significantly associated with the risk of hypertension with the adjusted OR (95% CI) of 3.626 (1.609–8.172, p = 0.002), but associations of rapid eye movement AHI (REM-AHI) and lowest SaO2 with hypertension were not statistically significant. Conclusion Increased AHI, NREM-AHI, ODI, and severities of OSAS were significantly associated with higher risks of hypertension in T2DM patients. Detection and treatment of OSAS are needed to prevent hypertension in T2DM patients.
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Brzecka A, Madetko N, Nikolenko VN, Ashraf GM, Ejma M, Leszek J, Daroszewski C, Sarul K, Mikhaleva LM, Somasundaram SG, Kirkland CE, Bachurin SO, Aliev G. Sleep Disturbances and Cognitive Impairment in the Course of Type 2 Diabetes-A Possible Link. Curr Neuropharmacol 2020; 19:78-91. [PMID: 32148197 PMCID: PMC7903492 DOI: 10.2174/1570159x18666200309101750] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
There is an increasing number of patients worldwide with sleep disturbances and diabetes. Various sleep disorders, including long or short sleep duration and poor sleep quality of numerous causes, may increase the risk of diabetes. Some symptoms of diabetes, such as painful peripheral neuropathy and nocturia, or associated other sleep disorders, such as sleep breathing disorders or sleep movement disorders, may influence sleep quality and quantity. Both sleep disorders and diabetes may lead to cognitive impairment. The risk of development of cognitive impairment in diabetic patients may be related to vascular and non-vascular and other factors, such as hypoglycemia, hyperglycemia, central insulin resistance, amyloid and tau deposits and other causes. Numerous sleep disorders, e.g., sleep apnea, restless legs syndrome, insomnia, and poor sleep quality are most likely are also associated with cognitive impairment. Adequate functioning of the system of clearance of the brain from toxic substances, such as amyloid β, i.e. glymphatic system, is related to undisturbed sleep and prevents cognitive impairment. In the case of coexistence, sleep disturbances and diabetes either independently lead to and/or mutually aggravate cognitive impairment.
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Affiliation(s)
- Anna Brzecka
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Natalia Madetko
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Vladimir N Nikolenko
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya Str., Moscow, 119991, Russian Federation
| | - Ghulam M Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Leszek
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Cyryl Daroszewski
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Sarul
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Liudmila M Mikhaleva
- Research Institute of Human Morphology,3 Tsyurupy Street, Moscow, 117418, Russian Federation
| | - Siva G Somasundaram
- Department of Biological Sciences, Salem University, Salem, WV, 26426, United States
| | - Cecil E Kirkland
- Department of Biological Sciences, Salem University, Salem, WV, 26426, United States
| | - Sergey O Bachurin
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, 142432, Russian Federation
| | - Gjumrakch Aliev
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya Str., Moscow, 119991, Russian Federation
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ALTIN Z, BAYRAK B. The relationship between sleep and metabolic factors in diabetes mellitus. FAMILY PRACTICE AND PALLIATIVE CARE 2020. [DOI: 10.22391/fppc.747615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Smyth A, Jenkins M, Dunham M, Kutzer Y, Taheri S, Whitehead L. Systematic review of clinical practice guidelines to identify recommendations for sleep in type 2 diabetes mellitus management. Diabetes Res Clin Pract 2020; 170:108532. [PMID: 33157114 DOI: 10.1016/j.diabres.2020.108532] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/24/2020] [Accepted: 10/26/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Sleep quality, quantity and timing have been shown to impact glycaemic control, with a role in insulin sensitivity, glucose tolerance and HbA1C levels, in both diabetic and non-diabetic populations. The aim of this study was to identify recommendations for sleep assessment and management in international clinical practice guidelines focused on type 2 diabetes mellitus management in adults. STUDY DESIGN Systematic Review. METHODOLOGY Clinical practice guidelines which focused on the management of type 2 diabetes mellitus in adults were included (n = 35). Two independent reviewers utilised the Appraisal of Guidelines for Research and Evaluation tool (AGREE) II and a third reviewer resolved any disagreements. Included guidelines were assessed for recommendations about sleep in diabetes management (n = 14). Data were extracted on sleep recommendations ,themes were generated from the extracted data and narrative syntheses were created. RESULTS From 1114 identified papers, 35 guidelines met the inclusion criteria. Fourteen of these guidelines included recommendations pertaining to sleep, which broadly fell into five categories; sleep assessment, sleep as a therapeutic target, sleep and co-morbidities of type 2 diabetes mellitus, shift work and sleep and driving. Recommendations varied across guidelines. CONCLUSION Few guidelines provided recommendations relating to assessment and management of sleep in type 2 diabetes care. Most of the recommendations were related to obstructive sleep apnoea. However, few guidelines discussed sleep as a therapeutic intervention for diabetes mellitus or described the potential importance of sleep quality and duration in glycaemic control. Prospero registration number: CRD42020142136.
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Affiliation(s)
- Aisling Smyth
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.
| | - Mark Jenkins
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia
| | - Melissa Dunham
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia
| | - Yvonne Kutzer
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia
| | - Shahrad Taheri
- Department of Medicine, Weill Cornell Medicine Qatar, Qatar Foundation - Education City, PO 24144, Doha, Qatar
| | - Lisa Whitehead
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia
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Jeon B, Sereika SM, Callan JA, Luyster FS, DiNardo MM, Chasens ER. Age-Related Differences in Mood, Diabetes-Related Distress, and Functional Outcomes in Adults With Type 2 Diabetes Mellitus and Comorbid Obstructive Sleep Apnea and Insomnia. DIABETES EDUCATOR 2020; 46:540-551. [PMID: 32948109 DOI: 10.1177/0145721720958396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to examine age-related differences in mood, diabetes-related distress, and functional outcomes in activities sensitive to impaired sleep in adults with type 2 diabetes mellitus (T2DM) and comorbid obstructive sleep apnea (OSA) and insomnia. This study also evaluated the associations of age, insomnia severity, and OSA severity on outcome variables. METHODS This study was a secondary analysis of pooled baseline data from 2 randomized controlled trials among adults with T2DM with symptoms of sleep disorders (N = 145,109 younger adults, 36 older adults; 46.2% male; 67.6% white). Comorbid OSA and insomnia was defined as Apnea-Hypopnea Index ≥5 events per hour and Insomnia Severity Index ≥10. Outcome variables included mood, diabetes-related distress, and functional outcomes. RESULTS Older adults reported better mood, lower diabetes-related distress, and higher functional outcomes relative to younger adults (all Ps < .05). Insomnia severity was associated with worse mood (b = 2.59, P < .001) and diabetes-related distress (b = 1.40, P < .001) and lower functional outcome (b = -0.22, P < .001). Older age was associated with lower diabetes-related distress (b = -0.44, P = .040). CONCLUSION Older age was a protective factor of mood disturbance, diabetes-related distress, and functional impairment in adults with T2DM and comorbid OSA and insomnia. Insomnia severity was associated with greater mood disturbance, diabetes-related distress, and functional impairment when OSA and insomnia coexist. The results suggest that diabetes care and education specialists should assess patients for impaired sleep.
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Affiliation(s)
- Bomin Jeon
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania
| | - Susan M Sereika
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania
| | - Judith A Callan
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania
| | - Faith S Luyster
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania
| | | | - Eileen R Chasens
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania
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Mikołajczyk-Solińska M, Śliwińska A, Kosmalski M, Drzewoski J. The Phenotype of Elderly Patients with Type 2 Diabetes Mellitus and Poor Sleep Quality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5992. [PMID: 32824748 PMCID: PMC7459960 DOI: 10.3390/ijerph17165992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/12/2020] [Accepted: 08/16/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Sleep disturbances are a common problem among patients with Type 2 diabetes mellitus (T2DM). The aim of the study was to identify the phenotype of T2DM patients with poor sleep quality. METHODS An observational, cross-sectional study was conducted between May 2013 and August 2015. One hundred and sixty consecutive patients with T2DM: 74 women and 86 men, with a median age of 69.50 years (59.00; 79.50 years) were enrolled in the study. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. RESULTS Poor sleep quality was noted in 85 (53%) patients. Sleep disorders were associated with older age, as well as female gender, longer duration of diabetes, lower level of fasting plasma glucose, glycated hemoglobin A1c, estimated glomerular filtration rate, triglycerides, waist-to-hip ratio, and the presence of nephropathy. A multivariate logistic regression revealed that sleep disorders were associated with older age (Odd Ratio (OR) = 1.11, 95% Confidence Interval (CI) 1.07-1.15). Fifty-one patients (31.87%) were treated with sleeping pills. We found that older age, female gender, longer duration of diabetes, lower level of fasting plasma glucose, glycated hemoglobin A1c, estimated glomerular filtration rate, triglycerides, and the presence of nephropathy were linked with more frequent usage of hypnotics. A multivariate logistic regression demonstrated that older age (OR = 1.09, 95% CI 1.05-1.14) and nephropathy (OR = 2.79, 95% CI 1.24-6.28) were associated with a more frequent receiving the hypnotics, whereas male gender (OR = 0.30, 95% CI 0.13-0.71) has less frequent hypnotics usage. CONCLUSION Although, we assessed a wide range of patients' characteristics, age had the most negative impact on the quality of sleep in patients with T2DM. We detected more frequent use of hypnotics in older females, with coexisting nephropathy.
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Affiliation(s)
- Melania Mikołajczyk-Solińska
- Department of Internal Medicine, Diabetology and Clinical Pharmacology, Medical University of Lodz, 92-213 Lodz, Poland
| | - Agnieszka Śliwińska
- Department of Nucleic Acids Biochemistry, Medical University of Lodz, 92-213 Lodz, Poland;
| | - Marcin Kosmalski
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland;
| | - Józef Drzewoski
- Central Teaching Hospital of Medical University of Lodz, 92-213 Lodz, Poland;
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Ma D, Zheng X, Dong L, Zheng C, Chen Y, Chen Z, Lin M, Li X, Li Z, Liu C. The Relationship of Serum 25-Hydroxyvitamin-D Level with Severity of Obstructive Sleep Apnea in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2020; 13:1391-1398. [PMID: 32440175 PMCID: PMC7211054 DOI: 10.2147/dmso.s250694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/08/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To explore the association of serum vitamin-D levels with the severity of obstructive sleep apnea (OSA) in patients with type 2 diabetes mellitus (T2DM). METHODS A cross-sectional study of 136 patients with T2DM who underwent overnight polysomnography (PSG) tests and serum 25-hydroxyvitamin-D3 (25(OH)D3) level detections was conducted. Multivariable linear regression and logistic regression analyses were performed to determine the associations of serum 25(OH)D3 levels with apnea-hypopnea index (AHI) and obstructive sleep apnea (OSA). RESULTS The prevalence rates of OSA were 84.4% for male and 65.2% for female patients, respectively (p = 0.011). With increasing severities of OSA categories (none, mild, moderate and severe), patients were more likely to be male and obese, but there was no significant difference in serum 25(OH)D3 level ((mean ± standard deviation) 21.8 ± 8.8, 27.7 ± 14.6, 24.2 ± 9.8 and 26.8 ± 6.2 ng/mL, respectively, p=0.086). Serum 25(OH)D3 level was not significantly correlated with AHI (log-transformed), with the correlation coefficient of 0.133 (p=0.124). With adjustment for potential confounding factors, multivariable linear regression and logistic regression analyses showed that serum 25(OH)D3 level was not significantly associated with either AHI (log-transformed) or the risk of OSA, with the standardized regression coefficient (95% confidence interval (CI)) of 0.098 (-0.004-0.014, p=0.252) and the adjusted odds ratio (95% CI) of 1.055 (0.991-1.124, p=0.095), respectively. CONCLUSION Serum 25(OH)D3 level was not significantly associated with either AHI or the risk of OSA in patients with T2DM.
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Affiliation(s)
- Danyan Ma
- School of Medicine, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Xuanling Zheng
- Department of Endocrinology and Diabetes, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Lianqin Dong
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China
| | - Caiyu Zheng
- Fujian Medical University Xiamen Humanity Hospital, Xiamen City, Fujian Province, People’s Republic of China
| | - Yun Chen
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China
| | - Zheng Chen
- Department of Endocrinology and Diabetes, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - MingZhu Lin
- Department of Endocrinology and Diabetes, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Xuejun Li
- Department of Endocrinology and Diabetes, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen Diabetes Institute, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Zhibin Li
- Epidemiology Research Unit, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
- Zhibin Li Epidemiology Research Unit, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of ChinaTel +86-592-2137364Fax +86-592-2137557 Email
| | - Changqin Liu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China
- Department of Endocrinology and Diabetes, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
- Correspondence: Changqin Liu Department of Endocrinology and Diabetes, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of ChinaTel +86-592-2137610Fax +86-592-2137557 Email
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Assessment of risk for obstructive sleep apnea by using STOP-BANG questionnaire in type 2 diabetes mellitus. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00768-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lee CP, Kushida CA, Abisheganaden JA. Epidemiological and pathophysiological evidence supporting links between obstructive sleep apnoea and Type 2 diabetes mellitus. Singapore Med J 2019; 60:54-56. [PMID: 30843078 DOI: 10.11622/smedj.2019015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Obstructive sleep apnoea (OSA) and Type 2 diabetes mellitus (T2DM) are common diseases. The global prevalence of OSA is between 2% and 7% in general population cohorts. The worldwide prevalence of T2DM among adults (aged 20-79 years) was estimated to be 6.4%. The concurrent presence of OSA and T2DM can be expected in the same patient, given their high prevalence and similar predisposition. We reviewed the overlapping pathophysiology of OSA and T2DM in this article.
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Affiliation(s)
- Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Clete A Kushida
- Stanford Sleep Medicine Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California, United States
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Fallahi A, Jamil DI, Karimi EB, Baghi V, Gheshlagh RG. Prevalence of obstructive sleep apnea in patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab Syndr 2019; 13:2463-2468. [PMID: 31405661 DOI: 10.1016/j.dsx.2019.06.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
Obstructive sleep apnea (OSA) is highly prevalent among patients with diabetes, intensifying the complications of the disease. Various studies in Iran have reported different prevalence rates. This systematic review and meta-analysis was performed to determine OSA prevalence in patients with type 2 diabetes in Iran. In this study, we evaluated five articles published in Persian and English. The articles were searched using the keywords of obstructive sleep apnea, sleep disordered breathing, sleep apnea, OSA, diabetes mellitus and Iran and all possible combinations of these terms in national databases of Scientific Information Database (SID) and Magiran and international databases of Google Scholar, Web of Science, PubMed and Scopus with no time limit. Data were analyzed using the meta-analysis and random effects model. In addition, the heterogeneity between studies was assessed using I2 statistic, and data analysis was performed in Stata version 11. In this study, five articles with a total sample size of 2360 were evaluated. According to the results, the prevalence of OSA in diabetic patients was reported to be 54.50% (95% Confidence Interval [CI]: 39.90-69.09). In addition, the results were indicative of a lower prevalence of OSA in men (63.26%; 95% CI: 43.26-83.26), compared to women (66.22%; 95% CI: 57.60-74.84). According to the results of the study, there was a high OSA prevalence in patients with type 2 diabetes. Therefore, it is crucial to recognize diabetic patients at risk of OSA to decrease the adverse effects of this condition.
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Affiliation(s)
- Arezoo Fallahi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Dashty Ismil Jamil
- Department of Health and Hospital Administration, Lebanese French University, Erbil, Kurdistan, Iraq.
| | | | - Vajiheh Baghi
- Be'sat Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Reza Ghanei Gheshlagh
- Clinical Care Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Saad AMJ, Hiyasat D, Jaddou H, Obeidat N. The prevalence of high risk obstructive sleep apnoea among patients with type 2 diabetes in Jordan. Diabetes Res Clin Pract 2019; 152:16-22. [PMID: 31078669 DOI: 10.1016/j.diabres.2019.04.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 04/03/2019] [Accepted: 04/30/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To estimate the prevalence of Obstructive Sleep Apnea (OSA) among patients with type 2 Diabetes Mellitus (T2DM) in Jordan, and to explore the association between sleep apnea and clinical and demographic variables. METHOD A cross-sectional study was carried out from the 1st of November 2011 to the 1st of February 2012 on 1143 patients with T2DM (aged 30-90 years) at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG). The center is considered to be the only referral center in the country and accordingly, the patients represent the population in different parts of the country. All participants completed the Arabic version of the Berlin Questionnaire and were categorized as either low or high-risk patients for OSA. RESULTS A total of 1143 patients with T2DM were included in this study. There were 587 (51.4%) males and 556 (48.6%) females. The findings showed that 554 (48.5%) patients were at high risk for OSA and 589 (51.5%) were low risk for OSA. Logistic regression analysis revealed that age, smoking, and neck circumference were significantly correlated with high risk for OSA. The clinical and demographic variables were also collected for analysis. CONCLUSIONS The study found that high risk for OSA was highly prevalent among Jordanian patients with T2DM and that age, smoking and neck circumference were significantly correlated with OSA. Health care providers should be made aware of the high prevalence of sleep problems affecting patients with diabetes and should consider the appropriate screening and treatment for these patients, therefore improving their quality of life.
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Affiliation(s)
- Ahmad M J Saad
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan.
| | - Dana Hiyasat
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
| | - Hashem Jaddou
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
| | - Nathir Obeidat
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
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Aurora RN, Punjabi NM. Obstructive Sleep Apnea, Sleepiness, and Glycemic Control in Type 2 Diabetes. J Clin Sleep Med 2019; 15:749-755. [PMID: 31053205 DOI: 10.5664/jcsm.7768] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/16/2019] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVES Self-reported sleepiness is common in patients with obstructive sleep apnea (OSA) and is being increasingly recognized as an effect modifier of the association between OSA and cardiovascular outcomes. However, data on whether sleepiness modifies the association between OSA and glycemic outcomes are lacking. The current study sought to characterize the association between glycemic control and sleepiness in people with OSA and type 2 diabetes. METHODS Adults with non-insulin requiring type 2 diabetes and undiagnosed moderate to severe OSA were recruited from the community. Demographic data, Epworth Sleepiness Scale (ESS), hemoglobin A1c (HbA1c), as well a type III home sleep test were obtained. The association between self-reported sleepiness and glycemic control was examined using quantile regression. RESULTS The study cohort included 311 participants with 56% of the sample being men. Stratified analyses by sex demonstrated that self-reported sleepiness was associated with a higher HbA1c level, but this association was present only in men with a body mass index (BMI) < 35 kg/m2. Mean HbA1c levels were higher by 0.57% (95% confidence interval: 0.11, 1.02) in men with an ESS ≥ 11 compared to men with an ESS < 11. No such association was observed in men with a BMI ≥ 35 kg/m2 or in women of any BMI category. CONCLUSIONS The association between self-reported sleepiness and glycemic control in people with type 2 diabetes and moderate to severe OSA varies a function of BMI and sex. The noted differences in association should be considered when assessing possible treatment effects of therapy for OSA on metabolic outcomes.
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Affiliation(s)
- R Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Naresh M Punjabi
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
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Zhou J, Huang X, Jiang X. Effects of Obstructive Sleep Apnea-Hypopnea Syndrome on Serum Carcinoembryonic Antigen Levels in Patients with Type 2 Diabetes Mellitus. Med Sci Monit 2019; 25:3558-3565. [PMID: 31086125 PMCID: PMC6530438 DOI: 10.12659/msm.913713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is related to the serum carcinoembryonic antigen (CEA) level, which is used as a marker of colorectal cancer. Obstructive sleep apnea-hypopnea syndrome (OSAS) has been recently reported to have cancer-promoting effects. The aim of our study was to observe the effect of OSAS on serum levels of CEA in patients with T2DM. Material/Methods We enrolled 401 T2DM patients in this study. There were 244 patients with OSAS and 157 patients without OSAS. Results The CEA level in T2DM patients with OSAS was higher than that in those without OSAS (p<0.05). The participants with AHI scores ≥30 had higher CEA levels than those with 5≤ AHI scores <30 (p<0.05). The AHI score and ODI score were independently associated with increased risk of high CEA level in T2DM patients (odds ratio [OR]=1.052, 95% confidence interval [CI]: 1.011~1.095) and (OR=1.214, 95% CI: 1.070~1.377). Moreover, among male T2DM patients, the AHI score and ODI score had a linear correlation with the CEA level; this association was also observed in T2DM patients who smoked, had an HbA1c level ≥7%, or had a BMI ≥28 kg/m2 (all p<0.05). Conclusions The AHI score and ODI score were positively associated with the CEA level in T2DM patients. The relationship was stronger in male T2DM patients and in those who smoked, were obese, or had poor glycemic control. The mechanism may be related to metabolic disorders, and the potential increased risk of colorectal cancer should be investigated in a prospective study.
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Affiliation(s)
- Jiayan Zhou
- Department of Endocrinology, First People's Hospital of Changzhou, Changzhou, Jiangsu, China (mainland)
| | - Xiaolin Huang
- Department of Endocrinology, First People's Hospital of Changzhou, Changzhou, Jiangsu, China (mainland)
| | - Xiaohong Jiang
- Department of Endocrinology, First People's Hospital of Changzhou, Changzhou, Jiangsu, China (mainland)
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Alshehri MA, Alharthi SR, Alsuwat AA, Alswat KA. Clinical Characteristics of Type 2 Diabetics Who are at High Risk for Obstructive Sleep Apnea. Med Arch 2019; 72:249-252. [PMID: 30514988 PMCID: PMC6195020 DOI: 10.5455/medarh.2018.72.249-252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Obstructive sleep apnea (OSA) has been associated with insulin resistance and glucose intolerance. Recent reports have indicated that the majority of patients with type 2 diabetes (T2D) are also having OSA. Aim/Objective: The primary goal of the study is to assess the risk of OSA among T2D patients and its impact on T2D related control and complications. Method: A cross-sectional study for the adult patients with T2D who had a routine follow up visit from Jun 2013- Aug 2014 was asked to participate. We excluded patients with existed psychiatric illness and those with history of diagnosed OSA. To screen for OSA we used Berlin Questionnaire. Result: A total of 265 T2D patients were included in the study with a mean age of 57.2+12.5 years and long standing T2D. Around 53.2% were classified as high risk for OSA. Compared to those who are considered low risk for OSA, those who are high risk for OSA have higher BMI (p <0.001), higher mean SBP (p 0.002), less likely to be male (p 0.003), more likely to have hyperlipidemia (p 0.058), more likely have neuropathy (p 0.021), more likely to report sedentary lifestyle (p 0.046), and more likely to report low income (p 0.068). Conclusion: High risk T2D patients for OSA tend to be older, have significantly higher BMI, systolic BP and tend to have significantly higher risk for neuropathy.
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Affiliation(s)
- Mohammed A Alshehri
- Department of Medicine, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | - Sameer R Alharthi
- Department of Medicine, Taif University School of Medicine, Taif, Saudi Arabia
| | - Ahmed A Alsuwat
- Department of Medicine, Taif University School of Medicine, Taif, Saudi Arabia
| | - Khaled A Alswat
- Department of Medicine, Taif University School of Medicine, Taif, Saudi Arabia
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Borel AL, Tamisier R, Böhme P, Priou P, Avignon A, Benhamou PY, Hanaire H, Pépin JL, Kessler L, Valensi P, Darmon P, Gagnadoux F. Obstructive sleep apnoea syndrome in patients living with diabetes: Which patients should be screened? DIABETES & METABOLISM 2019; 45:91-101. [DOI: 10.1016/j.diabet.2018.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/16/2018] [Accepted: 08/11/2018] [Indexed: 12/27/2022]
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Gupta RJ, Kademani D, Liu SYC. Upper Airway (Hypoglossal Nerve) Stimulation for Treatment of Obstructive Sleep Apnea. Atlas Oral Maxillofac Surg Clin North Am 2019; 27:53-58. [PMID: 30717924 DOI: 10.1016/j.cxom.2018.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Rishi Jay Gupta
- Oral and Maxillofacial Surgery Section, Department of Dental Service, San Francisco VA Health Care System, 4150 Clement Street (160), San Francisco, CA 94121, USA; Department of Oral and Maxillofacial Surgery, University of California, San Francisco, 707 Parnassus Ave, San Francisco, CA 94143, USA; Department of Otolaryngology Head and Neck Surgery, University of California, Davis, 2521 Stockton Blvd, Sacramento, CA 95817, USA
| | - Deepak Kademani
- Head and Neck Oncologic and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, North Memorial Medical Center, Minneapolis, MN 55422, USA
| | - Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology, Stanford Sleep Surgery Fellowship, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
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Gupta RJ, Silva R, Connelly ST. Bilateral Temporomandibular Joint Reconstruction and Maxillomandibular Advancement for Concomitant Temporomandibular Joint Degeneration and Obstructive Sleep Apnea. Atlas Oral Maxillofac Surg Clin North Am 2019; 27:43-52. [PMID: 30717923 DOI: 10.1016/j.cxom.2018.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Rishi Jay Gupta
- Oral and Maxillofacial Surgery Section, Department of Dental Service, San Francisco VA Health Care System, 4150 Clement Street (160), San Francisco, CA 94121, USA; Department of Oral and Maxillofacial Surgery, University of California, San Francisco, 707 Parnassus Ave, San Francisco, CA 94143, USA; Department of Otolaryngology Head and Neck Surgery, University of California, Davis, 2521 Stockton Blvd, Sacramento, CA 95817, USA.
| | - Rebeka Silva
- Oral and Maxillofacial Surgery Section, Department of Dental Service, San Francisco VA Health Care System, 4150 Clement Street (160), San Francisco, CA 94121, USA; Department of Oral and Maxillofacial Surgery, University of California, San Francisco, 707 Parnassus Ave, San Francisco, CA 94143, USA
| | - Stephen T Connelly
- Oral and Maxillofacial Surgery Section, Department of Dental Service, San Francisco VA Health Care System, 4150 Clement Street (160), San Francisco, CA 94121, USA; Department of Oral and Maxillofacial Surgery, University of California, San Francisco, 707 Parnassus Ave, San Francisco, CA 94143, USA
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40
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Borel AL, Tamisier R, Böhme P, Priou P, Avignon A, Benhamou PY, Hanaire H, Pépin JL, Kessler L, Valensi P, Darmon P, Gagnadoux F. [Reprint of : Management of obstructive sleep apnea syndrome in people living with diabetes: context, screening, indications and treatment modalities: context, screening, indications and treatment modalities: a French position statement]. Rev Mal Respir 2018; 35:1067-1089. [PMID: 30429090 DOI: 10.1016/j.rmr.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- A-L Borel
- Hôpital universitaire Grenoble Alpes, Département d'Endocrinologie, Diabétologie, Nutrition, 38043 Grenoble cedex 9, France; Université Grenoble Alpes, laboratoire "Hypoxie physiopahologie" INSERM U1042, Grenoble, France.
| | - R Tamisier
- Université Grenoble Alpes, laboratoire "Hypoxie physiopahologie" INSERM U1042, Grenoble, France; Hôpital universitaire Grenoble Alpes, Pôle "Thorax et Vaisseaux", clinique de physiologie, sommeil et exercice, Grenoble, France
| | - P Böhme
- Hôpital universitaire de Nancy, Département d'Endocrinologie, Diabétologie, Nutrition, Nancy, France; Université de Lorraine, EA4360 APEMAC, Nancy, France
| | - P Priou
- Hôpital universitaire d'Angers, Département des maladies respiratoires, Angers, France; Université d'Angers, INSERM UMR 1063, Angers, France
| | - A Avignon
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France; Hôpital universitaire de Montpellier, département de Nutrition, Montpellier, France
| | - P-Y Benhamou
- Hôpital universitaire Grenoble Alpes, Département d'Endocrinologie, Diabétologie, Nutrition, 38043 Grenoble cedex 9, France
| | - H Hanaire
- Hôpital universitaire de Toulouse, Université de Toulouse, Toulouse, France
| | - J-L Pépin
- Université Grenoble Alpes, laboratoire "Hypoxie physiopahologie" INSERM U1042, Grenoble, France; Hôpital universitaire Grenoble Alpes, Pôle "Thorax et Vaisseaux", clinique de physiologie, sommeil et exercice, Grenoble, France
| | - L Kessler
- Hôpital universitaire de Strasbourg, département de diabétologie, INSERM UMR 1260, Strasbourg, France
| | - P Valensi
- Departement d'Endocrinologie Diabétologie Nutrition, APHP, Hôpital Jean Verdier, Université Paris Nord, CRNH-IdF, CINFO, Bondy, France
| | - P Darmon
- Hôpital universitaire de Marseille, département d'Endocrinologie, et Université de France & Aix Marseille, INSERM, INRA, C2VN, Marseille, France
| | - F Gagnadoux
- Hôpital universitaire d'Angers, Département des maladies respiratoires, Angers, France; Université d'Angers, INSERM UMR 1063, Angers, France
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Liu L, Su G, Wang S, Zhu B. The prevalence of obstructive sleep apnea and its association with pregnancy-related health outcomes: a systematic review and meta-analysis. Sleep Breath 2018; 23:399-412. [PMID: 30255484 DOI: 10.1007/s11325-018-1714-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/06/2018] [Accepted: 08/27/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is common during pregnancy. Nevertheless, prevalence estimates of OSA have varied widely due to variabilities in the assessment methods. This meta-analysis aimed to examine the prevalence of objectively assessed OSA and its association with pregnancy-related health outcomes in pregnant women. METHODS This review was developed following the PRISMA guideline. A systematic search was conducted in major electronic databases to identify studies conducted from inception to January 2018. The pooled estimates with 95% confidence interval were calculated using the inverse variance method. Forest plots were used to present the results of individual studies and the pooled effect sizes. RESULTS Thirty-three studies were included. The mean gestational age was between 21.2 (8.5) and 37.3 (2.1) weeks. The pooled worldwide prevalence of OSA was 15% (95% CI 12-18%). The prevalence estimates ranged from 5% in the European Region to 20% in the Region of Americas. The prevalence estimates for different trimesters ranged from 15 to 19%. OSA was related to an increased risk for gestational hypertension, gestational diabetes, pre-eclampsia, C-section, postoperative wound complication, and pulmonary edema. The pooled adjusted odds ratio (aOR) values were 1.97, 1.55, 2.35, 1.42, 1.87, and 6.35, respectively. OSA was also related to an increased risk for preterm birth (aOR = 1.62) and neonatal intensive care unit admission (aOR = 1.28). CONCLUSIONS OSA is a common health issue in pregnant women. OSA is associated with various pregnancy-related health outcomes. Routine screening, early diagnosis, and effective treatment of OSA are recommended in pregnant women, particularly during mid and late pregnancy.
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Affiliation(s)
- Lina Liu
- Department of Gynecology, Beijing Chuiyangliu Hospital, Beijing, China
| | - Guang Su
- Department of Gynecology, Beijing Chuiyangliu Hospital, Beijing, China
| | - Shuling Wang
- Reproductive Center, Chinese PLA General Hospital, Beijing, China
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, 227 S Chongqing Rd, Shanghai, 200025, China.
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Abstract
PURPOSE OF REVIEW To provide an overview of the mechanistic and epidemiologic evidence linking sleep-related exposures, such as short sleep duration, obstructive sleep apnea, shift work, and insomnia, with type 2 diabetes risk in adults. RECENT FINDINGS Both poor sleep habits and sleep disorders are highly prevalent among adults with type 2 diabetes. In observational studies, short sleep duration, obstructive sleep apnea, shift work, and insomnia are all associated with higher risk of incident type 2 diabetes and may predict worse outcomes in those with existing diabetes. However, interventional studies addressing sleep abnormalities in populations with or at high risk for type 2 diabetes are scarce. Although common sleep abnormalities are associated with risk of incident type 2 diabetes and worse prognosis in those with established diabetes, there are few randomized trials evaluating the impact of sleep-focused interventions on diabetes, making it difficult to determine whether the relationship is causal.
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Affiliation(s)
- Rachel P Ogilvie
- Department of Psychiatry, University of Pittsburgh, 3471 Fifth Avenue, Suite 1216, Kaufmann Medical Building, Pittsburgh, PA, 15213, USA.
| | - Sanjay R Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 1216, Kaufmann Medical Building, Pittsburgh, PA, 15213, USA
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43
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Mok Y, Tan CW, Wong HS, How CH, Tan KLA, Hsu PP. Obstructive sleep apnoea and Type 2 diabetes mellitus: are they connected? Singapore Med J 2018; 58:179-183. [PMID: 28429032 DOI: 10.11622/smedj.2017027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Obstructive sleep apnoea (OSA), a sleep-related breathing condition, is diagnosed based on a patient's apnoea-hypopnea index from a sleep study, and the presence or absence of symptoms. Diabetes mellitus (DM) and OSA share a significant common risk factor, obesity, with all three conditions contributing to the risk of developing cardiovascular diseases. The pathophysiological links between OSA and DM are still unclear, but intermittent hypoxia may be an important mechanism. More awareness of the possible link between OSA and DM is needed, given their increasing prevalence locally and worldwide. Continuous positive airway pressure is the standard treatment for OSA, while weight loss through dietary and lifestyle modifications is important to holistically manage patients with either condition. There is currently insufficient evidence to support the benefits of screening every diabetic patient for OSA. However, diabetic patients with symptoms suggestive of OSA should be referred to a sleep specialist for further evaluation.
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Affiliation(s)
- Yingjuan Mok
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Chee Wei Tan
- Family Medicine, Changi General Hospital, Singapore
| | - Hang Siang Wong
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore
| | - Kah Leong Alvin Tan
- Department of Otorhinolaryngology - Head and Neck Surgery, Changi General Hospital, Singapore
| | - Pon Poh Hsu
- Department of Otorhinolaryngology - Head and Neck Surgery, Changi General Hospital, Singapore
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44
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McFarlane PA. Resistant Hypertension in Adults With Type 1 or 2 Diabetes: A Structured Diagnostic Approach. Can J Diabetes 2018; 42:173-178. [PMID: 29602405 DOI: 10.1016/j.jcjd.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
People with diabetes often have difficulty reaching their blood pressure targets and are labelled as having resistant hypertension. Clinicians often move quickly to screen such people for secondary causes of hypertension; however, such causes are rare, and resistant hypertension usually has other explanations that are significantly more common. By using a structured approach to resistant hypertension, clinicians can assist patients to reach their target blood pressure levels. Step 1 is to determine out-of-office blood pressure measurements using home or ambulatory blood pressure monitors. Step 2 is to determine the level of adherence to prescribed medications. Step 3 is to identify interfering substances. Step 4 is to check that the prescribed medications are synergistic and optimally dosed. Finally, if all other steps fail to get patients to their blood pressure targets, we consider possible secondary causes of hypertension. This approach is particularly useful in helping people with diabetes to reach their blood pressure targets.
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Affiliation(s)
- Philip A McFarlane
- Home Dialysis, Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada.
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45
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Tan X, van Egmond L, Chapman CD, Cedernaes J, Benedict C. Aiding sleep in type 2 diabetes: therapeutic considerations. Lancet Diabetes Endocrinol 2018; 6:60-68. [PMID: 28844889 DOI: 10.1016/s2213-8587(17)30233-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/16/2017] [Accepted: 06/16/2017] [Indexed: 12/13/2022]
Abstract
Insomnia and obstructive sleep apnoea (OSA) are more prevalent in patients with type 2 diabetes than in the general population. Both insomnia and OSA have been linked to cardiometabolic alterations (eg, hypertension, increased activity of the sympathetic nervous system, and systemic insulin resistance) that can exacerbate the pathophysiology of type 2 diabetes. Improvement of sleep in patients with diabetes could therefore aid the treatment of diabetes. To help health practitioners choose the best clinical tool to improve their patients' sleep without detrimentally affecting glucose regulation, this Review critically analyses the effects of common treatments for insomnia and OSA on both sleep and glucose metabolism in patients with type 2 diabetes. These treatments include pharmaceutical sleep aids (eg, benzodiazepine receptor agonists, melatonin) and cognitive behavioural therapy for insomnia, continuous positive airway pressure for OSA, and lifestyle interventions.
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Affiliation(s)
- Xiao Tan
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.
| | | | - Colin D Chapman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Kroner T, Arzt M, Rheinberger M, Gorski M, Heid IM, Böger CA, Stadler S. Sex Differences in the Prevalence and Modulators of Sleep-Disordered Breathing in Outpatients with Type 2 Diabetes. J Diabetes Res 2018; 2018:7617524. [PMID: 29805982 PMCID: PMC5901945 DOI: 10.1155/2018/7617524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 11/18/2022] Open
Abstract
In patients with type 2 diabetes, sleep-disordered breathing is a widespread cause of deteriorated quality of life. However, robust prevalence estimates for sleep-disordered breathing in patients with type 2 diabetes are limited due to scarce data. We investigated sex differences in sleep-disordered breathing prevalence and its modulators in the DIACORE SDB substudy, a sample of outpatient type 2 diabetes. 721 participants were tested for sleep-disordered breathing using a two-channel sleep apnoea monitoring device. Patients were stratified according to the severity of sleep-disordered breathing, defined as an apnoea-hypopnoea index < 15, ≥15 to 29, and ≥30 events per hour as no/mild, moderate, and severe sleep-disordered breathing, respectively. In the 679 analysed patients (39% women, age 66 ± 9 years, body mass index 31.0 ± 5.4 kg/m2), the prevalence of sleep-disordered breathing was 34%. The prevalence of sleep-disordered breathing was higher in men than in women (41% versus 22%, p < 0.001) and increased with age (15%, 21%, and 30% in women and 35%, 40%, and 47% in men in those aged 18-59, 60-69, or ≥70, respectively; age trend p = 0.064 in women and p = 0.15 in men). In linear regression analysis, age, BMI, and waist-hip ratio were associated with apnoea-hypopnoea index. Modulators for higher apnoea-hypopnoea index seem to be similar in men and women.
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Affiliation(s)
- T. Kroner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - M. Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - M. Rheinberger
- Department of Nephrology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - M. Gorski
- Department of Genetic Epidemiology, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - I. M. Heid
- Department of Genetic Epidemiology, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - C. A. Böger
- Department of Nephrology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - S. Stadler
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Rezaie L, Phillips D, Khazaie H. Barriers to acceptance and adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea: a report from Kermanshah province, western Iran. Patient Prefer Adherence 2018; 12:1299-1304. [PMID: 30050292 PMCID: PMC6056160 DOI: 10.2147/ppa.s165905] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA). CPAP acceptance and adherence are critical issues for optimal treatment outcome. Identifying barriers to acceptance and adherence can improve intervention development and outcomes. This study aimed to investigate the barriers to CPAP acceptance/adherence in patients with OSA in western Iran. PATIENTS AND METHODS Patients with OSA, who had been prescribed CPAP by the Sleep Disorders Research Center of Kermanshah University of Medical Sciences, were recruited. They were interviewed via telephone regarding acceptance (ie, CPAP use during the first 2 weeks) and adherence (ie, CPAP use 4 h/d for 70% of the nights per week). Barriers to acceptance and adherence were solicited. RESULTS Out of a possible sample of 101, 97 patients (79 male) were reached and included in the study. They had a mean age of 48.76 years (SD =12.04) and mean apnea/hypopnea index score of 36.06 (SD =1.87). Patients were categorized into the following acceptance/adherence groups: nonacceptance (CPAP not purchased; 72.2%), poor adherence (5.2%), and adherent (22.7%). Inability to afford a CPAP device, perception of symptom reduction/no need for treatment, and dissatisfaction with treatment were among the most common reasons for nonacceptance and poor adherence. CONCLUSION CPAP acceptance and adherence in western Iran are low. Approximately 70% of the patients did not accept CPAP treatment (due to not obtaining the device) and 5% did not adhere. To improve acceptance/adherence, increased access (ie, reduced cost or increased insurance coverage) and enhanced education about the benefits of the treatment are recommended. Treatment monitoring via regular follow-ups may also prove beneficial.
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Affiliation(s)
- Leeba Rezaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,
| | - David Phillips
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,
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48
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Shen H, Zhao J, Liu Y, Sun G. Interactions between and Shared Molecular Mechanisms of Diabetic Peripheral Neuropathy and Obstructive Sleep Apnea in Type 2 Diabetes Patients. J Diabetes Res 2018; 2018:3458615. [PMID: 30116739 PMCID: PMC6079583 DOI: 10.1155/2018/3458615] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/26/2018] [Indexed: 02/07/2023] Open
Abstract
Type 2 diabetes (T2D) accounts for about 90% of all diabetes patients and incurs a heavy global public health burden. Up to 50% of T2D patients will eventually develop neuropathy as T2D progresses. Diabetic peripheral neuropathy (DPN) is a common diabetic complication and one of the main causes of increased morbidity and mortality of T2D patients. Obstructive sleep apnea (OSA) affects over 15% of the general population and is associated with a higher prevalence of T2D. Growing evidence also indicates that OSA is highly prevalent in T2D patients probably due to diabetic peripheral neuropathy. However, the interrelations among diabetic peripheral neuropathy, OSA, and T2D hitherto have not been clearly elucidated. Numerous molecular mechanisms have been documented that underlie diabetic peripheral neuropathy and OSA, including oxidative stress, inflammation, endothelin-1, vascular endothelial growth factor (VEGF), accumulation of advanced glycation end products, protein kinase C (PKC) signaling, poly ADP ribose polymerase (PARP), nitrosative stress, plasminogen activator inhibitor-1, and vitamin D deficiency. In this review, we seek to illuminate the relationships among T2D, diabetic peripheral neuropathy, and OSA and how they interact with one another. In addition, we summarize and explain the shared molecular mechanisms involved in diabetic peripheral neuropathy and OSA for further mechanistic investigations and novel therapeutic strategies for attenuating and preventing the development and progression of diabetic peripheral neuropathy and OSA in T2D.
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Affiliation(s)
- Hong Shen
- Department of Endocrinology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Junrong Zhao
- Department of Nephrology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Ying Liu
- Department of Nephrology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Guangdong Sun
- Department of Nephrology, The Second Hospital of Jilin University, Changchun 130041, China
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49
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Deol R, Lee KA, Kandula NR, Kanaya AM. Risk of Obstructive Sleep Apnoea is Associated with Glycaemia Status in South Asian Men and Women in the United States. ACTA ACUST UNITED AC 2017; 9:1-6. [PMID: 29354780 DOI: 10.1016/j.obmed.2017.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims To examine the association between glycaemia status and the risk for obstructive sleep apnoea (OSA) in a cohort of South Asians living in the United States. Methods A secondary analysis of a community based cohort of 899 participants from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. The Berlin Questionnaire was used to screen for OSA. Results Almost one in four (24%) South Asians was at high risk for OSA. Compared to the normal glucose tolerance group (18%), high risk of OSA was significantly more likely in the prediabetes (24%) and diabetes (32%) groups (p = .007). More men (28%) than women (18%) were at high risk of OSA. Risk for OSA was also associated with higher haemoglobin A1c values, hypertension, large waist circumference, and BMI > 27.5 kg/m2. In a multivariate regression analysis, sleep disordered breathing (SDB) remained significantly associated with higher haemoglobin A1c values, even after controlling for waist circumference and other demographic and clinical factors. Conclusions The risk for SDB and OSA was high among South Asian men and women. Given the association between dysglycaemia and risk for OSA, these health issues require simultaneous clinical assessment. Future studies using objective sleep measures such as polysomnography are warranted in the diagnosis and treatment of OSA in the South Asian adult population already at high risk for dysglycaemia.
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Affiliation(s)
- Rupinder Deol
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA 94143
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA 94143
| | - Namratha R Kandula
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Alka M Kanaya
- Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA 94115
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50
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Shechter A, Foster GD, Lang W, Reboussin DM, St-Onge MP, Zammit G, Newman AB, Millman RP, Wadden TA, Jakicic JM, Strotmeyer ES, Wing RR, Xavier Pi-Sunyer F, Kuna ST, the Sleep AHEAD Research Group of the Look AHEAD Research Group. Effects of a lifestyle intervention on REM sleep-related OSA severity in obese individuals with type 2 diabetes. J Sleep Res 2017; 26:747-755. [PMID: 28560832 PMCID: PMC5705337 DOI: 10.1111/jsr.12559] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 04/11/2017] [Indexed: 11/28/2022]
Abstract
The aim of this study was to determine if an intensive lifestyle intervention (ILI) reduces the severity of obstructive sleep apnea (OSA) in rapid-eye movement (REM) sleep, and to determine if longitudinal changes in glycaemic control are related to changes in OSA severity during REM sleep over a 4-year follow-up. This was a randomized controlled trial including 264 overweight/obese adults with type 2 diabetes (T2D) and OSA. Participants were randomized to an ILI targeted to weight loss or a diabetes support and education (DSE) control group. Measures included anthropometry, apnea-hypopnea index (AHI) during REM sleep (REM-AHI) and non-REM sleep (NREM-AHI) and glycated haemoglobin (HbA1c) at baseline and year 1, year 2 and year 4 follow-ups. Mean baseline values of REM-AHI were significantly higher than NREM-AHI in both groups. Both REM-AHI and NREM-AHI were reduced significantly more in ILI versus DSE, but these differences were attenuated slightly after adjustment for weight changes. Repeated-measure mixed-model analyses including data to year 4 demonstrated that changes in HbA1c were related significantly to changes in weight, but not to changes in REM-AHI and NREM-AHI. Compared to control, the ILI reduced REM-AHI and NREM-AHI during the 4-year follow-up. Weight, as opposed to REM-AHI and NREM-AHI, was related to changes in HbA1c. The findings imply that weight loss from a lifestyle intervention is more important than reductions in AHI for improving glycaemic control in T2D patients with OSA.
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Affiliation(s)
- Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University, New York, NY, USA
| | - Gary D. Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Weight Watchers International, New York, NY,USA
| | - Wei Lang
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David M. Reboussin
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Marie-Pierre St-Onge
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University, New York, NY, USA
| | | | - Anne B. Newman
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard P. Millman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas A. Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - John M. Jakicic
- Physical Activity and Weight Management Research Center, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elsa S. Strotmeyer
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rena R. Wing
- Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - F. Xavier Pi-Sunyer
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University, New York, NY, USA
| | - Samuel T. Kuna
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
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