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Milicic Ivanovski D, Milicic Stanic B, Kopitovic I. Comorbidity Profile and Predictors of Obstructive Sleep Apnea Severity and Mortality in Non-Obese Obstructive Sleep Apnea Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050873. [PMID: 37241105 DOI: 10.3390/medicina59050873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
Backgrounds and Objectives: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality. OSA is an independent risk factor for many different conditions, especially cardiovascular diseases. The purpose of this study was to ascertain the comorbidity profile of non-obese patients with newly diagnosed OSA and evaluate the risk for cardiovascular disease and mortality. The present study also aimed to establish predictors for OSA severity. Materials and Methods: This study included 138 newly diagnosed patients who underwent polysomnographic analysis. The 10-year risk for cardiovascular disease was assessed using a newly validated prediction model: Systematic Coronary Risk Evaluation (SCORE-2). In addition, the Charlson Comorbidity Index (CCI) was assessed as a widely-used example of a mortality comorbidity index. Results: The study population included 138 patients: 86 males and 52 females. Patients were stratified, according to AHI (apnea/hypopnea index), into four groups: 33 patients had mild OSA (5 ≤ AHI < 15), 33 patients had moderate OSA (15 ≤ AHI < 30), 31 patients had severe OSA (AHI ≥ 30), and 41 individuals had AHI < 5, which were a part of the control group. SCORE-2 increased in line with OSA severity and was higher in OSA groups compared to the control group (H = 29.913; DF = 3; p < 0.001). Charlson Index was significantly higher in OSA patients compared to controls (p = 0.001), with a higher prevalence of total comorbidities in the OSA group of patients. Furthermore, CCI 10-year survival score was significantly lower in the OSA group, suggesting a shorter survival of those patients with a more severe form of OSA. We also examined the prediction model for OSA severity. Conclusions: Determining the comorbidity profile and estimation of the 10-year risk score of OSA patients could be used to classify these patients into various mortality risk categories and, according to that, provide them with adequate treatment.
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Affiliation(s)
| | - Branka Milicic Stanic
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
- Department of Medicine, Georgetown University Medical Center, 4000 Reservoir Road, NW, Washington, DC 20057, USA
| | - Ivan Kopitovic
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
- Center for Pathophysiology of Breathing and Respiratory Sleep Disorders, The Institute for Pulmonary Diseases of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia
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Wang C, Tan J, Miao Y, Zhang Q. Obstructive sleep apnea, prediabetes, and progression of type 2 diabetes: A systematic review and meta-analysis. J Diabetes Investig 2022; 13:1396-1411. [PMID: 35302714 PMCID: PMC9340883 DOI: 10.1111/jdi.13793] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022] Open
Abstract
Aims/Introduction Obstructive sleep apnea (OSA) is related to prediabetes and diabetes. Whether patients with OSA have a higher risk of prediabetes/diabetes remains unclear. We aimed to carry out a meta‐analysis of published studies to evaluate the relationships between OSA and prediabetes and diabetes, and the impact of the severity of OSA on diabetes. Materials and Methods The PubMed, EMBASE and Cochrane databases were searched from January 2011 to July 2021. The associations between OSA and impaired fasting glucose, impaired glucose tolerance, impaired glucose regulation and diabetes mellitus were analyzed. We estimated the pooled odds ratios using fixed or random effects models. We included 25 studies comprising a total of 154,948 patients with OSA and risk factors for prediabetes/diabetes (20 and 16, respectively) in the analysis. Results OSA was associated with a higher risk of impaired fasting glucose, impaired glucose tolerance, impaired glucose regulation and diabetes mellitus in the cohort studies and cross‐sectional studies. The pooled odds ratios were 2.34 (95% confidence interval [CI] 1.16–4.72), 1.58 (95% CI 1.15–2.15), 1.65 (95% CI 1.12–2.42), 2.15 (95% CI 1.68–2.75) and 3.62 (95% CI 2.75–4.75), respectively. Subgroup analyses were based on the proportions of men and women. The results showed that OSA was a risk factor, and there was no significant difference between the two groups. The risk of diabetes increased with the severity of OSA. Conclusions The risk of developing prediabetes and diabetes was higher in patients with OSA.
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Affiliation(s)
- Cong Wang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| | - Jin Tan
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| | | | - Qiang Zhang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
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Parker JL, Appleton SL, Melaku YA, D'Rozario AL, Wittert GA, Martin SA, Toson B, Catcheside PG, Lechat B, Teare AJ, Adams RJ, Vakulin A. The association between sleep microarchitecture and cognitive function in middle-aged and older men: a community-based cohort study. J Clin Sleep Med 2022; 18:1593-1608. [PMID: 35171095 DOI: 10.5664/jcsm.9934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep microarchitecture parameters determined by quantitative power spectral analysis (PSA) of electroencephalograms (EEGs) have been proposed as potential brain-specific markers of cognitive dysfunction. However, data from community samples remains limited. This study examined cross-sectional associations between sleep microarchitecture and cognitive dysfunction in community-dwelling men. METHODS Florey Adelaide Male Ageing Study participants (n=477) underwent home-based polysomnography (PSG) (2010-2011). All-night EEG recordings were processed using PSA following artefact exclusion. Cognitive testing (2007-2010) included the inspection time task, trail-making tests A (TMT-A) and B (TMT-B), and Fuld object memory evaluation. Complete case cognition, PSG, and covariate data were available in 366 men. Multivariable linear regression models controlling for demographic, biomedical, and behavioral confounders determined cross-sectional associations between sleep microarchitecture and cognitive dysfunction overall and by age-stratified subgroups. RESULTS In the overall sample, worse TMT-A performance was associated with higher NREM theta and REM theta and alpha but lower delta power (all p<0.05). In men ≥65 years, worse TMT-A performance was associated with lower NREM delta but higher NREM and REM theta and alpha power (all p<0.05). Furthermore, in men ≥65 years, worse TMT-B performance was associated with lower REM delta but higher theta and alpha power (all p<0.05). CONCLUSIONS Sleep microarchitecture parameters may represent important brain-specific markers of cognitive dysfunction, particularly in older community-dwelling men. Therefore, this study extends the emerging community-based cohort literature on a potentially important link between sleep microarchitecture and cognitive dysfunction. Utility of sleep microarchitecture for predicting prospective cognitive dysfunction and decline warrants further investigation.
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Affiliation(s)
- Jesse L Parker
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
| | - Gary A Wittert
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sean A Martin
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Barbara Toson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Alison J Teare
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, Adelaide, South Australia, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
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Pallangyo P, Mgopa LR, Mkojera Z, Komba M, Millinga J, Misidai N, Swai HJ, Mayala H, Bhalia S, Wibonela S, Janabi M. Obstructive sleep apnea and associated factors among hypertensive patients attending a tertiary cardiac center in Tanzania: a comparative cross-sectional study. SLEEP SCIENCE AND PRACTICE 2021. [DOI: 10.1186/s41606-021-00069-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
There is mounting evidence for a reciprocal yet bidirectional association between sleep-disordered breathing and hypertension. Obstructive sleep apnea (OSA), a common cause of systemic hypertension is an independent risk factor for hypertension-related cardiovascular morbidity and mortality. In this comparative hospital-based cross-sectional study, we sought to explore the burden of obstructive sleep apnea and its associated risk factors among hypertensive patients attending Jakaya Kikwete Cardiac Institute.
Methodology
A total of 1974 individuals (i.e. 1289 hypertensive and 685 normotensives) were consecutively enrolled in this study. The Berlin questionnaire and Epworth Sleepiness Scale were utilized in the assessment of OSA and excessive daytime sleepiness (EDS) respectively. Logistic regression analyses were employed in the determination of associated factors for OSA.
Results
The mean age was 53.4 years and females constituted the large majority (60.4%) of participants. About three quarters (74.1%) of participants had excess body weight, 11.6% had diabetes, 8.0% had asthma and 18.6% had history of recurrent nasal congestion. Positive family history of snoring was reported by 43.1% of participants and 36.9% had a personal history of snoring. Persons with hypertension displayed a higher frequency (42.1%) of OSA compared to their normotensive counterparts (11.8%), p < 0.001. Multivariate logistic regression analyses revealed hypertension (OR 5.1, 95% CI 3.2-8.2, p < 0.001), diabetes mellitus (OR 2.2, 95% CI 1.3-3.5, p < 0.01), chronic nasal congestion (OR 1.6, 95% CI 1.1-2.5, p = 0.01), obesity (OR 2.4, 95% CI 1.8-3.3, p < 0.001), increased neck circumference (OR 2.7, 95% CI 1.2-6.4, p = 0.02), family history of snoring (OR 5.5, 95% CI 4.0-7.5, p < 0.001), and working > 8 h/24 h (OR 0.6, 95% CI 0.4-1.0, p = 0.03) to have an independent association for OSA. Furthermore, participants with hypertension displayed superior odds for OSA compared to their normotensive counterparts across all subgroup analyses.
Conclusion
OSA is considerably common among patients with hypertension in a tertiary health care setting in Tanzania. Positive family history of snoring was the strongest associated factor; however, excess body weight proved to be the strongest modifiable risk factor. In view of its pervasiveness, OSA should be an integral part of the medical evaluation in hypertensive individuals.
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Association between Obstructive Sleep Apnea and Type 2 Diabetes Mellitus: A Dose-Response Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1337118. [PMID: 34630603 PMCID: PMC8497107 DOI: 10.1155/2021/1337118] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/14/2021] [Accepted: 09/16/2021] [Indexed: 01/11/2023]
Abstract
Materials and Methods We screened four databases (PubMed, Embase, Cochran Library, and CNKI) for the observational studies about the OSA and T2DM. Studies were collected from database establishment to October 2020. We performed a traditional subgroup meta-analysis. What is more, linear and spline dose-response models were applied to assess the association between apnea-hypopnea index (AHI), an indicator to evaluate the severity of OSA, and the risk of T2DM. Review Manager, version 5.3, software and Stata 16.0 were used for the analysis. Result Seven observational studies were included in the research. We excluded a study in the conventional meta-analysis. In the subgroup analysis, mild-dose AHI increased the risk of T2DM (odds ratio = 1.23, 95% confidence interval = 1.06–1.41, P < 0.05). Moderate-dose AHI increased the risk of T2DM with a higher odds ratio (OR = 1.35, 95% CI = 1.13–1.61, P < 0.05). Moderate-to-severe-dose AHI increased the risk of T2DM with a higher odds ratio (OR = 2.14, 95% CI = 1.72–2.67, P < 0.05). Severe-dose AHI increased the risk of T2DM with a higher odds ratio (OR = 2.19 95% CI = 1.30–3.68, P < 0.05). Furthermore, the spline and linear dose-response meta-analysis results revealed that the risk of T2DM increased with increasing AHI values. Conclusion Through the dose-response meta-analysis, we found a potential dose-response relationship existed between the severity of OSA and the risk of T2DM. This relationship in our passage should be considered in the prevention of T2DM in the future.
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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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Ribeiro OR, do Carmo I, Paiva T, Figueira ML. Body mass index and neuropsychological and emotional variables: joint contribution for the screening of sleep apnoea syndrome in obese. SLEEP SCIENCE (SAO PAULO, BRAZIL) 2021; 14:19-26. [PMID: 34104333 PMCID: PMC8157784 DOI: 10.5935/1984-0063.20200030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Obstructive sleep apnoea (OSA) is the most common sleep disorder and its prevalence has increased with the obesity pandemic. We aimed to explore the presence of OSA in severe obesity and to evaluate the association of body mass index (BMI) with sleep architecture, cognition, emotional distress and comorbidities in OSA versus non-OSA patients. METHODS A sample of 61 patients performed a neuropsychological battery that included tasks of attention, memory, perceptual/visuospatial ability, vocabulary, inhibition, cognitive flexibility and distress symptomatology, before overnight polysomnography. RESULTS More than half of the sample had OSA. Excessive daytime sleepiness was not a prominent complaint. Sleep architecture was worse in the OSA than in the non-OSA group, and hypertension was increased with OSA, especially in the severe OSA group. A higher BMI was associated with cognitive distress and sleep variables and with type 2 diabetes. The apnoea-hypopnoea index (AHI) was correlated with gender and cognitive measurements. Cognitive complaints were associated with enhanced distress in both OSA and non-OSA patients. DISCUSSION OSA is considerably present in severely obese patients. The BMI was strongly associated with other important anthropometric measurements along with worsening sleep architecture and lower executive functioning, both of which may contribute to weight gain. The AHI was significantly higher in men and affected memory and maintaining sets on the Wisconsin Card Sorting Test which may represent a barrier to treatment adherence for this disorder. The substantial presence of cognitive complaints in OSA and non-OSA patients suggests the need for psychological intervention focused on adaptive coping strategies, mostly for depressive symptoms. Given the current obesity epidemic, these results support the need for routine sleep investigation in obese people, particularly in primary care settings. BMI, neuropsychological and emotional screening can provide crucial information about asymptomatic and high-risk patients who require prompt sleep intervention and obesity treatment.
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Affiliation(s)
- Olga Rodrigues Ribeiro
- Hospital Egas Moniz, Neuroscience - Lisbon - Portugal.,ISAMB - Instituto de Saúde Ambiental - Lisbon - Portugal
| | - Isabel do Carmo
- Hospital de Santa Maria, Endocrinology, Diabetes and Metabolism - Lisbon - Portugal
| | - Teresa Paiva
- Sleep Medicine Centre, Sleep Medicine - Lisbon - Portugal
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Qie R, Zhang D, Liu L, Ren Y, Zhao Y, Liu D, Liu F, Chen X, Cheng C, Guo C, Li Q, Zhou Q, Tian G, Han M, Huang S, Wu X, Qin P, Li J, Cao J, Zhang M, Huang J, Lu J, Li H, Wang J, Cheng R, Hu D. Obstructive sleep apnea and risk of type 2 diabetes mellitus: A systematic review and dose-response meta-analysis of cohort studies. J Diabetes 2020; 12:455-464. [PMID: 31872550 DOI: 10.1111/1753-0407.13017] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/14/2019] [Accepted: 12/18/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This meta-analysis was performed to quantitatively evaluate the dose-response association between obstructive sleep apnea (OSA) and risk of type 2 diabetes mellitus (T2DM). METHODS PubMed, Embase, and Web of Science were searched up to 12 December 2018 for articles that assessed the OSA-T2DM association. Random effects models were used to analyze the quantitative association between OSA and risk of T2DM. Restricted cubic splines were used to model the dose-response association between apnea-hypopnea index (AHI), used to assess the severity of OSA according to events/h, and risk of T2DM. RESULTS We included 16 cohort studies in our meta-analysis. During a median follow-up of 10.5 years (range: 3.0-22.0), 19 355 T2DM cases were reported among 338 912 study participants. The pooled relative risk of T2DM was 1.40 (95% CI, 1.32-1.48) for OSA in the binary meta-analysis and 1.08 (1.01-1.14) for each 5-event/h increase in AHI value. We found a positive linear association between OSA and T2DM risk. CONCLUSIONS Our dose-response meta-analysis revealed a linear association between OSA and T2DM.
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Affiliation(s)
- Ranran Qie
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Dongdong Zhang
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Leilei Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yongcheng Ren
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Dechen Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Feiyan Liu
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Xu Chen
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Cheng Cheng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Chunmei Guo
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Quanman Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Qionggui Zhou
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Minghui Han
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Shengbing Huang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xiaoyan Wu
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Pei Qin
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Jianxin Li
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, People's Republic of China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jie Cao
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, People's Republic of China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ming Zhang
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Jianfeng Huang
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, People's Republic of China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jie Lu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Honghui Li
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Jian Wang
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Ruirong Cheng
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
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Riaz M, Ravula S, Obesso PD, Nigam G, Baran AS. The effect of torso elevation on minimum effective continuous positive airway pressure for treatment of obstructive sleep apnea. Sleep Breath 2020; 24:499-504. [PMID: 31286329 DOI: 10.1007/s11325-019-01880-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/02/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is considered the gold standard treatment of obstructive sleep apnea (OSA). However, it can be a challenge in some patients to find an effective CPAP setting that is well tolerated. A lower CPAP setting may improve patient tolerance of the treatment. The objective of this study was to evaluate the effect of approximately 30° torso elevation on minimum effective CPAP for the treatment of OSA. METHODS A retrospective chart review was performed to determine the effective CPAP setting required to treat OSA in patients who underwent CPAP titration with torso elevation using a wedge cushion, after having failed during the same titration study to achieve therapeutic results at CPAP of 20 cm H2O without torso elevation. RESULTS Thirty-nine patients who underwent CPAP titration with and without torso elevation utilizing a wedge cushion had statistically significant lowering of the minimum effective CPAP setting with torso elevation, with a mean CPAP reduction of 4.7 (p < 0.001) compared to ineffective treatment at CPAP of 20 cm H2O without torso elevation. Apnea hypopnea index (AHI), respiratory disturbance index (RDI), and lowest oxygen saturation (SpO2) were all improved with torso elevation, with a mean AHI difference of 4.4 (p = 0.03), mean RDI difference of 14.2 (p = 0.001), and mean SpO2 difference of 5.9% (p = 0.002). Age and BMI were inversely correlated, and gender had no correlation with therapeutic CPAP settings with use of torso elevation. CONCLUSION Torso elevation of approximately 30° resulted in effective CPAP treatment at settings significantly lower than 20 cm H2O in all reviewed OSA patients, who had been ineffectively treated without torso elevation at the maximum tested setting of 20 cm H2O. This intervention may be a useful adjunct during in-lab titration studies for patients who are not effectively treated at or cannot tolerate high CPAP settings.
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Affiliation(s)
- Muhammad Riaz
- Astria Health Center, 208 N. Euclid, Grandview, WA, 98930, USA
| | - Shantan Ravula
- St. Elizabeth Physicians, 2647 St. Elizabeth Blvd, Gonzales, LA, 70737, USA
| | - Peter Daniel Obesso
- University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA
| | - Gaurav Nigam
- Presbyterian Hospital, 1010 Spruce St, Espanola, NM, 87532, USA
| | - Alp Sinan Baran
- Sleep Disorders Center, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Pugliese G, Barrea L, Laudisio D, Salzano C, Aprano S, Colao A, Savastano S, Muscogiuri G. Sleep Apnea, Obesity, and Disturbed Glucose Homeostasis: Epidemiologic Evidence, Biologic Insights, and Therapeutic Strategies. Curr Obes Rep 2020; 9:30-38. [PMID: 31970714 DOI: 10.1007/s13679-020-00369-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA), obesity, and disturbed glucose homeostasis are usually considered distinct clinical condition, although they are tightly related to each other. The aim of our manuscript is to provide an overview of the current evidence on OSA, obesity, and disturbed glucose homeostasis providing epidemiologic evidence, biological insights, and therapeutic strategies. RECENT FINDINGS The mechanisms hypothesized to be involved in this complex interplay are the following: (1) "direct weight-dependent" mechanisms, according to which fat excess compromises respiratory mechanics, and (2) "indirect weight-dependent" mechanisms such as hyperglycemia, insulin resistance and secondary hyperinsulinemia, leptin resistance and other hormonal dysregulations frequently found in subjects with obesity, type 2 diabetes, and/or sleep disorders. Moreover, the treatment of each of these clinical conditions, through weight loss induced by diet or bariatric surgery, the use of anti-obesity or antidiabetic drugs, and continuous positive airway pressure (CPAP), seems to positively influence the others. These recent data suggest not only that there are multiple connections among these diseases but also that treating one of them may result in an improvement of the others.
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Affiliation(s)
- Gabriella Pugliese
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Luigi Barrea
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Daniela Laudisio
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Ciro Salzano
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Sara Aprano
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy.
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11
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Fang X, Chen J, Wang W, Feng G, Li X, Zhang X, Zhang Y, Zhang J, Xu Z, Tai J, Ni X. Matrix metalloproteinase 9 (MMP9) level and MMP9 -1562C>T in patients with obstructive sleep apnea: a systematic review and meta-analysis of case-control studies. Sleep Med 2020; 67:110-119. [PMID: 31918116 DOI: 10.1016/j.sleep.2019.11.1247] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The peripheral level of matrix metalloproteinase (MMP)-9 and polymorphism of MMP9 -1562C>T in patients with obstructive sleep apnea (OSA) remains controversial. Therefore, the aims of this systemic review and meta-analysis are to assess the MMP9 level in OSA patients and identify the relationship between MMP9 -1562C>T and OSA susceptibility. METHODS This systematic review was performed following the PRISMA guideline. We searched for studies in major databases, identifying those indexed from inception to July 3, 2019 which related to MMP9 level, MMP9 -1562C>T and OSA. The pooled standardized mean differences (SMDs) and 95% confidence interval (CI) of MMP9 levels were calculated. In addition, the relationship between MMP9 -1562C>T and OSA susceptibility was assessed by three genetic models. The heterogeneity analysis and calculation of the pooled odds ratio (OR) were also performed, followed by quality assessment using the Newcastle-Ottawa Scale (NOS). RESULTS In sum, our review included 15 eligible studies regarding MMP9 level and three regarding MMP9 -1562C>T. The pooled results showed that peripheral level of MMP9 was increased in OSA patients (SMD = 1.37; 95% CI = 1.15-1.59). Furthermore, significant difference of MMP9 level can be found between severe and mild-to-moderate OSA patients (SMD = 28.17; 95% CI = 4.23-52.11) or between moderate-severe and mild OSA (SMD = 36.62; 95% CI = 12.19-61.04). However, no relationship was observed between MMP9 -1562C>T and OSA susceptibility in three genetic models (Homozygote model, OR = 1.37; 95% CI = 0.87-2.18); (Recessive model, OR = 1.42; 95% CI = 0.83-2.42); (Allele model, OR = 1.07; 95% CI = 0.96-1.18). CONCLUSIONS This systemic review and meta-analysis indicated that the level of MMP9 was increased in patients with OSA and this increase is relevant to OSA severity. Moreover, the relationship between MMP9 -1562 C>T and OSA susceptibility has currently not been proven by current merging values. Further analyses with larger sample size are required to verify these associations.
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Affiliation(s)
- Xiaolian Fang
- Department of Otolaryngology, Head and Neck Surgery, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Beijing, PR China
| | - Jun Chen
- Big Data and Engineering Research Center, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Beijing, PR China
| | - Wei Wang
- Big Data and Engineering Research Center, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Beijing, PR China
| | - Guoshuang Feng
- Big Data and Engineering Research Center, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Beijing, PR China
| | - Xiaodan Li
- Department of Otolaryngology, Head and Neck Surgery, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Beijing, PR China
| | - Xin Zhang
- Big Data and Engineering Research Center, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Beijing, PR China
| | - Yamei Zhang
- Department of Otolaryngology, Head and Neck Surgery, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Beijing, PR China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Beijing, PR China
| | - Zhifei Xu
- Respiratory Department, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Beijing, PR China
| | - Jun Tai
- Department of Otolaryngology, Head and Neck Surgery, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Beijing, PR China.
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, National Children's Medical Center/Beijing Children's Hospital, Capital Medical University, Beijing, PR China.
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12
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Stevens D, Appleton S, Vincent AD, Melaku Y, Martin S, Gill T, Hill C, Vakulin A, Adams R, Wittert G. Associations of OSA and Nocturnal Hypoxemia with Strength and Body Composition in Community Dwelling Middle Aged and Older Men. Nat Sci Sleep 2020; 12:959-968. [PMID: 33204199 PMCID: PMC7667192 DOI: 10.2147/nss.s276932] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Reduced hand grip strength (HGS) is associated with poorer health in chronic conditions, yet there has been little research examining the association with hand grip strength and obstructive sleep apnea (OSA). Further, these studies have not examined, nor adjusted, for muscle mass. The aim of this study was to determine associations between OSA indices, HGS, muscle mass, and fat mass. PARTICIPANTS AND METHODS A total of 613 participants (age range 41-88, BMI 28.6 ± 4.3) from the population-based Men Androgen Inflammation Lifestyle Environment and Stress Study underwent in-home overnight polysomnography, assessment of dominant and non-dominant HGS, and dual x-ray absorptiometry to determine whole body muscle mass and fat mass. Linear models determined cross-sectional associations of polysomnographic-derived OSA indices with hand grip strength, muscle mass, and fat mass, whilst adjusting for lifestyle information (income, smoking status, diet, self-reported physical activity), blood sample derived testosterone and systemic inflammation (C-reactive protein), cardiometabolic health (cardiovascular disease, hypertension, type 2 diabetes), and depression. RESULTS In adjusted models, reduced dominant HGS was associated with lower oxygen nadir (unstandardised β [B] = 0.19, 95% confidence interval [CI] 0.08 to 0.29), greater time spent below 90% oxygen saturation (B = -0.08, 95% CI -0.14 to -0.02), and increased apnea duration (B = -0.3, 95% CI -0.23 to -0.02). By contrast, there were no associations between HGS and both AHI and REM AHI. Fat mass was consistently associated with worsening OSA indices, whereas muscle mass demonstrated no associations with any OSA index. CONCLUSION Our findings suggest impairments in HGS may be related to fat infiltration of muscle, hypoxemia-induced reductions in peripheral neural innervation, or even endothelial dysfunction, which is a common outcome of hypoxemia. Longitudinal data are needed to further examine these hypotheses and establish if reduced grip strength in patients with OSA is associated with long-term adverse health outcomes.
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Affiliation(s)
- David Stevens
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Sarah Appleton
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,The Health Observatory, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Freemason Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Andrew D Vincent
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Centre of Nutrition and Gastrointestinal Diseases, Nutrition Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Yohannes Melaku
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Sean Martin
- Freemason Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Tiffany Gill
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Catherine Hill
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Rheumatology Unit, The Queen Elizabeth Hospital and the Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,The Health Observatory, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Gary Wittert
- The Health Observatory, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Freemason Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Centre of Nutrition and Gastrointestinal Diseases, Nutrition Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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13
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Kimura H, Ota H, Kimura Y, Takasawa S. Effects of Intermittent Hypoxia on Pulmonary Vascular and Systemic Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173101. [PMID: 31455007 PMCID: PMC6747246 DOI: 10.3390/ijerph16173101] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnea (OSA) causes many systemic disorders via mechanisms related to sympathetic nerve activation, systemic inflammation, and oxidative stress. OSA typically shows repeated sleep apnea followed by hyperventilation, which results in intermittent hypoxia (IH). IH is associated with an increase in sympathetic activity, which is a well-known pathophysiological mechanism in hypertension and insulin resistance. In this review, we show the basic and clinical significance of IH from the viewpoint of not only systemic regulatory mechanisms focusing on pulmonary circulation, but also cellular mechanisms causing lifestyle-related diseases. First, we demonstrate how IH influences pulmonary circulation to cause pulmonary hypertension during sleep in association with sleep state-specific change in OSA. We also clarify how nocturnal IH activates circulating monocytes to accelerate the infiltration ability to vascular wall in OSA. Finally, the effects of IH on insulin secretion and insulin resistance are elucidated by using an in vitro chamber system that can mimic and manipulate IH. The obtained data implies that glucose-induced insulin secretion (GIS) in pancreatic β cells is significantly attenuated by IH, and that IH increases selenoprotein P, which is one of the hepatokines, as well as TNF-α, CCL-2, and resistin, members of adipokines, to induce insulin resistance via direct cellular mechanisms. Clinical and experimental findings concerning IH give us productive new knowledge of how lifestyle-related diseases and pulmonary hypertension develop during sleep.
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Affiliation(s)
- Hiroshi Kimura
- Department of Advanced Medicine for Pulmonary Circulation and Respiratory Failure, Graduate School of Medicine, Nippon Medical School, Bunkyo, Tokyo 113-8603, Japan.
| | - Hiroyo Ota
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yuya Kimura
- Center for Pulmonary Diseases, NHO Tokyo National Hospital, Kiyose, Tokyo 204-0023, Japan
| | - Shin Takasawa
- Department of Biochemistry, Nara Medical University, Kashihara, Nara 634-8521, Japan
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14
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Marin-Oto M, Vicente EE, Marin JM. Long term management of obstructive sleep apnea and its comorbidities. Multidiscip Respir Med 2019; 14:21. [PMID: 31312448 PMCID: PMC6609382 DOI: 10.1186/s40248-019-0186-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/08/2019] [Indexed: 12/24/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a worldwide highly prevalent disease associated with systemic consequences, including excessive sleepiness, impairment of neurocognitive function and daytime performance, including driving ability. The long-term sequelae of OSA include and increase risk for cardiovascular, cerebrovascular and metabolic syndrome disorders that ultimately lead to premature death if untreated. To ensure optimal long-term outcomes, the assessment and management of OSA should be personalized with the involvement of the appropriate specialist. Most studies have demonstrated inmediate improvement in daytime somnolence and quality of life with CPAP and other therapies, but the effect of long-term treatment on mortality is still under debate. Currently, the long-term management of OSA should be based on a) identifying physiological or structural abnormalities that are treatable at the time of patient evaluation and b) comprehensive lifestyle interventions, especially weight-loss interventions, which are associated with improvements in OSA severity, cardiometabolic comorbidities, and quality of life. In long-term management, attention should be paid to the clinical changes related to a potential reoccurrence of OSA symptoms and it is also necessary to monitor throughout the follow up how the main associated comorbidities evolve.
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Affiliation(s)
- Marta Marin-Oto
- 1Department of Respiratory Medicine, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Spain
| | - Eugenio E Vicente
- 2Otorhinolaryngology Service, Hospital Universitario Miguel Servet, Zaragoza, Spain.,4Traslational Respiratory Research Unit, IISAragon, Zaragoza and CIBER Enfermedades Respiratorias, Instituto Salud Carlos III, Madrid, Spain
| | - Jose M Marin
- 3Respiratory Service, Hospital Universitario Miguel Servet, and Department of Medicine, University of Zaragoza, Avda. Isabel la Católica, 1-3, 50009 Zaragoza, Spain.,4Traslational Respiratory Research Unit, IISAragon, Zaragoza and CIBER Enfermedades Respiratorias, Instituto Salud Carlos III, Madrid, Spain
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15
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Hirotsu C, Haba-Rubio J, Andries D, Tobback N, Marques-Vidal P, Vollenweider P, Waeber G, Heinzer R. Effect of Three Hypopnea Scoring Criteria on OSA Prevalence and Associated Comorbidities in the General Population. J Clin Sleep Med 2019; 15:183-194. [PMID: 30736872 DOI: 10.5664/jcsm.7612] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/21/2018] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVES Apnea-hypopnea index (AHI) is the main polysomnographic measure to diagnose obstructive sleep apnea (OSA). We aimed to evaluate the effect of three standard hypopnea definitions on the prevalence of OSA and its association with cardiometabolic outcomes in the general population. METHODS We analyzed data from the HypnoLaus study (Lausanne, Switzerland), in which 2,162 participants (51% women, 57 ± 19 years) underwent in-home full polysomnography. AHI was calculated using three hypopnea definitions: AASM1999 (≥ 50% decrease in airflow or lower airflow reduction associated with oxygen desaturation ≥ 3% or an arousal), AASM2007 (≥ 30% airflow reduction associated with ≥ 4% oxygen desaturation), and AASM2012 (≥ 30% airflow reduction associated with ≥ 3% oxygen desaturation or an arousal). Participants underwent clinical assessment for hypertension, diabetes, and metabolic syndrome. RESULTS Median AHI of AASM1999, AASM2007 and AASM2012 criteria were 10.9, 4.4, and 10.1 events/h, respectively. OSA prevalence defined as AHI ≥ 5, ≥ 15, and ≥ 30 events/h was 74.5%, 39.3%, and 16.3% using AASM1999; 46.9%, 18.8%, and 6.8% using AASM2007; and 72.2%, 36.6%, and 14.9% using AASM2012. Different AHI thresholds derived from AASM1999, AASM2007, and AASM2012 criteria, respectively, were associated with hypertension (11.5, 4.8, 10.7 events/h), diabetes (15.7, 7.1, 14.4 events/h), and metabolic syndrome (12.8, 5.5, 11.8 events/h). CONCLUSIONS Hypopnea definition has a major effect on AHI and on OSA prevalence in the general population and, hence, important implications for public health policies. There is a twofold difference in the threshold above which an association with diabetes, hypertension, and metabolic syndrome is observed using AASM2007 compared to AASM1999 or AASM2012 criteria.
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Affiliation(s)
- Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Daniela Andries
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Nadia Tobback
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Gérard Waeber
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,Pulmonary Department, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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16
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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: 0.5] [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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Huang T, Lin BM, Stampfer MJ, Tworoger SS, Hu FB, Redline S. A Population-Based Study of the Bidirectional Association Between Obstructive Sleep Apnea and Type 2 Diabetes in Three Prospective U.S. Cohorts. Diabetes Care 2018; 41:2111-2119. [PMID: 30072403 PMCID: PMC6150434 DOI: 10.2337/dc18-0675] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/08/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Multiple lines of evidence support a complex relationship between obstructive sleep apnea (OSA) and diabetes. However, no population-based study has evaluated the potential bidirectional association between these two highly prevalent disorders. RESEARCH DESIGN AND METHODS We followed 146,519 participants from the Nurses' Health Study (NHS; 2002-2012), Nurses' Health Study II (NHSII; 1995-2013), and Health Professionals Follow-up Study (HPFS; 1996-2012) who were free of diabetes, cardiovascular disease, and cancer at baseline. Cox proportional hazards models were used to estimate hazard ratios (HRs) for developing diabetes according to OSA status. In parallel, we used similar approaches to estimate risk of developing OSA according to diabetes status among 151,194 participants free of OSA, cardiovascular disease, and cancer at baseline. In all three cohorts, diagnoses of diabetes and OSA were identified by validated self-reports. RESULTS Similar results were observed across the three cohorts. In the pooled analysis, 9,029 incident diabetes cases were identified during follow-up. After accounting for potential confounders, the HR (95% CI) for diabetes was 2.06 (1.86, 2.28) comparing those with versus without OSA. The association was attenuated but remained statistically significant after further adjusting for waist circumference and BMI (HR 1.37 [95% CI 1.24, 1.53]), with the highest diabetes risk observed for OSA concomitant with sleepiness (1.78 [1.13, 2.82]). In the second analysis, we documented 9,364 incident OSA cases during follow-up. Compared with those without diabetes, the multivariable HR (95% CI) for OSA was 1.53 (1.32, 1.77) in individuals with diabetes. Adjustment for BMI and waist circumference attenuated the association (1.08 [1.00, 1.16]); however, an increased risk was observed among those with diabetes who used insulin compared with those without diabetes (1.43 [1.11, 1.83]), particularly among women (1.60 [1.34, 1.89]). CONCLUSIONS OSA is independently associated with an increased risk of diabetes, whereas insulin-treated diabetes is independently associated with a higher risk of OSA, particularly in women. Clinical awareness of this bidirectional association may improve prevention and treatment of both diseases. Future research aimed at elucidating the mechanisms that underlie each association may identify novel intervention targets.
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Affiliation(s)
- Tianyi Huang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA .,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Brian M Lin
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Meir J Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Shelley S Tworoger
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Frank B Hu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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18
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Framnes SN, Arble DM. The Bidirectional Relationship Between Obstructive Sleep Apnea and Metabolic Disease. Front Endocrinol (Lausanne) 2018; 9:440. [PMID: 30127766 PMCID: PMC6087747 DOI: 10.3389/fendo.2018.00440] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder, effecting 17% of the total population and 40-70% of the obese population (1, 2). Multiple studies have identified OSA as a critical risk factor for the development of obesity, diabetes, and cardiovascular diseases (3-5). Moreover, emerging evidence indicates that metabolic disorders can exacerbate OSA, creating a bidirectional relationship between OSA and metabolic physiology. In this review, we explore the relationship between glycemic control, insulin, and leptin as both contributing factors and products of OSA. We conclude that while insulin and leptin action may contribute to the development of OSA, further research is required to determine the mechanistic actions and relative contributions independent of body weight. In addition to increasing our understanding of the etiology, further research into the physiological mechanisms underlying OSA can lead to the development of improved treatment options for individuals with OSA.
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Affiliation(s)
| | - Deanna M. Arble
- Department of Biological Sciences, Marquette University, Milwaukee, WI, United States
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Adiponectin, Omentin, Ghrelin, and Visfatin Levels in Obese Patients with Severe Obstructive Sleep Apnea. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3410135. [PMID: 30151379 PMCID: PMC6087603 DOI: 10.1155/2018/3410135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/29/2018] [Accepted: 07/02/2018] [Indexed: 12/31/2022]
Abstract
Objectives Obstructive sleep apnea (OSA) is closely associated with obesity, insulin resistance, and inflammation. Adiponectin, omentin, ghrelin, and visfatin are adipokines involved in insulin sensitivity or regulation of inflammatory disease. This study aims to clarify the relationship between OSA and associated adipokines. Patients and Methods Thirty overweight male patients with severe OSA and twenty controls underwent standard diagnostic polysomnography (PSG), and 10 patients underwent overnight continuous positive airway pressure (CPAP) treatment. Blood samples were collected in the morning after PSG or CPAP procedures. Results Among the investigated adipokines, only plasma omentin levels of patients with OSA were significantly lower than those of control subjects (442.94 ± 191.89 ng/ml versus 573.52±228.67 ng/ml, p=0.034) and levels did not change after CPAP treatment. In patients with OSA, omentin levels were positively correlated with high-density lipoprotein cholesterol (HDL) levels (r=0.378, p=0.007), adiponectin levels (r=0.709, p<0.001), percentage of sleep at the rapid eye movement (REM) stage (r=0.307, p=0.003), and average and minimum SpO2 (p=0.041, 0.046, respectively) and negatively with hypersensitive C-reactive protein (hsCRP, r=-0.379, p=0.007) and apnea-hypopnea index (AHI, r=-0.315, p=0.026). However, plasma concentrations of adiponectin, ghrelin, and visfatin in patients with OSA did not significantly differ from those of the control or correlate with sleep parameters and CPAP treatment. Conclusions Patients with OSA have decreased omentin levels, which are associated with sleep parameters, including AHI, SpO2, percentage of REM sleep, hsCRP, HDL, and adiponectin levels.
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Hunyor I, Cook KM. Models of intermittent hypoxia and obstructive sleep apnea: molecular pathways and their contribution to cancer. Am J Physiol Regul Integr Comp Physiol 2018; 315:R669-R687. [PMID: 29995459 DOI: 10.1152/ajpregu.00036.2018] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is common and linked to a variety of poor health outcomes. A key modulator of this disease is nocturnal intermittent hypoxia. There is striking epidemiological evidence that patients with OSA have higher rates of cancer and cancer mortality. Small-animal models demonstrate an important role for systemic intermittent hypoxia in tumor growth and metastasis, yet the underlying mechanisms are poorly understood. Emerging data indicate that intermittent hypoxia activates the hypoxic response and inflammatory pathways in a manner distinct from chronic hypoxia. However, there is significant heterogeneity in published methods for modeling hypoxic conditions, which are often lacking in physiological relevance. This is particularly important for studying key transcriptional mediators of the hypoxic and inflammatory responses such as hypoxia-inducible factor (HIF) and NF-κB. The relationship between HIF, the molecular clock, and circadian rhythm may also contribute to cancer risk in OSA. Building accurate in vitro models of intermittent hypoxia reflective of OSA is challenging but necessary to better elucidate underlying molecular pathways.
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Affiliation(s)
- Imre Hunyor
- Department of Cardiology, Royal Prince Alfred Hospital , Sydney, New South Wales , Australia.,Faculty of Medicine and Health, University of Sydney School of Medicine , Sydney, New South Wales , Australia
| | - Kristina M Cook
- Faculty of Medicine and Health, University of Sydney School of Medicine , Sydney, New South Wales , Australia.,Charles Perkins Centre, University of Sydney , Sydney, New South Wales , Australia
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Deflandre E, Piette N, Bonhomme V, Degey S, Cambron L, Poirrier R, Brichant JF, Joris J. Comparison of clinical scores in their ability to detect hypoxemic severe OSA patients. PLoS One 2018; 13:e0196270. [PMID: 29734398 PMCID: PMC5937788 DOI: 10.1371/journal.pone.0196270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 04/10/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Severe obstructive sleep apnea (sOSA) and preoperative hypoxemia are risk factors of postoperative complications. Patients exhibiting the combination of both factors are probably at higher perioperative risk. Four scores (STOP-Bang, P-SAP, OSA50, and DES-OSA) are currently used to detect OSA patients preoperatively. This study compared their ability to specifically detect hypoxemic sOSA patients. METHODS One hundred and fifty-nine patients scheduled for an overnight polysomnography (PSG) were prospectively enrolled. The ability of the four scores to predict the occurrence of hypoxemic episodes in sOSA patients was compared using sensitivity (Se), specificity (Sp), Youden Index, Cohen kappa coefficient, and the area under ROC curve (AUROC) analyses. RESULTS OSA50 elicited the highest Se [95% CI] at detecting hypoxemic sOSA patients (1 [0.89-1]) and was significantly more sensitive than STOP-Bang in that respect. DES-OSA was significantly more specific (0.58 [0.49-0.66]) than the three other scores. The Youden Index of DES-OSA (1.45 [1.33-1.58]) was significantly higher than those of STOP-Bang, P-SAP, and OSA50. The AUROC of DES-OSA (0.8 [0.71-0.89]) was significantly the largest. The highest Kappa value was obtained for DES-OSA (0.33 [0.21-0.45]) and was significantly higher than those of STOP-Bang, and OSA50. CONCLUSIONS In our population, DES-OSA appears to be more effective than the three other scores to specifically detect hypoxemic sOSA patients. However prospective studies are needed to confirm these findings in a perioperative setting. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT02050685.
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Affiliation(s)
- Eric Deflandre
- Department of Anesthesia, Clinique Saint-Luc of Bouge, Namur, Belgium
- Department of Anesthesia, University of Liege, Liege, Belgium
- Cabinet Medical ASTES, Jambes, Namur, Belgium
- * E-mail:
| | - Nicolas Piette
- Department of Anesthesia, University of Liege, Liege, Belgium
| | - Vincent Bonhomme
- Department of Anesthesia, University of Liege, Liege, Belgium
- University Department of Anesthesia and ICM, CHR Citadelle, Liege, Belgium
| | | | - Laurent Cambron
- Sleep Laboratory Centre (CETES), University of Liege, Liege, Belgium
| | - Robert Poirrier
- Sleep Laboratory Centre (CETES), University of Liege, Liege, Belgium
| | | | - Jean Joris
- Department of Anesthesia, University of Liege, Liege, Belgium
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Stevens D, Martins RT, Mukherjee S, Vakulin A. Post-Stroke Sleep-Disordered Breathing-Pathophysiology and Therapy Options. Front Surg 2018. [PMID: 29536012 PMCID: PMC5834929 DOI: 10.3389/fsurg.2018.00009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sleep-disordered breathing (SDB), encompassing both obstructive and central sleep apnea, is prevalent in at least 50% of stroke patients. Small studies have shown vast improvements in post-stroke functional recovery outcomes after the treatment of SDB by continuous positive airway pressure. However, compliance to this therapy is very poor in this complex patient group. There are alternative therapy options for SDB that may be more amenable for use in at least some post-stroke patients, including mandibular advancement, supine avoidance, and oxygen therapy. There are few studies, however, that demonstrate efficacy and compliance with these alternative therapies currently. Furthermore, novel SDB-phenotyping approaches may help to provide important clinical information to direct therapy selection in individual patients. Prior to realizing individualized therapy, we need a better understanding of the pathophysiology of SDB in post-stroke patients, including the role of inherent phenotypic traits, as well as the contribution of stroke size and location. This review summarizes the available literature on SDB pathophysiology and treatment in post-stroke patients, identifies gaps in the literature, and sets out areas for further research.
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Affiliation(s)
- David Stevens
- A Flinders Centre of Research Excellence, College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Daw Park, SA, Australia
| | | | - Sutapa Mukherjee
- A Flinders Centre of Research Excellence, College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Daw Park, SA, Australia.,Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Andrew Vakulin
- A Flinders Centre of Research Excellence, College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Daw Park, SA, Australia.,The NHMRC Centre of Research Excellence, NEUROSLEEP, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
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Obesity, obstructive sleep apnea and type 2 diabetes mellitus: Epidemiology and pathophysiologic insights. SLEEP MEDICINE AND DISORDERS : INTERNATIONAL JOURNAL 2018; 2:52-58. [PMID: 30167574 PMCID: PMC6112821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Obesity is a major global health issue, and its prevalence is increasing. Obesity is associated with much comorbidity such as obstructive sleep apnea (OSA), type 2 diabetes mellitus (T2DM), and cardiovascular diseases (CVD). Obesity is also one of the major causative factors of OSA, and OSA itself can promote the onset of after T2DM because hypoxic episodes decrease insulin sensitivity, and activation of the sympathetic pathway leads to the release of inflammatory markers associated with insulin resistance. Continuous Positive Airway Pressure (CPAP) can be used to ameliorate both conditions, as CPAP decreased hypoxia episodes and increases insulin sensitivity and improves glucose metabolism. Weight-loss strategies play an important role in improving OSA, T2DM, and other associated comorbidities. Lifestyle modification of diet and exercise, medications or bariatric surgery should be considered weight loss. The purpose of this review is to describe the relationship between obesity, OSA, and T2DM.
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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: 2.8] [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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Circulating C3 and glucose metabolism abnormalities in patients with OSAHS. Sleep Breath 2017; 22:345-351. [DOI: 10.1007/s11325-017-1564-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 08/14/2017] [Accepted: 08/28/2017] [Indexed: 12/14/2022]
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Lang CJ, Appleton SL, Vakulin A, McEvoy RD, Wittert GA, Martin SA, Catcheside PG, Antic NA, Lack L, Adams RJ. Co-morbid OSA and insomnia increases depression prevalence and severity in men. Respirology 2017; 22:1407-1415. [DOI: 10.1111/resp.13064] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 02/26/2017] [Accepted: 03/07/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Carol J. Lang
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Sarah L. Appleton
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Andrew Vakulin
- Adelaide Institute of Sleep Health; Flinders University of South Australia; Adelaide South Australia Australia
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
| | - R. Doug McEvoy
- Adelaide Institute of Sleep Health; Flinders University of South Australia; Adelaide South Australia Australia
| | - Gary A. Wittert
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Sean A. Martin
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Peter G. Catcheside
- Adelaide Institute of Sleep Health; Flinders University of South Australia; Adelaide South Australia Australia
| | - Nicholas A. Antic
- Adelaide Institute of Sleep Health; Flinders University of South Australia; Adelaide South Australia Australia
| | - Leon Lack
- Adelaide Institute of Sleep Health; Flinders University of South Australia; Adelaide South Australia Australia
| | - Robert J. Adams
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
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Rusu A, Bala CG, Craciun AE, Roman G. HbA1c levels are associated with severity of hypoxemia and not with apnea hypopnea index in patients with type 2 diabetes: Results from a cross-sectional study. J Diabetes 2017; 9:555-561. [PMID: 27447735 DOI: 10.1111/1753-0407.12452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/16/2016] [Accepted: 07/19/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of the present study was to evaluate the effect of untreated sleep apnea syndrome (SAS) on glycemic control, evaluated by HbA1c, in patients with type 2 diabetes (T2D). METHODS The study sample consisted of 100 consecutive adult (≥18 years) patients with T2D without a prior diagnosis of sleep apnea recruited from an outpatient diabetes clinic. All patients underwent an in-hospital cardiorespiratory study using a three-channel portable sleep diagnostic tool; 64 were found to have sleep apnea, 36 were not. Information on medical history, body weight, height, sleep apnea symptoms, Epworth Sleepiness Scale scores, and HbA1c and fasting plasma glucose levels were recorded. RESULTS After adjusting for factors known to affect HbA1c (gender, age, diabetes duration, diabetes treatment, body mass index [BMI], and waist circumference), HbA1c was higher in patients with than without SAS (8.4 % vs 7.6 %, respectively; P = 0.04). A positive correlation was found between the presence of sleep apnea and HbA1c (r = 0.24; P = 0.02). After adjusting for confounding factors (including BMI), only mean and lowest O2 saturation during sleep were significantly associated with HbA1c (β = -0.23 [P = 0.03] and β = -0.24 [P = 0.007], respectively). After further adjusting for waist circumference, only lowest O2 saturation during recording remained independently associated with HbA1c (β = -0.21; P = 0.05). CONCLUSIONS The presence of sleep apnea is associated with poorer glycemic control in patients with T2D. In patients with sleep apnea and T2D, greater levels of oxygen desaturation are associated with poorer glycemic control.
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Affiliation(s)
- Adriana Rusu
- Department of Diabetes, Nutrition, Metabolic Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Cornelia Gabriela Bala
- Department of Diabetes, Nutrition, Metabolic Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Anca-Elena Craciun
- Department of Diabetes, Nutrition, Metabolic Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Gabriela Roman
- Department of Diabetes, Nutrition, Metabolic Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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Reutrakul S, Mokhlesi B. Obstructive Sleep Apnea and Diabetes: A State of the Art Review. Chest 2017; 152:1070-1086. [PMID: 28527878 DOI: 10.1016/j.chest.2017.05.009] [Citation(s) in RCA: 303] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/21/2017] [Accepted: 05/02/2017] [Indexed: 12/31/2022] Open
Abstract
OSA is a chronic treatable sleep disorder and a frequent comorbidity in patients with type 2 diabetes. Cardinal features of OSA, including intermittent hypoxemia and sleep fragmentation, have been linked to abnormal glucose metabolism in laboratory-based experiments. OSA has also been linked to the development of incident type 2 diabetes. The relationship between OSA and type 2 diabetes may be bidirectional in nature given that diabetic neuropathy can affect central control of respiration and upper airway neural reflexes, promoting sleep-disordered breathing. Despite the strong association between OSA and type 2 diabetes, the effect of treatment with CPAP on markers of glucose metabolism has been conflicting. Variability with CPAP adherence may be one of the key factors behind these conflicting results. Finally, accumulating data suggest an association between OSA and type 1 diabetes as well as gestational diabetes. This review explores the role of OSA in the pathogenesis of type 2 diabetes, glucose metabolism dysregulation, and the impact of OSA treatment on glucose metabolism. The association between OSA and diabetic complications as well as gestational diabetes is also reviewed.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Babak Mokhlesi
- Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, The University of Chicago, Chicago, IL.
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Effect of high-intensity aerobic exercise on aerobic fitness and HbA1c in patients with type 2 diabetes. Eur J Appl Physiol 2017; 117:1519-1520. [PMID: 28508111 DOI: 10.1007/s00421-017-3632-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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Lang CJ, Appleton SL, Vakulin A, McEvoy RD, Vincent AD, Wittert GA, Martin SA, Grant JF, Taylor AW, Antic N, Catcheside PG, Adams RJ. Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study. J Clin Sleep Med 2017; 13:575-582. [PMID: 28095971 DOI: 10.5664/jcsm.6546] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/27/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine whether undiagnosed obstructive sleep apnea (OSA) and/or excessive daytime sleepiness are associated with symptomatic depression in Australian men. METHODS Participants were randomly selected, urban community dwelling men aged 40 to 88 years without a prior diagnosis of OSA. Clinically significant depressive symptoms were assessed using the Beck Depression Inventory-1A or Centre for Epidemiological Studies Depression Scale (2007-2010). A random sample of men (n = 788) undertook full at-home unattended polysomnography (Embletta X100, Broomfield, Colorado, United States) and completed the Epworth Sleepiness Scale questionnaire (2010-2012). RESULTS Undiagnosed severe obstructive sleep apnea (apnea-hypopnea index ≥ 30 events/h) was associated with depressive symptoms (adjusted odds ratio = 1.98; 95% confidence interval [CI] 1.05-3.73; P = .036). However, a significant interaction was observed between obstructive sleep apnea and excessive daytime sleepiness (P = .03) such that individuals with OSA and excessive daytime sleepiness (Epworth Sleepiness Scale score of 10 or higher) exhibited the strongest associations with depression (mild-moderate apnea: adjusted odd ratio = 3.86; 95% CI 1.87-7.95; severe apnea: adjusted odd ratio = 4.82; 95% CI 1.42-16.35) when compared to individuals without apnea. CONCLUSIONS Depressive symptoms in men were associated with undiagnosed OSA in the community. It is important that clinicians and primary care practitioners consider screening for depression in men with severe OSA and for OSA in men with depression. Screening for depression should also be considered in men with excessive daytime sleepiness regardless of OSA severity.
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Affiliation(s)
- Carol J Lang
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Sarah L Appleton
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Andrew Vakulin
- Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.,NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, New South Wales, Australia
| | - R Doug McEvoy
- Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.,School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Andrew D Vincent
- Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Gary A Wittert
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.,Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sean A Martin
- Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Janet F Grant
- Population Research and Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Anne W Taylor
- Population Research and Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Nicholas Antic
- Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.,School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.,School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Robert J Adams
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia
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Bozic J, Galic T, Supe-Domic D, Ivkovic N, Ticinovic Kurir T, Valic Z, Lesko J, Dogas Z. Morning cortisol levels and glucose metabolism parameters in moderate and severe obstructive sleep apnea patients. Endocrine 2016; 53:730-9. [PMID: 27000083 DOI: 10.1007/s12020-016-0925-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/11/2016] [Indexed: 12/26/2022]
Abstract
Obstructive sleep apnea (OSA) has been associated with dysregulation of the hypothalamic-pituitary-adrenal axis and alterations in glucose metabolism with increased risk for type 2 diabetes. The aim of the current study was to compare morning plasma cortisol levels and glucose metabolism parameters between moderate (apnea-hypopnea index (AHI): 15-30 events/h) and severe OSA patients (AHI >30 events/h), with respective controls. A total of 56 male OSA patients, 24 moderate (AHI = 21.1 ± 5.3) and 32 severe (AHI = 49.7 ± 18.1), underwent a full-night polysomnography, oral glucose tolerance test (OGTT), and measurement of morning plasma cortisol levels. These groups were compared to 20 matched subjects in a control group. Morning plasma cortisol levels were statistically lower in severe OSA group than in moderate OSA and control groups (303.7 ± 93.5 vs. 423.9 ± 145.1 vs. 417.5 ± 99.8 pmol/L, P < 0.001). Significant negative correlations were found between morning plasma cortisol levels and AHI (r = -0.444, P = 0.002), as well as oxygen desaturation index (r = -0.381, P = 0.011). Fasting plasma glucose (5.0 ± 0.5 vs. 5.4 ± 0.7 vs. 4.9 ± 0.6 mmol/L, P = 0.009) was higher in the severe OSA group compared to moderate OSA and controls. Homeostasis model assessment insulin resistance (HOMA-IR) was higher in the severe OSA group compared to moderate OSA and controls (4.6 ± 3.7 vs. 2.7 ± 2.0 and 2.2 ± 1.8, respectively, P = 0.006). In conclusion, our study showed that morning plasma cortisol levels measured at 8 a.m. were significantly lower in severe OSA patients than those in moderate OSA group and controls. Morning plasma cortisol levels showed a negative correlation with AHI and oxygen desaturation index. Additionally, this study confirmed the evidence of glucose metabolism impairment in moderate and severe OSA patients, with more pronounced effect in the severe OSA patients group.
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Affiliation(s)
- Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Tea Galic
- Study of Dental Medicine, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Daniela Supe-Domic
- Department of Medical Laboratory Diagnostics, University Hospital Split, Spinciceva 1, Split, Croatia
| | - Natalija Ivkovic
- Split Sleep Medicine Center, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Zoran Valic
- Department of Physiology, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Josip Lesko
- Departments of Anatomy and Neuroscience, University of Mostar School of Medicine, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Zoran Dogas
- Split Sleep Medicine Center, University of Split School of Medicine, Soltanska 2, Split, Croatia.
- Department of Neuroscience, University of Split School of Medicine, Soltanska 2, Split, 21000, Croatia.
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Hui P, Zhao L, Xie Y, Wei X, Ma W, Wang J, Hou Y, Ning J, Zhou L, Guo Q, Zhou S. Nocturnal Hypoxemia Causes Hyperglycemia in Patients With Obstructive Sleep Apnea and Type 2 Diabetes Mellitus. Am J Med Sci 2016; 351:160-8. [PMID: 26897271 DOI: 10.1016/j.amjms.2015.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/13/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Our purpose was to investigate the relationship between oxygen saturation (SpO2) and dynamic interstitial glucose level (IGL) in patients with obstructive sleep apnea (OSA) along with type 2 diabetes mellitus (T2DM), and to investigate the potential mechanisms thereof. MATERIALS AND METHODS A total of 130 patients with OSA and T2DM underwent polysomnography and oral glucose tolerance tests at the Sleep Medicine Center. Using the lowest (L) SpO2% tested, patients were divided into mild, moderate and severe LSpO2 groups. Polysomnography and continuous glucose monitoring systems were used to analyze the altered pattern of SpO2 and dynamic IGL in the 3 groups. RESULTS LSpO2 during sleep in patients with OSA and T2DM stimulated an increase in IGL. The moderate and severe levels were represented by IGL45 and IGL30, respectively. The average nocturnal and peak IGL after LSpO2 in the severe group were significantly higher than in the mild and moderate groups. Stepwise multiple regression analysis showed that the body mass index (β = 0.301, P < 0.001), homeostatic model assessment of insulin resistance (β = 0.260, P < 0.001), apnea-hypopnea index (β = 0.309, P < 0.001), average SpO2 (β = -0.423, P = 0.008), LSpO2 (β = -0.369, P < 0.001) and microarousal index (β = 0.335, P = 0.044) were probably related to nocturnal IGL in patients with OSA along with T2DM. CONCLUSIONS Severe and moderate OSA with T2DM is marked by a delayed IGL peak following LSpO2. Nocturnal hypoxemia causes hyperglycemia in patients with OSA along with T2DM.
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Affiliation(s)
- Peilin Hui
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Lijun Zhao
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yuping Xie
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China.
| | - Xiaoquan Wei
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Wei Ma
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jinfeng Wang
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yiping Hou
- Department of Neuroscience, Anatomy, Histology and Embryology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Jing Ning
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Liya Zhou
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Qian Guo
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Shuhong Zhou
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
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Phillips CL, Hoyos CM, Yee BJ, Grunstein RR. CrossTalk opposing view: Sleep apnoea causes metabolic syndrome. J Physiol 2016; 594:4691-4. [PMID: 27358216 DOI: 10.1113/jp272115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Craig L Phillips
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. .,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.
| | - Camilla M Hoyos
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Brendon J Yee
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
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Adams RJ, Appleton SL, Vakulin A, Lang C, Martin SA, Taylor AW, McEvoy RD, Antic NA, Catcheside PG, Wittert GA. Association of daytime sleepiness with obstructive sleep apnoea and comorbidities varies by sleepiness definition in a population cohort of men. Respirology 2016; 21:1314-21. [DOI: 10.1111/resp.12829] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/29/2016] [Accepted: 04/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Robert J. Adams
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
| | - Sarah L. Appleton
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
- Freemasons Centre for Men's Health, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School; University of Sydney; Sydney New South Wales Australia
| | - Carol Lang
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
| | - Sean A. Martin
- Freemasons Centre for Men's Health, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Anne W. Taylor
- Population Research & Outcomes Studies, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - R. Doug McEvoy
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- Department of Medicine; Flinders University; Bedford Park, Adelaide South Australia Australia
| | - Nick A. Antic
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- Department of Medicine; Flinders University; Bedford Park, Adelaide South Australia Australia
| | - Peter G. Catcheside
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- Department of Medicine; Flinders University; Bedford Park, Adelaide South Australia Australia
| | - Gary A. Wittert
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
- Freemasons Centre for Men's Health, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
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Daulatzai MA. Fundamental role of pan-inflammation and oxidative-nitrosative pathways in neuropathogenesis of Alzheimer's disease in focal cerebral ischemic rats. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2016; 5:102-30. [PMID: 27335702 PMCID: PMC4913220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 06/06/2023]
Abstract
Alzheimer's disease (AD) is a chronic progressive neurodegenerative condition of the brain, and it is the most common cause of dementia. Several neurobiological etiologies of AD are described in the literature. These include vascular, infectious, toxic, nutritional, metabolic, and inflammatory. However, these heterogeneous etiologies have a common denominator - viz. Inflammation and oxidative stress. Lipopolysaccharide (LPS) elevates the synthesis of proinflammatory cytokines and chemokines; chronically, together they trigger various pathological responses in the periphery and the CNS including dysfunctional memory consolidation and memory decline. Aging - the main risk factor for AD is inherently associated with inflammation. There are several age-related comorbidities that are also associated with inflammation and oxidative stress. Such co-prevailing aggravating factors, therefore, persist against a background of underlying aging-related pathology. They may converge, and their synergistic propagation may modify the disease course. A critical balance exists between homeostasis/repair and inflammatory factors; chronic, unrelenting inflammatory milieu succeeds in promoting a neuroinflammatory and neurodegenerative outcome. Extensive evidence is available that CNS inflammation is associated with neurodegeneration. LPS, proinflammatory cytokines, several mediators secreted by microglia, and oxidative-nitrosative stress in concert play a pivotal role in triggering neuroinflammatory processes and neurodegeneration. The persistent uncontrolled activity of the above factors can potentiate cognitive decline in tandem enhancing vulnerability to AD. Despite significant progress during the past twenty years, the prevention and treatment of AD have been tantalizingly elusive. Current studies strongly suggest that amelioration/prevention of the deleterious effects of inflammation may prove beneficial in preventing AD onset and retarding cognitive dysfunction in aging and AD. A concerted multi-focal therapeutic effort around the inflammation-oxidative-nitrosative stress paradigm may be crucial in preventing and treating AD. This paper informs on such relevant polypharmacy approach.
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Affiliation(s)
- Mak Adam Daulatzai
- Sleep Disorders Group, EEE/Melbourne School of Engineering, The University of Melbourne Parkville, Victoria 3010, Australia
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36
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Associations between Macronutrient Intake and Obstructive Sleep Apnoea as Well as Self-Reported Sleep Symptoms: Results from a Cohort of Community Dwelling Australian Men. Nutrients 2016; 8:207. [PMID: 27070639 PMCID: PMC4848676 DOI: 10.3390/nu8040207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 01/08/2023] Open
Abstract
Background: macronutrient intake has been found to affect sleep parameters including obstructive sleep apnoea (OSA) in experimental studies, but there is uncertainty at the population level in adults. Methods: cross-sectional analysis was conducted of participants in the Men Androgen Inflammation Lifestyle Environment and Stress cohort (n = 784, age 35–80 years). Dietary intake was measured by a validated food frequency questionnaire. Self-reported poor sleep quality and daytime sleepiness were measured by questionnaires. Overnight in-home polysomnography (PSG) was conducted among participants with without previously diagnosed OSA. Results: after adjusting for demographic, lifestyle factors, and chronic diseases, the highest quartile of fat intake was positively associated with excessive daytime sleepiness (relative risk ratio (RRR) = 1.78, 95% CI 1.10, 2.89) and apnoea-hypopnoea index (AHI) ≥20, (RRR = 2.98, 95% CI 1.20–7.38). Body mass index mediated the association between fat intake and AHI (30%), but not daytime sleepiness. There were no associations between other intake of macronutrient and sleep outcomes. Conclusion: high fat is associated with daytime sleepiness and AHI. Sleep outcomes are generally not assessed in studies investigating the effects of varying macronutrient diets on weight loss. The current result highlights the potential public health significance of doing so.
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Daulatzai MA. Fundamental role of pan-inflammation and oxidative-nitrosative pathways in neuropathogenesis of Alzheimer's disease. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2016; 5:1-28. [PMID: 27073740 PMCID: PMC4788729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/09/2016] [Indexed: 06/05/2023]
Abstract
Alzheimer's disease (AD) is a chronic progressive neurodegenerative condition of the brain, and it is the most common cause of dementia. Several neurobiological etiologies of AD are described in the literature. These include vascular, infectious, toxic, nutritional, metabolic, and inflammatory. However, these heterogeneous etiologies have a common denominator - viz. Inflammation and oxidative stress. Lipopolysaccharide (LPS) elevates the synthesis of proinflammatory cytokines and chemokines; chronically, together they trigger various pathological responses in the periphery and the CNS including dysfunctional memory consolidation and memory decline. Aging - the main risk factor for AD is inherently associated with inflammation. There are several age-related comorbidities that are also associated with inflammation and oxidative stress. Such co-prevailing aggravating factors, therefore, persist against a background of underlying aging-related pathology. They may converge, and their synergistic propagation may modify the disease course. A critical balance exists between homeostasis/repair and inflammatory factors; chronic, unrelenting inflammatory milieu succeeds in promoting a neuroinflammatory and neurodegenerative outcome. Extensive evidence is available that CNS inflammation is associated with neurodegeneration. LPS, proinflammatory cytokines, several mediators secreted by microglia, and oxidative-nitrosative stress in concert play a pivotal role in triggering neuroinflammatory processes and neurodegeneration. The persistent uncontrolled activity of the above factors can potentiate cognitive decline in tandem enhancing vulnerability to AD. Despite significant progress during the past twenty years, the prevention and treatment of AD have been tantalizingly elusive. Current studies strongly suggest that amelioration/prevention of the deleterious effects of inflammation may prove beneficial in preventing AD onset and retarding cognitive dysfunction in aging and AD. A concerted multi-focal therapeutic effort around the inflammation-oxidative-nitrosative stress paradigm may be crucial in preventing and treating AD. This paper informs on such relevant polypharmacy approach.
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Affiliation(s)
- Mak Adam Daulatzai
- Sleep Disorders Group, EEE/Melbourne School of Engineering, The University of Melbourne Parkville, Victoria 3010, Australia
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