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Breznoscakova D, Pallayova M. Case report: Uncovering hidden glucose patterns in medicated versus unmedicated bipolar disorder and comorbid type 1 diabetes mellitus. Front Endocrinol (Lausanne) 2024; 15:1354749. [PMID: 38419952 PMCID: PMC10899695 DOI: 10.3389/fendo.2024.1354749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Type 1 diabetes mellitus is characterized by an absolute insulin deficiency requiring the lifetime intensive insulin therapy accompanied by daily self-monitoring, self-management, ongoing education, and complex diabetes care. Regular patient-clinician shared therapeutic decisions based on age, sex, comorbidities, medications, predicted impact of meals, physical activity, stress, hormonal changes, insulin therapy, and patterns of glycemic changes are key for achieving glycemic targets. The impact of various phases of bipolar disorder and their treatment on continuous glucose levels remains unexplored and calls for future assessments. Case presentation The present case reports a 41-year-old Caucasian female with an established diagnosis of bipolar II disorder and type 1 diabetes mellitus who discontinued long-term mood-stabilizing pharmacotherapy with quetiapine. Real-time continuous glucose monitoring performed before and 6-months following the discontinuation of quetiapine revealed hidden glucose patterns in medicated versus unmedicated bipolar disorder. Despite the known adverse metabolic effects of quetiapine, the continuous glucose monitoring captured more stable and near-normal continuous glucose values during the antipsychotic treatment compared to unmedicated stages of bipolar disorder with considerably higher glucose values and glucose variability. Conclusion The case report highlights the importance of the ongoing psychopharmacotherapy of bipolar disorder in comorbid type 1 diabetes mellitus to reduce mood-induced reactivity, emotional urgency, and non-emotional impulsivity that may contribute to dysglycemia. If not effectively treated, the "bipolar diabetes" is likely to progress to multiple psychiatric and somatic complications. The bidirectional links between the phases of bipolar disorder and the corresponding continuous glucose patterns can help advance clinical decision-making and yield innovative1 research that can translate into efficacious clinical practice.
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Affiliation(s)
- Dagmar Breznoscakova
- Department of Social and Behavioural Medicine, Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovakia
- Center for Mental Functions, Vranov nad Toplou, Slovakia
| | - Maria Pallayova
- Department of Human Physiology, Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovakia
- 1 Department of Psychiatry, University Hospital of Louis Pasteur, Kosice, Slovakia
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Gresova S, Gaborova M, Stimmelova J, Peregrim I, Svorc P, Donic V, Pallayova M. An Obstructive Sleep Apnea - A Novel Public Health Threat. Physiol Res 2023; 72:415-423. [PMID: 37795885 PMCID: PMC10634565 DOI: 10.33549/physiolres.935065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/18/2023] [Indexed: 01/05/2024] Open
Abstract
In patients with obstructive sleep apnea (OSA) during obstructive events, episodes of hypoxia and hypercapnia may modulate the autonomic nervous system (ANS) by increasing sympathetic tone and irritability, which contributes to sympathovagal imbalance and ultimately dysautonomia. Because OSA can alter ANS function through biochemical changes, we can assume that heart rate variability (HRV) will be altered in patients with OSA. Most studies show that in both the time and frequency domains, patients with OSA have higher sympathetic components and lower parasympathetic dominance than healthy controls. These results confirm autonomic dysfunction in these patients, but also provide new therapeutic directions. Respiratory methods that modulate ANS, e.g., cardiorespiratory biofeedback, could be beneficial for these patients. Heart rate variability assessment can be used as a tool to evaluate the effectiveness of OSA treatment due to its association with autonomic impairment.
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Affiliation(s)
- S Gresova
- Department of Human Physiology, Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovak Republic
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Dragasek J, Minar M, Valkovic P, Pallayova M. Factors associated with psychiatric and physical comorbidities in bipolar disorder: a nationwide multicenter cross-sectional observational study. Front Psychiatry 2023; 14:1208551. [PMID: 37559916 PMCID: PMC10407573 DOI: 10.3389/fpsyt.2023.1208551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic and disabling affective disorder with significant morbidity and mortality. Despite the high rate of psychiatric and physical health comorbidity, little is known about the complex interrelationships between clinical features of bipolar illness and comorbid conditions. The present study sought to examine, quantify and characterize the cross-sectional associations of psychiatric and physical comorbidities with selected demographic and clinical characteristics of adults with BD. METHODS A nationwide multicenter cross-sectional observational epidemiological study conducted from October 2015 to March 2017 in Slovakia. RESULTS Out of 179 study participants [median age 49 years (interquartile range IQR 38-58); 57.5% females], 22.4% were free of comorbidity, 42.5% had both psychiatric and physical comorbidities, 53.6% at least one psychiatric comorbidity, and 66.5% at least one physical comorbidity. The most prevalent were the essential hypertension (33.5%), various psychoactive substance-related disorders (21.2%), specific personality disorders (14.6%), obesity (14.5%), and disorders of lipoprotein metabolism (14%). The presence of an at least one physical comorbidity, atypical symptoms of BD, and unemployed status were each associated with an at least one psychiatric comorbidity independent of sex, early onset of BD (age of onset <35 years), BD duration and pattern of BD illness progression (p < 0.001). The presence of various psychoactive substance-related disorders, BD duration, atypical symptoms of BD, unemployed status, pension, female sex, and not using antipsychotics were each associated with an at least one physical comorbidity independent of the pattern of BD illness progression (p < 0.001). In several other multiple regression models, the use of antipsychotics (in particular, olanzapine) was associated with a decreased probability of the essential hypertension and predicted the clinical phenotype of comorbidity-free BD (p < 0.05). CONCLUSION This cross-national study has reported novel estimates and clinical correlates related to both the comorbidity-free phenotype and the factors associated with psychiatric and physical comorbidities in adults with BD in Slovakia. The findings provide new insights into understanding of the clinical presentation of BD that can inform clinical practice and further research to continue to investigate potential mechanisms of BD adverse outcomes and disease complications onset.
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Affiliation(s)
- Jozef Dragasek
- 1st Department of Psychiatry, University Hospital of Louis Pasteur and Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovakia
| | - Michal Minar
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Valkovic
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Bratislava, Slovakia
- Centre of Experimental Medicine, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Maria Pallayova
- 1st Department of Psychiatry, University Hospital of Louis Pasteur and Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovakia
- Department of Human Physiology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
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4
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Breznoscakova D, Kovanicova M, Sedlakova E, Pallayova M. Autogenic Training in Mental Disorders: What Can We Expect? Int J Environ Res Public Health 2023; 20:4344. [PMID: 36901353 PMCID: PMC10001593 DOI: 10.3390/ijerph20054344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
Autogenic training (AT) is a well-established self-induced relaxation technique based on autosuggestion. From the past two decades, an increasing number of AT studies strongly suggests the practical usefulness of psychophysiological relaxation in the area of medicine. Despite this interest, to date, limited critical clinical reflection on the application and effects of AT in mental disorders exists. The present paper reviews psychophysiological, psychopathological, and clinical aspects of AT in persons with mental disorders with emphasis on implications for future research and practice. Based on a formal literature search, 29 reported studies (7 meta-analyses/systematic reviews) were identified that examined the effects and impact of AT on mental disorders. The main psychophysiological effects of AT include autonomic cardiorespiratory changes paralleled by central nervous system activity modifications and psychological outputs. Studies demonstrate consistent efficacy of AT in reducing anxiety and medium range positive effects for mild-to-moderate depression. The impact on bipolar disorders, psychotic disorders, and acute stress disorder remains unexplored. As an add-on intervention psychotherapy technique with beneficial outcome on psychophysiological functioning, AT represents a promising avenue towards expanding research findings of brain-body links beyond the current limits of the prevention and clinical management of number of mental disorders.
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Affiliation(s)
- Dagmar Breznoscakova
- Department of Social and Behavioural Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia
- Center for Mental Functions, Crystal Comfort, LLC, M. R. Stefanika 2427, 093 01 Vranov nad Toplou, Slovakia
| | - Milana Kovanicova
- 2nd Department of Psychiatry, University Hospital of Louis Pasteur, Rastislavova 43, 041 90 Kosice, Slovakia
| | - Eva Sedlakova
- Department of Pathological Physiology, Faculty of Medicine, Pavol Jozef Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia
| | - Maria Pallayova
- Department of Human Physiology, Faculty of Medicine, Pavol Jozef Safarik University, Trieda SNP 1, 040 11 Kosice, Slovakia
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Breznoscakova D, Pallayova M. Uncovering the Untold Emotional Toll of Living with Diabetes in the COVID-19 Era. Psychother Psychosom 2022; 91:286-287. [PMID: 35390785 DOI: 10.1159/000524178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/16/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Dagmar Breznoscakova
- Department of Social and Behavioural Medicine, Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovakia
| | - Maria Pallayova
- Department of Human Physiology, Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovakia
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6
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Pallayova M. Glycemic index versus glycemic load - What does matter in life? Diabetes Res Clin Pract 2021; 173:108639. [PMID: 33359082 DOI: 10.1016/j.diabres.2020.108639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Maria Pallayova
- Department of Human Physiology, Pavol Jozef Safarik University, Faculty of Medicine, Trieda SNP 1, 040 11 Kosice, Slovak Republic.
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Pallayova M, Brenisin M, Putrya A, Vrsko M, Drazilova S, Janicko M, Marekova M, Pella D, Geckova AM, Urdzik P, Jarcuska P, Team H. Roma Ethnicity and Sex-Specific Associations of Serum Uric Acid with Cardiometabolic and Hepatorenal Health Factors in Eastern Slovakian Population: The HepaMeta Study. Int J Environ Res Public Health 2020; 17:E7673. [PMID: 33096683 PMCID: PMC7589897 DOI: 10.3390/ijerph17207673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 11/16/2022]
Abstract
Background: Health characteristics associated with uric acid (UA) in the Roma minority remain less well known. The study sought to determine the ethnicity- and sex-specific associations of serum UA with health factors in Eastern Slovakian Roma and non-Roma populations. Methods: Data from the comparative cross-sectional HepaMeta study conducted in Slovakia in 2011 were used. The study enrolled 452 Roma subjects (35.2% men) and 403 non-Roma individuals (45.9% men) aged 18-55 years. Results: All study parameters differed between the sexes in both the Roma and non-Roma participants (p < 0.05). UA was related to sex with odds ratio for female sex 0.873, 95% CI 0.853-0.893 (p < 0.0001) per 10-unit increase of UA. Average level of UA ± standard deviation was lower in Roma than in non-Roma (226.54 ± 79.8 vs. 259.11 ± 84.53 umol/L; p < 0.0001). The Roma population presented with greater levels of high-sensitivity C-reactive protein (hsCRP) (3.07 ± 4 mg/L vs. 1.98 ± 2.83 mg/L; p < 0.0001) and ferritin in Roma males (403.78 ± 391.84 vs. 302.67 ± 236.26 mg/L; p < 0.0001). Conclusions: Serum UA is sex- and ethnicity specific. Elevated levels of hsCRP and ferritin particularly in Roma males can reflect low-grade systemic inflammation and thus serve as a marker of an increased cardiovascular risk.
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Affiliation(s)
- Maria Pallayova
- Department of Medical Physiology, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia;
| | - Marek Brenisin
- Department of Pathological Physiology, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia;
| | - Alina Putrya
- 2nd Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia; (A.P.); (D.P.)
- Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia
| | - Martin Vrsko
- Department of Internal Medicine, AGEL Hospital, Kosice-Saca, 04015 Kosice, Slovakia;
| | - Sylvia Drazilova
- 2nd Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia; (S.D.); (M.J.); (P.J.)
- Louis Pasteur University Hospital, 04011 Kosice, Slovakia
| | - Martin Janicko
- 2nd Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia; (S.D.); (M.J.); (P.J.)
- Louis Pasteur University Hospital, 04011 Kosice, Slovakia
| | - Maria Marekova
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia;
| | - Daniel Pella
- 2nd Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia; (A.P.); (D.P.)
- Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia
| | - Andrea Madarasova Geckova
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia;
| | - Peter Urdzik
- Louis Pasteur University Hospital, 04011 Kosice, Slovakia
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia
| | - Peter Jarcuska
- 2nd Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, 04011 Kosice, Slovakia; (S.D.); (M.J.); (P.J.)
- Louis Pasteur University Hospital, 04011 Kosice, Slovakia
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8
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Pallayova M, Brandeburova A, Tokarova D. Update on Sexual Dimorphism in Brain Structure–Function Interrelationships: A Literature Review. Appl Psychophysiol Biofeedback 2019; 44:271-284. [DOI: 10.1007/s10484-019-09443-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Zaghloul H, Pallayova M, Al-Nuaimi O, Hovis KR, Taheri S. Association between diabetes mellitus and olfactory dysfunction: current perspectives and future directions. Diabet Med 2018; 35:41-52. [PMID: 29108100 DOI: 10.1111/dme.13542] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 12/28/2022]
Abstract
The increasing global prevalence of diabetes mellitus presents a significant challenge to healthcare systems today. Although diabetic retinopathy, nephropathy and neuropathy are well-established complications of diabetes, there is a paucity of research examining the impact of dysglycaemia on the olfactory system. Olfaction is an important sense, playing a role in the safety, nutrition and quality of life of an individual, but its importance is often overlooked when compared with the other senses. As a result, olfactory dysfunction is often underdiagnosed. The present review article aims to present and discuss the available evidence on the relationship between diabetes and olfaction. It also explores the associations between olfactory dysfunction and diabetes complications that could explain the underlying pathogenesis. Finally, it summarizes the putative pathological mechanisms underlying olfactory dysfunction in diabetes that require further investigation.
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Affiliation(s)
- H Zaghloul
- Clinical Research Core, Weill Cornell Medicine, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
- Weill Cornell Medicine, New York, NY, USA
| | - M Pallayova
- Clinical Research Core, Weill Cornell Medicine, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
- Weill Cornell Medicine, New York, NY, USA
| | - O Al-Nuaimi
- Carnegie Mellon University, Doha, Qatar
- Carnegie Mellon University, Pittsburgh, PA, USA
| | - K R Hovis
- Carnegie Mellon University, Doha, Qatar
- Carnegie Mellon University, Pittsburgh, PA, USA
| | - S Taheri
- Clinical Research Core, Weill Cornell Medicine, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
- Weill Cornell Medicine, New York, NY, USA
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Lecube A, Simó R, Pallayova M, Punjabi NM, López-Cano C, Turino C, Hernández C, Barbé F. Pulmonary Function and Sleep Breathing: Two New Targets for Type 2 Diabetes Care. Endocr Rev 2017; 38:550-573. [PMID: 28938479 DOI: 10.1210/er.2017-00173] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
Abstract
Population-based studies showing the negative impact of type 2 diabetes (T2D) on lung function are overviewed. Among the well-recognized pathophysiological mechanisms, the metabolic pathways related to insulin resistance (IR), low-grade chronic inflammation, leptin resistance, microvascular damage, and autonomic neuropathy are emphasized. Histopathological changes are exposed, and findings reported from experimental models are clearly differentiated from those described in humans. The accelerated decline in pulmonary function that appears in patients with cystic fibrosis (CF) with related abnormalities of glucose tolerance and diabetes is considered as an example to further investigate the relationship between T2D and the lung. Furthermore, a possible causal link between antihyperglycemic therapies and pulmonary function is examined. T2D similarly affects breathing during sleep, becoming an independent risk factor for higher rates of sleep apnea, leading to nocturnal hypoxemia and daytime sleepiness. Therefore, the impact of T2D on sleep breathing and its influence on sleep architecture is analyzed. Finally, the effect of improving some pathophysiological mechanisms, primarily IR and inflammation, as well as the optimization of blood glucose control on sleep breathing is evaluated. In summary, the lung should be considered by those providing care for people with diabetes and raise the central issue of whether the normalization of glucose levels can improve pulmonary function and ameliorate sleep-disordered breathing. Therefore, patients with T2D should be considered a vulnerable group for pulmonary dysfunction. However, further research aimed at elucidating how to screen for the lung impairment in the population with diabetes in a cost-effective manner is needed.
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Affiliation(s)
- Albert Lecube
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
| | - Rafael Simó
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Spain
| | - Maria Pallayova
- Department of Medicine, Weill Cornell Medicine.,Department of Human Physiology and Sleep Laboratory, Faculty of Medicine, Pavol Jozef Šafárik University, Slovak Republic
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
| | - Carolina López-Cano
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain
| | - Cecilia Turino
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain
| | - Cristina Hernández
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Spain
| | - Ferran Barbé
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Spain
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Pallayova M, Rayner H, Taheri S, Dasgupta I. Is there a difference in progression of renal disease between South Asian and white European diabetic adults with moderately reduced kidney function? J Diabetes Complications 2015; 29:761-5. [PMID: 26093483 DOI: 10.1016/j.jdiacomp.2015.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 12/22/2022]
Abstract
AIMS We examined potential ethnicity-related differences in progression of chronic kidney disease (CKD) between South Asian and white European diabetic adults with CKD stage 3 over a 5-year period. METHODS We analysed data collected from diabetic adults of white European and South Asian ethnicity who had attended diabetes and diabetes-renal outpatient clinics with baseline estimated glomerular filtration rate (eGFR) values ≥30 and <60 ml/min/1.73 m(2) over 5 years (2005-2010); 891 (76%) were white Europeans, 282 (24%) were South Asians. RESULTS Despite similar baseline eGFR (P=0.103), South Asians were younger [median (interquartile range) 68 (63-73) vs. 70 (64-77) years; P<0.001] and had worse baseline glycated haemoglobin than white Europeans [8.0 (7.0-9.1) vs. 7.6 (6.8-8.7)%; P=0.004]. The 5-year follow-up eGFR and the decline in eGFR did not differ between the two groups. Thirty-five (12.4%) South Asians and 82 (9.2%) white Europeans progressed to stages 4-5 CKD (P=0.112). There was a trend towards higher follow-up glycated haemoglobin levels in South Asians (P=0.064). CONCLUSIONS Despite worse glycaemic control, South Asian diabetic adults with CKD stage 3 did not show any difference in 5-year decline in eGFR compared with white Europeans. These data do not support ethnic differences in progression of CKD between the South Asian and white European patient populations.
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Affiliation(s)
- Maria Pallayova
- Renal Unit, Heartlands Hospital, Bordesley Green East, Birmingham, UK; Department of Human Physiology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Slovak Republic
| | - Hugh Rayner
- Renal Unit, Heartlands Hospital, Bordesley Green East, Birmingham, UK
| | - Shahrad Taheri
- Department of Medicine and Clinical Research Core, Weill Cornell Medical College - Qatar, Doha, Qatar; Specialist Weight Management Service and Diabetes Centre, Hamad Medical Corporation, Doha, Qatar; Department of Medicine, King's College London, London, UK
| | - Indranil Dasgupta
- Renal Unit, Heartlands Hospital, Bordesley Green East, Birmingham, UK.
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12
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Pallayova M, Mohammed A, Langman G, Taheri S, Dasgupta I. Predicting non-diabetic renal disease in type 2 diabetic adults: The value of glycated hemoglobin. J Diabetes Complications 2015; 29:718-23. [PMID: 25633572 DOI: 10.1016/j.jdiacomp.2014.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/28/2014] [Accepted: 12/08/2014] [Indexed: 11/17/2022]
Abstract
AIMS The indications for renal biopsy in type 2 diabetes mellitus (T2D) are not well established. We investigated the prevalence, spectrum, and predictors of biopsy-proven non-diabetic renal disease (NDRD) in T2D. METHODS An observational, single-center, retrospective study of T2D adults who underwent renal biopsies (N = 51) over 10 years for nephrotic-range proteinuria, microscopic hematuria, or rapidly declining renal function. RESULTS Thirty-five (68.6%) biopsies were diagnostic of NDRD, and 16 (31.4%) revealed isolated diabetic nephropathy. The most common NDRDs were interstitial nephritis (20%), progressive crescentic glomerulonephritis (14%), membranous nephropathy (11%), and focal segmental glomerulosclerosis (11%). The odds for NDRD declined by 97% in the presence of diabetic retinopathy (P < 0.001). The deterioration of HbA1c during the year before biopsy predicted NDRD even after adjusting for diabetic retinopathy (OR, 7.65; 95% CI, 1.36-123.04; P = 0.003). A model based on the interaction between the HbA1c values 12 months before biopsy and the absolute change in these values during the preceding year predicted NDRD with 73.7% sensitivity and 75% specificity (AUC, 0.77; 95% CI, 0.59-0.94). CONCLUSIONS This study demonstrated a considerably high prevalence of NDRD in T2D adults undergoing renal biopsy. The absence of diabetic retinopathy, lower HbA1c values 12 months before biopsy and greater deterioration in HbA1c prior to biopsy predicted NDRD in T2D. Further studies are needed to validate the findings.
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Affiliation(s)
- Maria Pallayova
- Renal Unit, Heartlands Hospital, Bordesley Green East, Birmingham, UK.
| | | | - Gerald Langman
- Department of Histopathology, Heartlands Hospital, Bordesley Green East, Birmingham, UK.
| | - Shahrad Taheri
- Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country/National Institute for Health Research, University of Birmingham, Birmingham, UK; Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK.
| | - Indranil Dasgupta
- Renal Unit, Heartlands Hospital, Bordesley Green East, Birmingham, UK.
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Pallayova M, Taheri S. Non-alcoholic fatty liver disease in obese adults: clinical aspects and current management strategies. Clin Obes 2014; 4:243-53. [PMID: 25825857 DOI: 10.1111/cob.12068] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/15/2014] [Accepted: 05/28/2014] [Indexed: 12/18/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder whose prevalence is strongly linked to the current epidemic of obesity in many western countries. The prevalence of NAFLD is two to four times higher in populations with pre-existing metabolic comorbidities than in the general population. The diagnosis of primary NAFLD involves establishing the presence of hepatic steatosis or steatohepatitis by imaging or histology, along with establishing the non-alcoholic nature of the disease process and excluding competing aetiologies for hepatic steatosis. Among the indirect serum biomarkers, the NAFLD fibrosis score can help to identify patients with NAFLD and with higher likelihood of having fibrosis or cirrhosis. A liver biopsy should be considered in NAFLD patients at increased risk for steatohepatitis/advanced fibrosis and in cases where a liver biopsy is necessary to exclude co-existing chronic liver diseases and other aetiologies for hepatic steatosis. The treatment and management recommendations for obesity-associated NAFLD are aimed towards weight reduction. The currently available interventions employed to promote weight loss and improve the metabolic responses in NAFLD include lifestyle modification, pharmacotherapy and bariatric surgery.
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Affiliation(s)
- M Pallayova
- Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic
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Pallayova M, Banerjee D, Taheri S. Novel insights into metabolic sequelae of obstructive sleep apnoea: a link between hypoxic stress and chronic diabetes complications. Diabetes Res Clin Pract 2014; 104:197-205. [PMID: 24485855 DOI: 10.1016/j.diabres.2014.01.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 08/16/2013] [Accepted: 01/02/2014] [Indexed: 11/23/2022]
Abstract
An increasing body of evidence suggests that obstructive sleep apnoea (OSA) is independently associated with an increased risk of cardiovascular disease, glucose intolerance, and deteriorations in glycaemic control. Despite the knowledge of a multifactorial pathogenesis of long-term diabetes complications, there is a paucity of information on impact of comorbidities associated with chronic intermittent hypoxemia on development and progression of chronic diabetes complications. This review explores the clinical and scientific overlap of OSA and type 2 diabetes mellitus (T2DM) and its possible impact on the development and progression of diabetes macrovascular and microvascular complications. Multiple prospective observational cohort studies have demonstrated that OSA significantly increases the risk of cardiovascular disease independent of potential confounding risk factors. The current evidence further suggests that OSA with concurrent T2DM is associated with an increased risk of oxidative stress-induced damage of vulnerable endothelial and mesangial cells and peripheral nerves. Further studies are needed to validate the impact of OSA treatment on diabetes micro- and macrovascular complications. Since it is presently still unknown whether OSA treatment may provide a diabetes-modifying intervention that could delay or halt the progression of chronic diabetes complications, the emphasis is on early diagnosis and satisfactory treatment of both OSA and T2DM.
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Affiliation(s)
- Maria Pallayova
- Department of Human Physiology and Sleep Laboratory, Faculty of Medicine and Dentistry, PJ Safarik University, Kosice, Slovakia
| | - Dev Banerjee
- St Vincents Clinical School, University of New South Wales, St Vincents Hospital, Sydney, Australia; NHMRC Centre for Integrated Research and Understanding Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Australia
| | - Shahrad Taheri
- Department of Medicine, Weill Cornell Medical College - Qatar, Doha, Qatar; Department of Medicine, King's College London, London, UK.
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Affiliation(s)
- Maria Pallayova
- Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country/National Institute for Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Violet Wilson
- Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Reggie John
- Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Shahrad Taheri
- Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country/National Institute for Health Research, University of Birmingham, Birmingham, United Kingdom
- Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, United Kingdom
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Elewa U, Fernandez B, Egido J, Ortiz A, Kaifu K, Tahara N, Ueda S, Yamagishi SI, Takeuchi M, Okuda S, Buraczynska M, Zukowski P, Wacinski P, Ksiazek A, Wu HY, Peng YS, Hung KY, Wu KD, Tu YK, Chien KL, Papale M, Vocino G, Di Paolo S, Pontrelli P, Conserva F, Rocchetti MT, Grandaliano G, De Cosmo S, Gesualdo L, Prkacin I, Duvnjak L, Bulum T, Prkacin I, Duvnjak L, Bulum T, Dumann K, Horrmann B, Lammert A, Gorski M, Kramer B, Heid I, Boger C, Aggarwal HK, Jain D, Talapatra P, Lenghel AR, Moldovan D, Rusu CC, Rusu A, Rahaian R, Bondor CI, Kacso IM, Unal A, Kocyigit I, Yilmaz S, Eser B, Elmali F, Sipahioglu M, Tokgoz B, Oymak O, Velioglu A, Guler D, Arikan H, Koc M, Tuglular S, Ozener C, Pallayova M, Rayner HC, Taheri S, Dasgupta I, Fernandes FB, Fernandes AB, Febba ACDS, Vitalle MSDS, Jung F, Casarini DE, Liu F, Huang M, Fu P, Bulatovic A, Popovic J, Ille K, Jelic S, Beljic Zivkovic T, Dimkovic N, Kohli HS, Ramachandran R, Kumar S, Jha V, Sakhuja V, Hamamoto K, Inaba M, Yamada S, Yoda K, Imanishi Y, Emoto M, Okuno S, Shoji S, Silva A, Fragoso A, Pinho A, Silva C, Santos N, Faisca M, Neves PL, Capolongo G, Restivo A, Pluvio M, Capasso G, Bello BT, Mabayoje OM, Amira OC, Theodoridis M, Panagoutsos S, Roumeliotis A, Kantartzi K, Tsigalou C, Passadakis P, Vargemezis V, Deeb A, Zaoui P, Le Penven S, Tartry D, Ducher M, Fauvel JP, Angioi A, Asunis AM, Cao R, Atzeni A, Conti M, Floris M, Melis P, Pili G, Piras D, Piredda G, Pani A, Murata M, Ishikawa SE, Aoki A, Unal A, Kocyigit I, Cerci I, Dogan E, Arikan T, Sipahioglu M, Tokgoz B, Oymak O, Madziarska K, Letachowicz K, Golebiowski T, Zmonarski SC, Krajewska M, Letachowicz W, Penar J, Kusztal M, Augustyniak-Bartosik H, Klak R, Weyde W, Klinger M. Diabetes - clinical studies. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tomori Z, Donic V, Benacka R, Gresova S, Peregrim I, Kundrik M, Pallayova M, Jakus J. Reversal of functional disorders by aspiration, expiration, and cough reflexes and their voluntary counterparts. Front Physiol 2012; 3:467. [PMID: 23248602 PMCID: PMC3522066 DOI: 10.3389/fphys.2012.00467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 11/26/2012] [Indexed: 12/02/2022] Open
Abstract
Agonal gasping provoked by asphyxia can save ~15% of mammals even from untreated ventricular fibrillation (VF), but it fails to revive infants with sudden infant death syndrome (SIDS). Our systematic study of airway reflexes in cats and other animals indicated that in addition to cough, there are two distinct airway reflexes that may contribute to auto-resuscitation. Gasp- and sniff-like spasmodic inspirations (SIs) can be elicited by nasopharyngeal stimulation, strongly activating the brainstem generator for inspiration, which is also involved in the control of gasping. This “aspiration reflex” (AspR) is characterized by SI without subsequent active expiration and can be elicited during agonal gasping, caused by brainstem trans-sections in cats. Stimulation of the larynx can activate the generator for expiration to evoke the expiration reflex (ExpR), manifesting with prompt expiration without preceding inspiration. Stimulation of the oropharynx and lower airways provokes the cough reflex (CR) which results from activating of both generators. The powerful potential of the AspR resembling auto-resuscitation by gasping can influence the control mechanisms of vital functions, mediating reversal of various functional disorders. The AspR in cats interrupted hypoxic apnea, laryngo- and bronchospasm, apneusis and even transient asphyxic coma, and can normalize various hypo- and hyper-functional disorders. Introduction of a nasogastric catheter evoked similar SIs in premature infants and interrupted hiccough attacks in adults. Coughing on demand can prevent anaphylactic shock and resuscitate the pertinent subject. Sniff representing nasal inspiratory pressure and maximal inspiratory and expiratory pressures (MIP and MEP) are voluntary counterparts of airway reflexes, and are useful for diagnosis and therapy of various cardio-respiratory and neuromuscular disorders.
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Affiliation(s)
- Zoltan Tomori
- Department of Human Physiology, Faculty of Medicine, University of PJ Safarik Kosice, Slovakia
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Pallayova M. The vicious cycle of leptin-insulin resistance predicts impaired glucose metabolism in obese adults with obstructive sleep apnea. J Clin Sleep Med 2012; 8:227-8; author reply 229. [PMID: 22505873 DOI: 10.5664/jcsm.1794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pallayova M, Lazurova I, Donic V. Hypoxic damage to pancreatic beta cells--the hidden link between sleep apnea and diabetes. Med Hypotheses 2011; 77:930-4. [PMID: 21899957 DOI: 10.1016/j.mehy.2011.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 08/12/2011] [Indexed: 11/17/2022]
Abstract
Despite a large body of epidemiologic and clinical evidence suggesting that sleep disordered breathing is an independent risk factor for development of type 2 diabetes (T2DM), the underlying pathogenesis of altered glucose metabolism in sleep apnea remains to be unraveled. While previous studies have proposed some causal pathways linking sleep apnea with T2DM through increased insulin resistance and deterioration in insulin sensitivity, there has been a particular lack of research into sleep apnea-related alterations in pancreatic beta-cell function. Drawing upon our previous observation that sleep apnea is independently associated with an increased basal pancreatic beta-cell function in adults with normal glucose metabolism, the idea presented here suggests that sleep apnea imposes an excessive demand for insulin secretion, which may lead to progressive pancreatic beta-cell failure in high-risk individuals. Specifically, we hypothesize that in addition to diabetogenic effects of acute hypoxic activation of the sympathetic nervous system, the chronic intermittent hypoxemia represses the expression of key genes regulating biosynthesis of pancreatic proinsulin convertases with a resultant progressive decrease in their catalytic activity. The long-term hypoxic damage to pancreatic beta-cells may thus contribute to progression of glucose dysregulation in persons with untreated sleep apnea over time. Strategies to prevent and decrease the high prevalence and associated morbidity of T2DM are critically needed. The ideas and hypotheses presented here address the unexplored pathophysiological mechanisms underlying the potential causal link between sleep apnea and T2DM. Future hypotheses-testing will seek to delineate the role of sleep apnea in the development of T2DM, probe the underlying molecular mechanisms for pancreatic beta-cell dysfunction in sleep apnea, and obtain information on clinical, epidemiologic, and other factors responsible for protecting individuals from alterations in insulin-glucose homeostasis. These results could further be utilized in testing genetic susceptibilities and various therapy modalities to prevent pancreatic beta-cell dysfunction and maintain normal glucose status in persons with sleep apnea in the long term.
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Affiliation(s)
- Maria Pallayova
- Department of Physiology and Sleep Laboratory, School of Medicine, P.J. Safarik University, Kosice, Slovakia.
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Gresova S, Tomori Z, Widdicombe J, Donic V, Kundrik M, Bacova I, Pallayova M. Heart rate variability in hypertension caused by sleep disordered breathing and its modification by CPAP. BRATISL MED J 2011; 112:125-130. [PMID: 21452763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES 1) To analyze heart rate variability (HRV) changes, reflecting the sympathovagal balance with secondary hypertension caused by sleep disordered breathing (SDB), compared to healthy controls and essential hypertension without SDB; 2) to compare HRV changes between various degrees of SDB severity; and 3) to test the modification of HRV indices by continuous positive airway pressure (CPAP) in SDB patients. BACKGROUND Differentiation of secondary hypertension caused by SDB from essential hypertension and healthy controls by ambulatory blood pressure measurement (ABPM) and its modification by CPAP, requires an analysis of HRV changes, as frequently used for the prediction of cardiovascular risk. METHODS HRV changes were analyzed in 48 adults divided into six groups according to the apnoea/hypopnoea index (AHI), i.e. three groups with various degrees of SDB, a group with severe SDB after CPAP application, a group with essential hypertension without SDB, and a group of healthy controls. Night-time and daytime values of low frequency (LF) and high frequency (HF) bands and the LF/HF ratio were compared in the six groups. RESULTS The night-time values of LF bands were higher in severe than in moderate and mild degrees of SDB, and the correlation of LF/HF ratio with AHI (r = 0.3511) suggests the gradual increase of sympathetic predominance with the severity of SDB. The high sympathetic activity substantially decreased after application of CPAP in severe SDB. CONCLUSION The increased nocturnal values of the LF band and the LF/HF ratio, caused by frequent apnoea/ hypopnoea episodes, support the usefulness of HRV spectral analysis for the prediction of cardiovascular risk in patients with SDB (Tab. 1, Fig. 3, Ref. 36).
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Affiliation(s)
- S Gresova
- Department of Physiology, Faculty of Medicine, University of PJ Safarik, Kosice, Slovakia
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Pallayova M, Steele KE, Magnuson TH, Schweitzer MA, Hill NR, Bevans-Fonti S, Schwartz AR. Sleep apnea predicts distinct alterations in glucose homeostasis and biomarkers in obese adults with normal and impaired glucose metabolism. Cardiovasc Diabetol 2010; 9:83. [PMID: 21122092 PMCID: PMC3002325 DOI: 10.1186/1475-2840-9-83] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 12/01/2010] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Notwithstanding previous studies supporting independent associations between obstructive sleep apnea (OSA) and prevalence of diabetes, the underlying pathogenesis of impaired glucose regulation in OSA remains unclear. We explored mechanisms linking OSA with prediabetes/diabetes and associated biomarker profiles. We hypothesized that OSA is associated with distinct alterations in glucose homeostasis and biomarker profiles in subjects with normal (NGM) and impaired glucose metabolism (IGM). METHODS Forty-five severely obese adults (36 women) without certain comorbidities/medications underwent anthropometric measurements, polysomnography, and blood tests. We measured fasting serum glucose, insulin, selected cytokines, and calculated homeostasis model assessment estimates of insulin sensitivity (HOMA-IS) and pancreatic beta-cell function (HOMA-B). RESULTS Both increases in apnea-hypopnea index (AHI) and the presence of prediabetes/diabetes were associated with reductions in HOMA-IS in the entire cohort even after adjustment for sex, race, age, and BMI (P = 0.003). In subjects with NGM (n = 30), OSA severity was associated with significantly increased HOMA-B (a trend towards decreased HOMA-IS) independent of sex and adiposity. OSA-related oxyhemoglobin desaturations correlated with TNF-α (r=-0.76; P = 0.001) in women with NGM and with IL-6 (rho=-0.55; P = 0.035) in women with IGM (n = 15) matched individually for age, adiposity, and AHI. CONCLUSIONS OSA is independently associated with altered glucose homeostasis and increased basal beta-cell function in severely obese adults with NGM. The findings suggest that moderate to severe OSA imposes an excessive functional demand on pancreatic beta-cells, which may lead to their exhaustion and impaired secretory capacity over time. The two distinct biomarker profiles linking sleep apnea with NGM and IGM via TNF-α and IL-6 have been discerned in our study to suggest that sleep apnea and particularly nocturnal oxyhemoglobin desaturations are associated with chronic metabolic fluxes and specific cytokine stressors that reflect links between sleep apnea and glucose metabolism. The study may help illuminate potential mechanisms for glucose dysregulation in OSA, and resolve some controversy over the associations of OSA with TNF-α and IL-6 in previous studies.
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Affiliation(s)
- Maria Pallayova
- Johns Hopkins Sleep Disorders Center, Johns Hopkins University, Baltimore, MD, USA.
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Abstract
BACKGROUND It has been shown previously that the suppression of slow-wave sleep (SWS) markedly reduced insulin sensitivity and led to an impairment of glucose tolerance. We hypothesized that a decreased amount of SWS is a feature peculiar to subjects with type 2 diabetes. METHOD A retrospective case-control study analyzed polysomnographic recordings and covariate data of 22 type 2 diabetic and 22 nondiabetic subjects [n = 44; 8 women, 36 men, aged 57.5 +/- 5.5 years, body mass index (BMI) 33.8 +/- 5.9 kg/m(2), apnea-hypopnea index (AHI) 29.6 +/- 22.2 episodes/hr] matched individually for sex, race, age, BMI, and severity of sleep-related breathing disorders (SRBD). We assessed differences in sleep architecture between the study group and the control group. Primary end points included the percentage of total sleep time spent in each sleep stage. RESULTS Despite similar age and severity of SRBD, subjects with type 2 diabetes demonstrated a significantly decreased amount of SWS (3.9 +/- 5.95% vs 8.4 +/- 4.57%; p = 0.012), increased percentage time in rapid eye movement sleep (24.1 +/- 12.14% vs 13.8 +/- 6.96%; p = 0.005), and higher arousal index (44.3 +/- 19.53/hr vs 35.7 +/- 12.67/hr; p = 0.037) compared to nondiabetic controls. After adjustment for sex, BMI, AHI, and smoking, age and presence of type 2 diabetes were independent predictors of the decreased SWS percentage (p = 0.001). Variables in this model accounted for 34% of the variance in the SWS percentage in our cohort. CONCLUSIONS Results demonstrated distinct differences in sleep architecture in our cohort with decreased amounts of SWS in type 2 diabetes. These findings suggest that polysomnographic recognition of altered sleep architecture may be partially implicated in the early detection of persons with type 2 diabetes.
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Affiliation(s)
- Maria Pallayova
- Department of Physiology and Sleep Laboratory, PJ Safarik University School of Medicine, Kosice, Slovakia.
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Pribylova H, Pallayova M, Hucikova J, Luza J. Evaluation of the new software program DegifXL4 in the determination of the glycaemic indices of foodstuffs. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 152:65-71. [PMID: 18795077 DOI: 10.5507/bp.2008.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS There is no standardized protocol for measuring glycemic index (GI) that takes time-of-day effects into account. The software DegifXL2 and Medtronic-Minimed's CGMS and Solutions, makes the GI calculation at breakfast and dinner time possible. The aim of this study was to assess the enhanced data processing software (DegifXL4) enabling the GI calculation at breakfast, lunch, afternoon snack and dinner times. METHODS The glucose levels of 20 healthy volunteers were monitored after they consumed either 50 g of glucose or one of ten alternative foodstuffs either for breakfast and dinner or for lunch or snack. Within the 9-day test period, 10 such meals were monitored in 3 replicates for each volunteer. Specifically, CGMS was used to monitor plasma glucose levels at 5-minute intervals for a period of 120 min following the foodstuff ingestion. RESULTS Using the enhanced spreadsheed DegifXL 4, a total of 640 profiles were obtained and 491 (77 %) accomplished the criteria for further processing. The percentage of successful tests in each foodstuff varied from 57 to 87 %. CONCLUSIONS The use of the new software DegifXL4 offers accurate GI estimates for foodstuffs eaten for breakfast, lunch, snacks and dinners in three replicates. In combination with the CGMS Solutions Software is DegifXL4 an enhanced efficient and comfortable way to routinely measure GI values.
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Affiliation(s)
- Helena Pribylova
- Department of Physiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
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Lippaiova N, Pallayova M, Kuzmina G, Peterson K, Fajkosova L, Luza J. Safety of new algorithms for premeal insulin boluses in high glycaemic index meals in persons with type 1 diabetes mellitus using insulin pumps. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 152:73-7. [PMID: 18795078 DOI: 10.5507/bp.2008.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIMS Consumption of glucose or foodstuffs with high glycaemic index (GI) in persons with type 1 diabetes mellitus (PWD1) is a hot topic in present diabetology. The aim of our pilot prospective study was to assess the efficiency of empirically suggested simple algorithms for premeal boluses in PWD1 using insulin pumps and continuous glucose monitoring (CGM). METHODS Six PWD1 (aged 46.2+/-15.09 y, diabetes duration 14.5+/-9.65 y, HbA1c/IFCC 6.3+/-1.59%, BMI 23.6+/-1.67 kg/m(2), mean+/-SD) on insulin pumps Paradigm 522/722 with RT-CGMS sensors (Medtronic MiniMed, Northridge, CA) underwent a 12-week CGM. In one week, subjects consumed 50 g of carbohydrates in eleven alternative meals (rice squares, dark chocolate, white bread, honey, glucose, ravioli with meat and Eidam cheese, mashed potatoes with fish fingers, apricot dumplings with butter, spa waffles, spalta squares, and tomato soup with pasta) eaten for breakfasts, lunches, snacks and dinners in order to calculate their GI. The insulin boluses were adjusted according to empirically defined algorithms. Average glucose levels and daily insulin doses over three one-week periods (before testing, testing and after testing) were compared. RESULTS During the observational period, the weekly averages of glucose levels (9.1+/-2.33 mmol/l vs. 9.2+/-2.30 mmol/l vs. 9.0+/-2.43 mmol/l, respectively) and daily insulin doses (39.1+/- 8.14 IU/d vs. 39.7+/-10.7 IU/d vs. 38.6+/-9.97 IU/d, respectively) were similar. One-week consumption of high GI foodstuffs had only a negligeable effect on average glucose levels. CONCLUSION The suggested algorithms for premeal insulin boluses appear to limit the risk of potential hyperglycaemia resulting from intake of high GI foodstuffs.
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Affiliation(s)
- Natalia Lippaiova
- Department of Physiology, 2nd Department of Medicine, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic.
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Jadviscokova T, Fajkusova Z, Pallayova M, Luza J, Kuzmina G. Occurence of adverse events due to continuous glucose monitoring. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 151:263-6. [PMID: 18345261 DOI: 10.5507/bp.2007.044] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS Continuous glucose monitoring (CGM) using transcutaneous sensors is becoming a sophisticated method to control and regulate glucose metabolism. The transcutaneous sensor of the CGM system (CGMS Medtronic Minimed, Northridge, CA, USA) is chosen to measure glucose concentration in interstitial fluid up to three days after insertion even though its function remains stable for a longer period. The question arises, which factors really limit the period of sensor insertion without unnecessary risk. The aim of this study was to assess any adverse events occurring in the course of 9 days after the sensor insertion. METHODS In a group of 22 healthy volunteers aged 21.8+/-1.30 y (mean +/- SE) a total of 26 sensors was inserted subcutaneously in gluteal or lumbar region for 9 days. Before insertion the site was sprayed with an antiseptic (Cutasept F, Bode Chemie, Hamburg, Germany). Local adverse reactions and disturbances in general condition were examined. RESULTS In the course of 184 sensor-days, there were only minor local adverse events: hypersensitivity, itching, pain, redness, burning, subcutaneous hemorrhage. Additionally, sleep disturbances, attention deficits, problems related to the CGMS monitor, to adhesive tape and/or sensor were found. None of these resulted in sensor withdrawal. In 12 volunteers (55 %) no complications were observed. The sensor function measured according to electrical signals (ISIG) failed (always on day 1-2) in 4 cases (16 %). CONCLUSIONS The present FDA approved 3-day insertion period for Medtronic transcutaneous sensor does not seem to limit its use and appears to be worth a careful revision.
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Affiliation(s)
- Tereza Jadviscokova
- Department of Physiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
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Fajkusova Z, Jadviscokova T, Pallayova M, Matuskova V, Luza J, Kuzmina G. Glycaemic index of selected foodstuffs in healthy persons. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 151:257-61. [PMID: 18345260 DOI: 10.5507/bp.2007.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS The aim of this study was to determine glycaemic index (GI) of 10 popular foodstuffs/mixed meals in healthy persons. METHODS Ten tested foodstuffs and glucose standard were consumed in three replicates in the course of a defined 9-day meal plan: puffed rice squares with chocolate, dark chocolate, white bread, honey and glucose for breakfast (at 7 a.m.) and dinner (at 8 p.m.); pasta with meat, fried fish with mashed potatoes, and buttered apricot dumplings for lunch (at 12 a.m.); wafers, puffed spelt squares with chocolate, and tomato soup for snack (at 4 p.m.). Each portion contained 50 g of carbohydrates and was consumed within 30 minutes. Glucose concentrations were measured by means of the Continous Glucose Monitoring System (CGMS, Medtronic Minimed, Northridge, CA, USA). The results were processed by Solutions Software (Medtronic Minimed, Northridge, CA, USA) and DegifXL4 software, Palacký University, Olomouc, CZ. Twenty healthy persons aged 21.9 +/- 1.39 y (mean +/- SE), BMI 23.6 +/- 0.63 kg/m(2) completed the study. RESULTS GI of tested foodstuffs ranged from 34.7 % (chocolate) to 105.3 % (puffed rice squares with chocolate). There were more than tenfold differences between minimal and maximal values of the GI for some foodstuffs. Significant interindividual differences were found between GIs of foodstuffs. CONCLUSIONS In twenty healthy persons the glycaemic indexes of ten popular foodstuffs were determined, to be added to the nutritional labels in order to facilitate the optimum meal planning.
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Affiliation(s)
- Zuzana Fajkusova
- Department of Physiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
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Pallayova M, Donic V, Tomori Z. Beneficial effects of severe sleep apnea therapy on nocturnal glucose control in persons with type 2 diabetes mellitus. Diabetes Res Clin Pract 2008; 81:e8-11. [PMID: 18440086 DOI: 10.1016/j.diabres.2008.03.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Accepted: 03/14/2008] [Indexed: 12/11/2022]
Abstract
Given the consequences of sleep apnea and coexisting diabetes, satisfactory treatment of both diseases is required. Our results of continuous glucose monitoring in severe sleep apnea diabetic patients before and during continuous positive airway pressure/CPAP therapy showed significant reduction of nocturnal glucose variability and improved overnight glucose control on CPAP.
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Affiliation(s)
- Maria Pallayova
- Department of Physiology and Sleep Laboratory, PJ Safarik University School of Medicine, Kosice, Slovakia.
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Donic V, Pallayova M, Donicova V, Tomori Z. O0003 Continuous glucose monitoring during OSAS episodes and treatment with CPAP in type 2 diabetic males. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pallayova M, Donic V, Donicova V, Tomori Z, Gresova S. The effect of continuous positive airway pressure on glucose excursions in diabetics with sleep-disordered breathing: the results of continuous glucose monitoring. Eur Respir Rev 2006. [DOI: 10.1183/09059180.00010123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Pallayova M, Donic V, Donicova V, Tomori Z. P320 Effect of continuous positive airway pressure on nocturnal glucose levels in type 2 diabetics with sleep apnoea: Results of continuous glucose monitoring. Sleep Med 2006. [DOI: 10.1016/j.sleep.2006.07.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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