51
|
Brzecka A, Madetko N, Nikolenko VN, Ashraf GM, Ejma M, Leszek J, Daroszewski C, Sarul K, Mikhaleva LM, Somasundaram SG, Kirkland CE, Bachurin SO, Aliev G. Sleep Disturbances and Cognitive Impairment in the Course of Type 2 Diabetes-A Possible Link. Curr Neuropharmacol 2020; 19:78-91. [PMID: 32148197 PMCID: PMC7903492 DOI: 10.2174/1570159x18666200309101750] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
There is an increasing number of patients worldwide with sleep disturbances and diabetes. Various sleep disorders, including long or short sleep duration and poor sleep quality of numerous causes, may increase the risk of diabetes. Some symptoms of diabetes, such as painful peripheral neuropathy and nocturia, or associated other sleep disorders, such as sleep breathing disorders or sleep movement disorders, may influence sleep quality and quantity. Both sleep disorders and diabetes may lead to cognitive impairment. The risk of development of cognitive impairment in diabetic patients may be related to vascular and non-vascular and other factors, such as hypoglycemia, hyperglycemia, central insulin resistance, amyloid and tau deposits and other causes. Numerous sleep disorders, e.g., sleep apnea, restless legs syndrome, insomnia, and poor sleep quality are most likely are also associated with cognitive impairment. Adequate functioning of the system of clearance of the brain from toxic substances, such as amyloid β, i.e. glymphatic system, is related to undisturbed sleep and prevents cognitive impairment. In the case of coexistence, sleep disturbances and diabetes either independently lead to and/or mutually aggravate cognitive impairment.
Collapse
Affiliation(s)
- Anna Brzecka
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Natalia Madetko
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Vladimir N Nikolenko
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya Str., Moscow, 119991, Russian Federation
| | - Ghulam M Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Leszek
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Cyryl Daroszewski
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Sarul
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Liudmila M Mikhaleva
- Research Institute of Human Morphology,3 Tsyurupy Street, Moscow, 117418, Russian Federation
| | - Siva G Somasundaram
- Department of Biological Sciences, Salem University, Salem, WV, 26426, United States
| | - Cecil E Kirkland
- Department of Biological Sciences, Salem University, Salem, WV, 26426, United States
| | - Sergey O Bachurin
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, 142432, Russian Federation
| | - Gjumrakch Aliev
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya Str., Moscow, 119991, Russian Federation
| |
Collapse
|
52
|
Diagnostic accuracy of the Berlin questionnaire and therapeutic effect of nasal continuous positive airway pressure in OSAHS patients with glucose metabolic dysfunction. Sleep Breath 2020; 25:867-876. [PMID: 33001351 DOI: 10.1007/s11325-020-02198-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/06/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with alterations in glucose metabolism. The Berlin questionnaire (BQ) is effective in identifying subjects with high risk of OSAHS. However, its validity in patients with glucose metabolic dysfunction remains unclear. Our study aims to examine the diagnostic efficacy of the BQ in detecting OSAHS in patients with glucose metabolic dysfunction and to explore the effect of nasal CPAP on glucose metabolism. METHODS Patients with glucose metabolic dysregulation were first asked to complete the BQ and then recruited for polysomnogram (PSG). The diagnostic accuracy of the BQ and the relationships between groups with normal glucose tolerance (NGT), elevated fasting blood glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus (DM) were analyzed. Subjects with both OSAHS and glucose dysregulation received CPAP treatment and underwent an oral glucose tolerance test. Changes in apnea-hypopnea indices (AHI) and glycemic parameters were calculated to determine the efficacy of CPAP. RESULTS Glycosylated hemoglobin and insulin levels were statistically different between the high-risk and low-risk groups according to the BQ. For diagnosis of subjects with OSAHS who also had glucose metabolic dysfunction, the sensitivity and specificity of the BQ using AHI cut-off values at 5 events per hour were 73% and 67%. CPAP therapy effectively reduced the blood glucose, HOMA-IR, and insulin levels. CONCLUSIONS The BQ can be considered to be an effective and economical screening tool for patieints with OSAHS who also have glucose metabolic dysfunction. Treatment with CPAP may improve glycemic parameters.
Collapse
|
53
|
Jeon B, Sereika SM, Callan JA, Luyster FS, DiNardo MM, Chasens ER. Age-Related Differences in Mood, Diabetes-Related Distress, and Functional Outcomes in Adults With Type 2 Diabetes Mellitus and Comorbid Obstructive Sleep Apnea and Insomnia. DIABETES EDUCATOR 2020; 46:540-551. [PMID: 32948109 DOI: 10.1177/0145721720958396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to examine age-related differences in mood, diabetes-related distress, and functional outcomes in activities sensitive to impaired sleep in adults with type 2 diabetes mellitus (T2DM) and comorbid obstructive sleep apnea (OSA) and insomnia. This study also evaluated the associations of age, insomnia severity, and OSA severity on outcome variables. METHODS This study was a secondary analysis of pooled baseline data from 2 randomized controlled trials among adults with T2DM with symptoms of sleep disorders (N = 145,109 younger adults, 36 older adults; 46.2% male; 67.6% white). Comorbid OSA and insomnia was defined as Apnea-Hypopnea Index ≥5 events per hour and Insomnia Severity Index ≥10. Outcome variables included mood, diabetes-related distress, and functional outcomes. RESULTS Older adults reported better mood, lower diabetes-related distress, and higher functional outcomes relative to younger adults (all Ps < .05). Insomnia severity was associated with worse mood (b = 2.59, P < .001) and diabetes-related distress (b = 1.40, P < .001) and lower functional outcome (b = -0.22, P < .001). Older age was associated with lower diabetes-related distress (b = -0.44, P = .040). CONCLUSION Older age was a protective factor of mood disturbance, diabetes-related distress, and functional impairment in adults with T2DM and comorbid OSA and insomnia. Insomnia severity was associated with greater mood disturbance, diabetes-related distress, and functional impairment when OSA and insomnia coexist. The results suggest that diabetes care and education specialists should assess patients for impaired sleep.
Collapse
Affiliation(s)
- Bomin Jeon
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania
| | - Susan M Sereika
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania
| | - Judith A Callan
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania
| | - Faith S Luyster
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania
| | | | - Eileen R Chasens
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania
| |
Collapse
|
54
|
Abstract
Purpose of review Sleep is intimately involved in overall health and wellbeing. We provide a comprehensive report on the interplay between systemic diseases and sleep to optimize the outcomes of systemic disorders. Recent findings Spanning the categories of endocrinologic disorders, metabolic/toxic disturbances, renal, cardiovascular, pulmonary, gastrointestinal, infectious diseases, autoimmune disorders, malignancy, and critical illness, the review highlights the prevalent coexisting pathology of sleep across the spectrum of systemic disorders. Although it is rare that treating a sleep symptom can cure disease, attention to sleep may improve quality of life and may mitigate or improve the underlying disorder. Recent controversies in assessing the cardiovascular relationship with sleep have called into question some of the benefits of treating comorbid sleep disorders, thereby highlighting the need for an ongoing rigorous investigation into how sleep interplays with systemic diseases. Summary Systemic diseases often have sleep manifestations and this report will help the clinician identify key risk factors linking sleep disorders to systemic diseases so as to optimize the overall care of the patient.
Collapse
Affiliation(s)
- Eric M. Davis
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA USA
| | - Chintan Ramani
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA USA
| | - Mark Quigg
- Department of Neurology, University of Virginia, Charlottesville, VA USA
| |
Collapse
|
55
|
Control of 24-hour blood pressure with SGLT2 inhibitors to prevent cardiovascular disease. Prog Cardiovasc Dis 2020; 63:249-262. [PMID: 32275926 DOI: 10.1016/j.pcad.2020.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023]
Abstract
The presence of hypertension (HTN) in patients with diabetes mellitus (DM) further worsens cardiovascular disease (CVD) prognosis. In addition, masked HTN and abnormal circadian blood pressure (BP) variability are common among patients with DM. Clinical trial data show that sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve CVD prognosis and prevent progression of renal dysfunction in high-risk patients with type 2 DM (T2DM). Consistent reductions in 24-hour, daytime and nocturnal BP have been documented during treatment with SGLT2i in patients with DM and HTN, and these reductions are of a magnitude that is likely to be clinically significant. SGLT2i agents also appear to have beneficial effects on morning, evening and nocturnal home BP. Greater reductions in BP during treatment with SGLT2i have been reported in patient subgroups with higher body mass index, and in those with higher baseline BP. Other documented beneficial effects of SGLT2i include reductions in arterial stiffness and the potential to decrease the apnea-hypopnea index in patients with DM and obstructive sleep apnea. Recent guidelines highlight the important role of SGLT2i as part of the pharmacological management of patients with DM and HTN, and recommend consideration of SGLT2i early in the clinical course to reduce all-cause and CVD mortality in patients with T2DM and CVD. Overall, available data support a role for SGLT2i as effective BP-lowering agents in patients with T2DM and poorly controlled HTN, irrespective of baseline glucose control status. Sustained improvements in 24-hour BP and the 24-hour BP profile are likely to contribute to the CVD benefits of SGLT2i treatment.
Collapse
|
56
|
Khalil M, Power N, Graham E, Deschênes SS, Schmitz N. The association between sleep and diabetes outcomes - A systematic review. Diabetes Res Clin Pract 2020; 161:108035. [PMID: 32006640 DOI: 10.1016/j.diabres.2020.108035] [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: 11/09/2019] [Revised: 01/14/2020] [Accepted: 01/27/2020] [Indexed: 12/21/2022]
Abstract
AIM This study aimed to systematically review the prevalence of diagnosed sleep disorders in people with diabetes and to determine the association between sleep disorders and blood glucose levels and diabetes outcomes. METHODS We conducted a literature search in the following databases: MEDLINE (Pubmed), EMBASE, CINAHL, PsychInfo and Web of Science Citation Index. Meta-analysis (random-effects models) was conducted to estimate the prevalence of sleep disorders in people with diabetes. RESULTS Forty-one articles measured the prevalence of sleep disorders in adults with diabetes. The estimated pooled prevalence of sleep disorders in diabetes was estimated to be 52% (95% CI 42-63%). The highest pooled prevalence was observed for unspecified sleep apnea (69%; 95% CI: 59-78%), followed by obstructive sleep apnea (60%; 95% CI 39-80%), and restless leg syndrome (27%; 95% CI 20-34%). Eleven studies examined the association between sleep disorders and diabetes control and complications. The presence of comorbid sleep disorders was associated with increased diabetes outcomes. CONCLUSIONS Diagnosed sleep disorders are highly prevalent in people with diabetes. Sleep disorders are associated with diabetes outcomes, though there was considerable heterogeneity across studies.
Collapse
Affiliation(s)
- Marina Khalil
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada; Douglas Research Centre, Montreal, QC, Canada
| | - Niamh Power
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada; Douglas Research Centre, Montreal, QC, Canada
| | - Eva Graham
- Douglas Research Centre, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sonya S Deschênes
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada; Douglas Research Centre, Montreal, QC, Canada; School of Psychology, University College Dublin, Dublin, Ireland
| | - Norbert Schmitz
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada; Douglas Research Centre, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada; Montreal Diabetes Research Centre, Montreal, QC, Canada.
| |
Collapse
|
57
|
Yan B, Zhao B, Fan Y, Yang J, Zhu F, Chen Y, Ma X. The association between sleep efficiency and diabetes mellitus in community-dwelling individuals with or without sleep-disordered breathing. J Diabetes 2020; 12:215-223. [PMID: 31503406 DOI: 10.1111/1753-0407.12987] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/26/2019] [Accepted: 09/08/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sleeping habits have been reported to be associated with diabetes mellitus. This study aimed to explore the relationship of sleep efficiency with diabetes mellitus in individuals with or without sleep-disordered breathing based on polysomnography records. METHODS We enrolled participants from the Sleep Heart Health Study. Objective indicators of sleep characteristics including sleep efficiency, sleep latency, slow-wave sleep, wake after sleep onset, and total arousal index were monitored via in-home polysomnography. Sleep efficiency was divided into grade 1 (≥85%), grade 2 (80%-84.9%), and grade 3 (<80%). Multivariate logistic regression models were utilized to investigate the association between sleep quality and diabetes mellitus. RESULTS The present study comprised 4737 participants with a mean age of 63.6 ± 11.0 years. The prevalence of diabetes mellitus was higher in those with grade 3 sleep efficiency than that in those with grade 1 and grade 2 sleep efficiency in participants with (10.9% vs 8.5% vs 8.3%, respectively; P =.134) or without (9.5% vs 5.6% vs 3.5%, respectively; P <.001) sleep-disordered breathing. After adjusting for potential confounding factors, sleep efficiency <80% was associated with the prevalence of diabetes mellitus only in participants without sleep-disordered breathing (odds ratio, 1.894; 95% confidence interval, 1.187-3.022, P =.007). CONCLUSION Poor sleep efficiency is associated with diabetes mellitus in those without sleep-disordered breathing. Therefore, the relationship between sleep efficiency and diabetes mellitus is worth further investigation.
Collapse
Affiliation(s)
- Bin Yan
- Department of Clinical Research Centre, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Binbin Zhao
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yajuan Fan
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian Yang
- Department of Clinical Research Centre, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Feng Zhu
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yunchun Chen
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiancang Ma
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
58
|
Clancy F, Prestwich A, Caperon L, Tsipa A, O’Connor DB. The association between worry and rumination with sleep in non-clinical populations: a systematic review and meta-analysis. Health Psychol Rev 2020; 14:427-448. [DOI: 10.1080/17437199.2019.1700819] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- F. Clancy
- School of Psychology, Faculty of Medicine and Health, The University of Leeds, Leeds, UK
| | - A. Prestwich
- School of Psychology, Faculty of Medicine and Health, The University of Leeds, Leeds, UK
| | - L. Caperon
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, The University of Leeds, Leeds, UK
| | - A. Tsipa
- School of Psychology, Faculty of Medicine, The University of Leeds, Leeds, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Camden and Islington Foundation Trust, London, UK
| | - D. B. O’Connor
- School of Psychology, Faculty of Medicine and Health, The University of Leeds, Leeds, UK
| |
Collapse
|
59
|
Meszaros M, Tarnoki AD, Tarnoki DL, Kovacs DT, Forgo B, Lee J, Sung J, Vestbo J, Müller V, Kunos L, Bikov A. Obstructive sleep apnea and hypertriglyceridaemia share common genetic background: Results of a twin study. J Sleep Res 2020; 29:e12979. [PMID: 31908118 DOI: 10.1111/jsr.12979] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/24/2019] [Accepted: 12/12/2019] [Indexed: 12/14/2022]
Abstract
Obstructive sleep apnea is associated with an increased risk of hypertension, diabetes and dyslipidaemia. Both obstructive sleep apnea and its comorbidities are at least partly heritable, suggesting a common genetic background. Our aim was to analyse the heritability of the relationship between obstructive sleep apnea and its comorbidities using a twin study. Forty-seven monozygotic and 22 dizygotic adult twin pairs recruited from the Hungarian Twin Registry (mean age 51 ± 15 years) attended an overnight diagnostic sleep study. A medical history was taken, blood pressure was measured, and blood samples were taken for fasting glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and lipoprotein (a). To evaluate the heritability of obstructive sleep apnea and its comorbidities bivariate analysis was performed with an adjustment for age, gender, body mass index (BMI) and smoking after false discovery rate correction and following exclusion of patients on lipid-lowering and antidiabetic medications. There was a significant correlation between indices of obstructive sleep apnea severity, such as the apnea-hypopnea index, oxygen desaturation index and percentage of sleep time spent with oxygen saturation below 90%, as well as blood pressure, serum triglyceride, lipoprotein (a) and glucose levels (all p < .05). The bivariate analysis revealed a common genetic background for the correlations between serum triglyceride and the oxygen desaturation index (r = .63, p = .03), as well as percentage of sleep time spent with oxygen saturation below 90% (r = .58, p = .03). None of the other correlations were significantly genetically or environmentally determined. This twin study demonstrates that the co-occurrence of obstructive sleep apnea with hypertriglyceridaemia has a genetic influence and heritable factors play an important role in the pathogenesis of dyslipidaemia in obstructive sleep apnea.
Collapse
Affiliation(s)
- Martina Meszaros
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | | | | | - Bianka Forgo
- Department of Medical Imaging, Semmelweis University, Budapest, Hungary
| | - Jooyeon Lee
- Complex Disease and Genome Epidemiology Branch, Department of Public Health Science, School of Public Health, Seoul National University, Seoul, Korea
| | - Joohon Sung
- Complex Disease and Genome Epidemiology Branch, Department of Public Health Science, School of Public Health, Seoul National University, Seoul, Korea
| | - Jørgen Vestbo
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Laszlo Kunos
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Andras Bikov
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.,North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| |
Collapse
|
60
|
4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020; 43:S37-S47. [PMID: 31862747 DOI: 10.2337/dc20-s004] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
61
|
Umoh VA, Akpan EE, Ekrikpo UE, Idung AU, Ekpe EE. The Risk of Obstructive Sleep Apnea among Patients with Type 2 Diabetes Mellitus. Niger Med J 2020; 61:32-36. [PMID: 32317819 PMCID: PMC7113821 DOI: 10.4103/nmj.nmj_129_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/26/2019] [Accepted: 10/18/2019] [Indexed: 11/04/2022] Open
Abstract
CONTEXT/AIMS Obstructive sleep apnea (OSA) and Type 2 diabetes mellitus share obesity as a common risk factor. The presence of OSA may contribute to increased morbidity and mortality of diabetes. Despite their close association, OSA is not routinely evaluated in diabetic patients. This study was conducted to determine the risk of OSA among Type 2 diabetes mellitus patients. METHODS Type 2 diabetic patients attending a tertiary hospital in Nigeria were evaluated for OSA risk using the Berlin Questionnaire. Other parameters measured included anthropometry and blood pressure (BP). RESULTS Three hundred and twenty-seven patients participated in this survey: 177 (54.1%) were female and 150 (45.9%) were male. The average age of the patients was 56.2 ± 9.3 years. Seventy-eight (44.8%) females were obese compared to 30 (20.0%) males,P < 0.001. Two hundred and one (61.5%) patients were previously known hypertensives with only 48 (23.9%; 95% confidence interval [CI]: 18.2-30.4) of them having good BP control. One hundred and sixty-two (49.5%, 95% CI; 44.0-55.1) patients had a high risk for OSA: 96 (54.2%; 95% CI: 44.6-61.7) females and 66 (44.0%; 95% CI: 35.9-52.3) males. The strongest predictor for a high risk of OSA was poorly controlled BP with an odds ratio of 2.6 (95% CI: 1.6-4.3). CONCLUSION This study has demonstrated that there is a high risk of OSA among Type 2 diabetic patients and that OSA risk is significantly associated with poor BP control and obesity. We recommend that diabetic patients should be assessed for OSA risk as part of their routine evaluation.
Collapse
|
62
|
Wojujutari AK, Alabi OT, Emmanuel IE. Psychological resilience moderates influence of depression on sleep dysfunction of people living with diabetes. J Diabetes Metab Disord 2019; 18:429-436. [PMID: 31890668 PMCID: PMC6915166 DOI: 10.1007/s40200-019-00436-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 08/26/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The study examined the influence of depression on sleep dysfunction in people living with diabetes mellitus and investigated the moderating role of psychological resilience on the influence of depression on sleep dysfunction of patients. METHODS A cross-sectional survey was carried out among 380 (age 25-77 years; mean = 38.6; SD = 6.07) people living with diabetes who are registered patients and were attending the clinic in Department of Endocrinology, Ondo State Specialist Hospital, Akure. RESULTS Results showed that depression significantly influence sleep dysfunction of people living with diabetes, β = 0.3991, 95% CI (0.5393, 0.2588), t = 21.5010, p < 0.005. Results also showed significant moderating role of psychological resilience on the influence depression on sleep dysfunction of people living with diabetes, β = 0.7805, 95% CI (0.7091, 0.8519), t = 21.5010, p < 0.005. CONCLUSIONS Sleep dysfunction of individuals living with diabetes as result of their level of depression could be moderated by patient's level of psychological resilience. Along these lines, the study concludes that experts should focus more on diabetes patient's psychological resilience adequacy in their management, guidance and modification programs.
Collapse
|
63
|
Harding KA, Pushpanathan ME, Whitworth SR, Nanthakumar S, Bucks RS, Skinner TC. Depression prevalence in Type 2 diabetes is not related to diabetes-depression symptom overlap but is related to symptom dimensions within patient self-report measures: a meta-analysis. Diabet Med 2019; 36:1600-1611. [PMID: 31532013 DOI: 10.1111/dme.14139] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2019] [Indexed: 01/24/2023]
Abstract
AIM Depression is common in Type 2 diabetes, yet rates vary. Overlap between symptoms of depression and diabetes may account for this variability in depression prevalence rates. We examined to what extent depression prevalence was a function of the proportion of depression-diabetes symptom overlap (items within symptom dimensions) and sample characteristics. METHODS Electronic and hand searching of published and unpublished works identified 147 eligible papers. Of 3656 screened, 147 studies (149 samples, N = 17-229 047, mean sample age 25.4-82.8 years, with 152 prevalence estimates), using 24 validated depression questionnaires were selected. Sample size, publication type, sample type, gender, age, BMI, HbA1c , depression questionnaire and prevalence rates were extracted. RESULTS Prevalence rates ranged from 1.8% to 88% (mean = 28.30%) and were higher in younger samples, samples with higher mean HbA1c and clinic samples. Diabetes-depression symptom overlap did not affect prevalence. A higher proportion of anhedonia, cognition, cognitive, negative affect and sleep disturbance symptoms, and a lower proportion of somatic symptoms were consistently associated with higher depression prevalence. CONCLUSIONS The lack of an overall effect of diabetes-depression symptom overlap might suggest that assessment of depression in Type 2 diabetes is generally not confounded by co-occuring symptoms. However, questionnaires with proportionally more or fewer items measuring other symptom categories were associated with higher estimates of depression prevalence. Depression measures that focus on the cardinal symptoms of depression (e.g. negative affect and cognition), limiting symptoms associated with increasing diabetes symptomatology (e.g. sleep disturbance, cognitive) may most accurately diagnose depression.
Collapse
Affiliation(s)
- K A Harding
- VA Puget Sound Healthcare System, Seattle, WA, USA
| | - M E Pushpanathan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - S R Whitworth
- Australian Government Department of Health, Canberra, Australia
| | - S Nanthakumar
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - R S Bucks
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - T C Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
64
|
Mazzotti DR, Keenan BT, Lim DC, Gottlieb DJ, Kim J, Pack AI. Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes. Am J Respir Crit Care Med 2019; 200:493-506. [PMID: 30764637 PMCID: PMC6701040 DOI: 10.1164/rccm.201808-1509oc] [Citation(s) in RCA: 275] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/06/2019] [Indexed: 01/04/2023] Open
Abstract
Rationale: Symptom subtypes have been described in clinical and population samples of patients with obstructive sleep apnea (OSA). It is unclear whether these subtypes have different cardiovascular consequences.Objectives: To characterize OSA symptom subtypes and assess their association with prevalent and incident cardiovascular disease in the Sleep Heart Health Study.Methods: Data from 1,207 patients with OSA (apnea-hypopnea index ≥ 15 events/h) were used to evaluate the existence of symptom subtypes using latent class analysis. Associations between subtypes and prevalence of overall cardiovascular disease and its components (coronary heart disease, heart failure, and stroke) were assessed using logistic regression. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate whether subtypes were associated with incident events, including cardiovascular mortality.Measurements and Main Results: Four symptom subtypes were identified (disturbed sleep [12.2%], minimally symptomatic [32.6%], excessively sleepy [16.7%], and moderately sleepy [38.5%]), similar to prior studies. In adjusted models, although no significant associations with prevalent cardiovascular disease were found, the excessively sleepy subtype was associated with more than threefold increased risk of prevalent heart failure compared with each of the other subtypes. Symptom subtype was also associated with incident cardiovascular disease (P < 0.001), coronary heart disease (P = 0.015), and heart failure (P = 0.018), with the excessively sleepy again demonstrating increased risk (hazard ratios, 1.7-2.4) compared with other subtypes. When compared with individuals without OSA (apnea-hypopnea index < 5), significantly increased risk for prevalent and incident cardiovascular events was observed mostly for patients in the excessively sleepy subtype.Conclusions: OSA symptom subtypes are reproducible and associated with cardiovascular risk, providing important evidence of their clinical relevance.
Collapse
Affiliation(s)
- Diego R. Mazzotti
- Division of Sleep Medicine, Department of Medicine and
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Brendan T. Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Diane C. Lim
- Division of Sleep Medicine, Department of Medicine and
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Daniel J. Gottlieb
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts; and
| | - Jinyoung Kim
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Allan I. Pack
- Division of Sleep Medicine, Department of Medicine and
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
65
|
RELATIONSHIP BETWEEN OBSTRUCTIVE SLEEP APNEA AND THE PRESENCE AND SEVERITY OF DIABETIC RETINOPATHY. Retina 2019; 38:2197-2206. [PMID: 28937527 DOI: 10.1097/iae.0000000000001848] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the relationship between obstructive sleep apnea (OSA) and the presence and severity of diabetic retinopathy (DR). METHODS Three hundred seventeen patients with International Classification of Diseases diagnoses of both DR and OSA were evaluated retrospectively. Diabetic retinopathy severity and diabetic macular edema status were determined by diagnostic coding and medical records. Obstructive sleep apnea severity and additional sleep measures were obtained from overnight polysomnography. Analysis was performed using multivariable logistic regression. RESULTS After adjustment, an association was seen between DR and severe OSA (odds ratio [OR]: 2.18, 95% confidence interval [CI]: 1.14-4.18, P = 0.019). Proliferative DR was associated with severe OSA versus no DR (OR: 2.40, 95% CI: 1.12-5.14, P = 0.024) and mild nonproliferative DR (OR: 2.87, 95% CI: 1.26-6.55, P = 0.012). Comparing all nonproliferative DR with proliferative DR, proliferative DR and severe OSA were associated (OR: 2.20, 95% CI: 1.03-4.70, P = 0.043), as well as diabetic macular edema and severe OSA (OR: 2.89, 95% CI: 1.58-5.27, P = 0.001). No association was seen between DR/diabetic macular edema and secondary sleep measures. CONCLUSION The findings suggest an increased risk of DR, proliferative DR, and diabetic macular edema in patients with severe OSA. Ophthalmologists following these patients should be aware of this association to better manage ocular sequelae of diabetes.
Collapse
|
66
|
Reshetnik A, Puppe S, Bonnemeier H. Central Sleep Apnoea and Arrhythmogenesis After Myocardial Infarction-The CESAAR Study. Front Cardiovasc Med 2019; 6:108. [PMID: 31448290 PMCID: PMC6691753 DOI: 10.3389/fcvm.2019.00108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/19/2019] [Indexed: 12/26/2022] Open
Abstract
The prevalence of sleep disordered breathing (SDB) after acute myocardial infarction (AMI) is high. However, little is known about predominant SDB type and the impact of SDB severity on arrhythmogenesis. We conducted a prospective single-center observational study and performed an unattended sleep study and Holter monitoring within 10 days after AMI, and an unattended sleep study 11.3 months after AMI. All patients were included from the Department of Cardiology at the University Hospital Schleswig-Holstein, Lübeck, Germany. A total of 202 subjects with AMI (73.8% with ST-elevation; 59.8 years; 73.8% male) were included. The mean BMI was 27.8 kg/m2 and the mean neck/waist circumference was 41.7/103.3 cm. The mean left ventricular ejection fraction was 56.6%. The SDB prevalence defined as apnoea-hypopnea-index (AHI) ≥ 5/h was 66.7% with 44.9% having central (CSA), and 21.8% obstructive sleep apnoea (OSA). The mean AHI was 13.8 1/h. In 10.2% nsVT was detected in the Holter monitoring. AI >23/h was independently associated with higher risk of nsVT in the subacute AMI period. SDB is highly prevalent and CSA a predominant type of SDB in the subacute phase after uncomplicated AMI treated with modern revascularization procedures and evidence-based pharmacological therapy. Severe SDB is independently associated with higher risk for nsVT in the subacute AMI period and its course should be monitored as it can potentially have a negative impact on relevant outcomes of AMI patients. Further prospective studies are needed to assess long-term follow up of SDB after AMI and its impact on mortality and morbidity.
Collapse
Affiliation(s)
- Alexander Reshetnik
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Nephrology, Berlin, Germany
| | - Swetlana Puppe
- Department of Psychiatry, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany
| | - Hendrik Bonnemeier
- Department of Cardiology, Universitätsklinik Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
67
|
Yu W, Wang X, Ni Y, Huai D, Hao H, Li Q, Liu Z, Wen S, Cheng L, Hu W. Association of OSAHS Hypoxia Indicators with Early Renal Injury and Serum Fibroblast Growth Factor 21 in Obese Type 2 Diabetic Patients. Diabetes Ther 2019; 10:1357-1368. [PMID: 31172456 PMCID: PMC6612341 DOI: 10.1007/s13300-019-0639-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This study aimed to explore the association of obstructive sleep apnea-hypopnea syndrome (OSAHS) hypoxia indicators with early renal injury and serum fibroblast growth factor 21 (FGF21) in obese type 2 diabetic patients. METHODS A total of 109 obese patients with type 2 diabetes mellitus (T2DM) were recruited, including 70 males and 39 females, with an average age of 52.77 ± 13.57 years and average BMI of 29.08 ± 4.36 kg/m2. Overnight sleep monitoring was performed with a portable monitor to record respiratory parameters [apnea-hypopnea index (AHI), oxygen desaturation index (ODI), lowest oxygen saturation (LSaO2), mean oxygen saturation (MSaO2/MPO2) and cumulative time of oxygen saturation < 90% (CT < 90%)]. Ultrasonography was done to detect the quantitative liver fat content (LFC). The urine microalbumin and creatinine ratio (ACR) were determined by immunoturbidimetry. FGF21 was measured at baseline by enzyme-linked immunosorbent assay. Patients were divided into the proteinuria group (n = 42) and non-proteinuria group (n = 67). Correlation analysis and multivariate linear regression analysis were used to analyze the related data. In addition, patients were divided into the T2DM without OSAHS group (n = 16) and T2DM with OSAHS group (n = 93) according to the AHI value. The correlation analysis was used to assess the relationship between FGF21 and clinical variables. RESULTS (1) ACR positively correlated with waist circumference (WC), AHI, ODI, CT < 90% and LFC, but negatively with MSaO2 and LSaO2. (2) AHI, ODI, CT < 90% and LFC were independent risk factors for ACR, LSaO2 and MSaO2 was a protective factor. (3) Serum FGF21 decreased in the OSAHS group compared with the non-OSAHS group. After adjustment for age, WC and TG, FGF21 correlated negatively with AHI, but positively with MSaO2. CONCLUSIONS AHI, ODI, CT < 90% and LFC are independent risk factors for ACR. FGF21 is associated with hypoxia indicators, and improving OSAHS status and reducing liver fat content may be helpful for the prevention and treatment of early diabetic nephropathy (DN). CLINICAL TRIAL REGISTRATION NUMBER ChiCTR-IOR-15006225.
Collapse
Affiliation(s)
- Weinan Yu
- Department of Endocrinology, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223002, Jiangsu, China
| | - Xiaoqing Wang
- Department of Endocrinology, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223002, Jiangsu, China
| | - Yaojun Ni
- Department of Cardiothoracic Surgery, Huai'an Hospital Affiliated to Nanjing Medical College and Huai'an First People's Hospital, Huai'an, 223002, Jiangsu, China
| | - De Huai
- Department of Otolaryngology, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223002, Jiangsu, China
| | - Hairong Hao
- Department of Endocrinology, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223002, Jiangsu, China
| | - Qingjun Li
- Department of Endocrinology, Jiangning Hospital Affiliated to Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Ziyu Liu
- Department of Endocrinology, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223002, Jiangsu, China
| | - Surong Wen
- Department of Endocrinology, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223002, Jiangsu, China
| | - Liang Cheng
- Department of Endocrinology, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223002, Jiangsu, China
| | - Wen Hu
- Department of Endocrinology, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223002, Jiangsu, China.
| |
Collapse
|
68
|
Andrade AG, Bubu OM, Varga AW, Osorio RS. The Relationship between Obstructive Sleep Apnea and Alzheimer's Disease. J Alzheimers Dis 2019; 64:S255-S270. [PMID: 29782319 DOI: 10.3233/jad-179936] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Obstructive sleep apnea (OSA) and Alzheimer's disease (AD) are highly prevalent conditions with growing impact on our aging society. While the causes of OSA are now better characterized, the mechanisms underlying AD are still largely unknown, challenging the development of effective treatments. Cognitive impairment, especially affecting attention and executive functions, is a recognized clinical consequence of OSA. A deeper contribution of OSA to AD pathogenesis is now gaining support from several lines of research. OSA is intrinsically associated with disruptions of sleep architecture, intermittent hypoxia and oxidative stress, intrathoracic and hemodynamic changes as well as cardiovascular comorbidities. All of these could increase the risk for AD, rendering OSA as a potential modifiable target for AD prevention. Evidence supporting the relevance of each of these mechanisms for AD risk, as well as a possible effect of AD in OSA expression, will be explored in this review.
Collapse
Affiliation(s)
- Andreia G Andrade
- Department of Neurology, Alzheimer's Disease Center, NYU Langone Medical Center, New York, NY, USA.,Department of Psychiatry, Center for Brain Health, NYU Langone Medical Center, New York, NY, USA
| | - Omonigho M Bubu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo S Osorio
- Department of Psychiatry, Center for Brain Health, NYU Langone Medical Center, New York, NY, USA.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, NY, USA
| |
Collapse
|
69
|
Saad AMJ, Hiyasat D, Jaddou H, Obeidat N. The prevalence of high risk obstructive sleep apnoea among patients with type 2 diabetes in Jordan. Diabetes Res Clin Pract 2019; 152:16-22. [PMID: 31078669 DOI: 10.1016/j.diabres.2019.04.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 04/03/2019] [Accepted: 04/30/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To estimate the prevalence of Obstructive Sleep Apnea (OSA) among patients with type 2 Diabetes Mellitus (T2DM) in Jordan, and to explore the association between sleep apnea and clinical and demographic variables. METHOD A cross-sectional study was carried out from the 1st of November 2011 to the 1st of February 2012 on 1143 patients with T2DM (aged 30-90 years) at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG). The center is considered to be the only referral center in the country and accordingly, the patients represent the population in different parts of the country. All participants completed the Arabic version of the Berlin Questionnaire and were categorized as either low or high-risk patients for OSA. RESULTS A total of 1143 patients with T2DM were included in this study. There were 587 (51.4%) males and 556 (48.6%) females. The findings showed that 554 (48.5%) patients were at high risk for OSA and 589 (51.5%) were low risk for OSA. Logistic regression analysis revealed that age, smoking, and neck circumference were significantly correlated with high risk for OSA. The clinical and demographic variables were also collected for analysis. CONCLUSIONS The study found that high risk for OSA was highly prevalent among Jordanian patients with T2DM and that age, smoking and neck circumference were significantly correlated with OSA. Health care providers should be made aware of the high prevalence of sleep problems affecting patients with diabetes and should consider the appropriate screening and treatment for these patients, therefore improving their quality of life.
Collapse
Affiliation(s)
- Ahmad M J Saad
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan.
| | - Dana Hiyasat
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
| | - Hashem Jaddou
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
| | - Nathir Obeidat
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
| |
Collapse
|
70
|
Borel AL, Tamisier R, Böhme P, Priou P, Avignon A, Benhamou PY, Hanaire H, Pépin JL, Kessler L, Valensi P, Darmon P, Gagnadoux F. Obstructive sleep apnoea syndrome in patients living with diabetes: Which patients should be screened? DIABETES & METABOLISM 2019; 45:91-101. [DOI: 10.1016/j.diabet.2018.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/16/2018] [Accepted: 08/11/2018] [Indexed: 12/27/2022]
|
71
|
Wang Y, Zhu D, Chen Y, Jiang R, Xu H, Qiu Z, Liu D, Luo H. Metabonomics Study of Ginseng Glycoproteins on Improving Sleep Quality in Mice. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2561828. [PMID: 30941359 PMCID: PMC6421049 DOI: 10.1155/2019/2561828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 01/28/2019] [Indexed: 01/08/2023]
Abstract
The changes of brain metabolism in mice after injection of ginseng glycoproteins (GPr) were analyzed by gas chromatography mass spectrometry- (GC/MS-) based metabolomics platform. The relationship between sedative and hypnotic effects of ginseng glycoproteins and brain metabolism was discussed. Referring to pentobarbital sodium subthreshold test, we randomly divided 20 mice into two groups: control and ginseng glycoproteins group. The mice from the control group were treated with normal saline by i.p and GPr group were treated with 60 mg/kg of GPr by i.p. The results indicated that GPr could significantly improve the sleep quality of mice. Through multivariate statistical analysis, we found that there were 23 differential metabolites in whole brain tissues between the control group and the GPr group. The pathway analysis exhibited that GPr may be involved in the regulation of the pathway including purine metabolism, nicotinate and nicotinamide metabolism, glycine, serine and threonine metabolism, arginine and proline metabolism, alanine, aspartate and glutamate metabolism, and steroid hormone biosynthesis. This work is helpful to understand the biochemical mechanism of GPr on promoting sleep and lay a foundation for further development of drugs for insomnia.
Collapse
Affiliation(s)
- Ying Wang
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun 130117, China
- Jilin Academy of Chinese Medicine and Material Medica Science, Changchun 130012, China
| | - Difu Zhu
- Jilin Jice Inspection Technology Co., Ltd., Changchun 130117, China
| | - Yinghong Chen
- Jilin Jice Inspection Technology Co., Ltd., Changchun 130117, China
| | - Ruizhi Jiang
- Jilin Academy of Chinese Medicine and Material Medica Science, Changchun 130012, China
- Jilin Jice Inspection Technology Co., Ltd., Changchun 130117, China
| | - Hong Xu
- Jilin Academy of Chinese Medicine and Material Medica Science, Changchun 130012, China
| | - Zhidong Qiu
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Da Liu
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Haoming Luo
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun 130117, China
| |
Collapse
|
72
|
Grant RW, Lyles C, Uratsu CS, Vo MT, Bayliss EA, Heisler M. Visit Planning Using a Waiting Room Health IT Tool: The Aligning Patients and Providers Randomized Controlled Trial. Ann Fam Med 2019; 17:141-149. [PMID: 30858257 PMCID: PMC6411400 DOI: 10.1370/afm.2352] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Time during primary care visits is limited. We tested the hypothesis that a waiting room health information technology (IT) tool to help patients identify and voice their top visit priorities would lead to better visit interactions and improved quality of care. METHODS We designed a waiting room tool, the Visit Planner, to guide adult patients through the process of identifying their top priorities for their visit and effectively expressing these priorities to their clinician. We tested this tool in a cluster-randomized controlled trial with usual care as the control. Eligible patients had at least 1 clinical care gap (eg, overdue for cancer screening, suboptimal chronic disease risk factor control, or medication nonadherence). RESULTS The study (conducted March 31, 2016 through December 31, 2017) included 750 English- or Spanish-speaking patients. Compared with usual care patients, intervention patients more often reported "definitely" preparing questions for their doctor (59.5% vs 45.1%, P <.001) and "definitely" expressing their top concerns at the beginning of the visit (91.3% vs 83.3%, P = .005). Patients in both arms reported high levels of satisfaction with their care (86.8% vs 89.9%, P = .20). With 6 months of follow-up, prevalence of clinical care gaps was reduced by a similar amount in each study arm. CONCLUSIONS A simple waiting room-based tool significantly improved visit communication. Patients using the Visit Planner were more prepared and more likely to begin the visit by communicating their top priorities. These changes did not, however, lead to further reduction in aggregate clinical care gaps beyond the improvements seen in the usual care arm.
Collapse
Affiliation(s)
- Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Courtney Lyles
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Center for Vulnerable Populations and Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - Connie S Uratsu
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Michelle T Vo
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Michele Heisler
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan Department of Internal Medicine, Ann Arbor, Michigan
| |
Collapse
|
73
|
Falck RS, Best JR, Davis JC, Eng JJ, Middleton LE, Hall PA, Liu-Ambrose T. Sleep and cognitive function in chronic stroke: a comparative cross-sectional study. Sleep 2019; 42:5364812. [DOI: 10.1093/sleep/zsz040] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/10/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Ryan S Falck
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health and Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - John R Best
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health and Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Jennifer C Davis
- University of British Columbia-Okanagan Campus, Faculty of Management, Kelowna, BC, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Faculty of Medicine, Neurorehabilitation Research Program, GFS Rehabilitation Centre, Vancouver, BC, Canada
| | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Peter A Hall
- University of Waterloo, School of Public Health and Health Systems, Waterloo, ON, Canada
| | - Teresa Liu-Ambrose
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health and Centre for Hip Health and Mobility, Vancouver, BC, Canada
| |
Collapse
|
74
|
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: 36] [Impact Index Per Article: 7.2] [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.
Collapse
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
| |
Collapse
|
75
|
Pasha S. Screening for Obstructive Sleep Apnea: Should We Do It? CURRENT PULMONOLOGY REPORTS 2019. [DOI: 10.1007/s13665-019-0222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
76
|
Toh ST, Phua CQ, Loh S. Holistic Management of Obstructive Sleep Apnea: Translating Academic Research to Patient Care. Sleep Med Clin 2019; 14:1-11. [PMID: 30709524 DOI: 10.1016/j.jsmc.2018.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A holistic approach is pertinent in managing obstructive sleep apnea (OSA). It goes beyond integrated multidisciplinary assessment and management in the hospital setting. Although clinicians should be aware of different treatment modalities and adjunctive measures, proactive management of OSA is as important. The future of OSA management lies in identifying patients at risk of developing OSA and developing strategy to prevent OSA from taking root. It involves active screening of patients with OSA and treating them and identifying patients with OSA with high risk of preventable serious morbidity and death and intervening early to prevent these from happening.
Collapse
Affiliation(s)
- Song Tar Toh
- Department of Otolaryngology, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore.
| | - Chu Qin Phua
- Department of Otolaryngology, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore
| | - Shaun Loh
- Department of Otolaryngology, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore
| |
Collapse
|
77
|
Siegmann MJ, Athinarayanan SJ, Hallberg SJ, McKenzie AL, Bhanpuri NH, Campbell WW, McCarter JP, Phinney SD, Volek JS, Van Dort CJ. Improvement in patient-reported sleep in type 2 diabetes and prediabetes participants receiving a continuous care intervention with nutritional ketosis. Sleep Med 2019; 55:92-99. [PMID: 30772699 DOI: 10.1016/j.sleep.2018.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Sleep disruption is frequently associated with type 2 diabetes (T2D) and hyperglycemia. We recently reported the effectiveness of a continuous care intervention (CCI) emphasizing nutritional ketosis for improving HbA1c, body weight and cardiovascular risk factors in T2D patients. The present study assessed the effect of this CCI approach on sleep quality using a subjective patient-reported sleep questionnaire. METHODS A non-randomized, controlled longitudinal study; 262 T2D and 116 prediabetes patients enrolled in the CCI and 87 separately recruited T2D patients continued usual care (UC) treatment. Patients completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. A PSQI score of >5 (scale 0 to 21) was used to identify poor sleepers. RESULTS Global sleep quality improved in the CCI T2D (p < 0.001) and prediabetes (p < 0.001) patients after one year of intervention. Subjective sleep quality (component 1), sleep disturbance (component 5) and daytime dysfunction (component 7), also showed improvements in the CCI T2D (p < 0.01 for sleep quality and sleep disturbance; and p < 0.001 for daytime dysfunction) and prediabetes patients (p < 0.001 for all three components); compared to the UC T2D group after one year. The proportion of patients with poor sleep quality was significantly reduced after one year of CCI (T2D; from 68.3% at baseline to 56.5% at one year, p = 0.001 and prediabetes; from 77.9% at baseline to 48.7% at one year, p < 0.001). CONCLUSION This study demonstrates improved sleep quality as assessed by PSQI in patients with T2D and prediabetes undergoing CCI including nutritional ketosis but not in T2D patients receiving UC. The dietary intervention benefited both sleep quality and the severity of T2D symptoms suggesting that nutritional ketosis improves overall health via multiple mechanisms.
Collapse
Affiliation(s)
- Morgan J Siegmann
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Sarah J Hallberg
- Virta Health, 535 Mission Street, San Francisco, CA, USA; Indiana University Health Arnett, Lafayette, IN, USA
| | - Amy L McKenzie
- Virta Health, 535 Mission Street, San Francisco, CA, USA
| | | | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - James P McCarter
- Virta Health, 535 Mission Street, San Francisco, CA, USA; Department of Genetics, Washington University School of Medicine, St Louis, MO, USA
| | | | - Jeff S Volek
- Virta Health, 535 Mission Street, San Francisco, CA, USA; Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Christa J Van Dort
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.
| |
Collapse
|
78
|
López-Cano C, Gutiérrez-Carrasquilla L, Sánchez E, González J, Yeramian A, Martí R, Hernández M, Cao G, Ribelles M, Gómez X, Barril S, Barbé F, Hernández C, Simó R, Lecube A. Sympathetic Hyperactivity and Sleep Disorders in Individuals With Type 2 Diabetes. Front Endocrinol (Lausanne) 2019; 10:752. [PMID: 31736881 PMCID: PMC6839128 DOI: 10.3389/fendo.2019.00752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/17/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction: Many studies on the impact of type 2 diabetes mellitus (T2DM) on sleep breathing have shown a higher prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) in those with T2DM. Moreover, an increased activity of the sympathetic nervous system has been described in both pathologies. This cross-sectional study aimed to assess sympathetic activity in patients with T2DM, and to investigate the relationship between sympathetic activity and polysomnographic parameters. Materials and Methods: Thirty-six patients with T2DM without known clinical macrovascular nor pulmonary disease and 11 controls underwent respiratory polygraphy, and their cardiac variability and 24-h urine total metanephrines were measured. Results: SAHS was highly prevalent with a mean apnea-hypopnea index (AHI) in the range of moderate SAHS. In patients with T2DM, the nocturnal concentration of total metanephrines in urine were higher than diurnal levels [247.0 (120.0-1375.0) vs. 210.0 (92.0-670.0), p = 0.039]. The nocturnal total metanephrine concentration was positively and significantly associatedwith the percentage of sleeping time spent with oxygen saturation <90%(CT90). In the entire population and in subjects with T2DM, the multivariate regression analysis showed a direct interaction between the nocturnal concentration of urine metanephrines and the CT90. Conclusion: These findings suggest that the increase in sympathetic activity previously described in patients with T2DM could be mediated through nocturnal breathing disturbances. The diagnosis and treatment of SAHS may influence sympathetic activity disorders and may contribute to an improvement in T2DM and cardiovascular risk.
Collapse
Affiliation(s)
- Carolina López-Cano
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Liliana Gutiérrez-Carrasquilla
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Enric Sánchez
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Jessica González
- Respiratory Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Andree Yeramian
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Raquel Martí
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Marta Hernández
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
| | - Gonzalo Cao
- Section of Hormones, Clinic Laboratory, Hospital Universitari Arnau de Vilanova, Universitat de Lleida (UdL), Lleida, Spain
| | - Mercè Ribelles
- Clinic Laboratory, Hospital Universitari Arnau de Vilanova, Universitat de Lleida (UdL), Lleida, Spain
| | - Xavier Gómez
- Clinic Laboratory, Department of Laboratory Medicine, Hospital Universitari Arnau de Vilanova, Universitat de Lleida (UdL), Lleida, Spain
| | - Silvia Barril
- Respiratory Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ferran Barbé
- Respiratory Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit, Endocrinology and Nutrition Department, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Endocrinology and Nutrition Department, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain
- Centro de Investigación en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- *Correspondence: Albert Lecube
| |
Collapse
|
79
|
Wang X, Fan J, Du Y, Ma C, Ma X, Nie S, Wei Y. Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status. BMJ Open Diabetes Res Care 2019; 7:e000737. [PMID: 31908793 PMCID: PMC6936388 DOI: 10.1136/bmjdrc-2019-000737] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/17/2019] [Accepted: 11/23/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to diabetes mellitus (DM) status remains unclear. We aimed to elucidate the association of OSA with subsequent cardiovascular events in patients with ACS with or without DM. RESEARCH DESIGN AND METHODS In this prospective cohort study, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy between June 2015 and May 2017. OSA was defined as an Apnea Hypopnea Index ≥15 events/hour. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. RESULTS Among 804 patients, 248 (30.8%) had DM and 403 (50.1%) had OSA. OSA was associated with 2.5 times the risk of 1 year MACCE in patients with DM (22.3% vs 7.1% in the non-OSA group; adjusted HR (HR)=2.49, 95% CI 1.16 to 5.35, p=0.019), but not in patients without DM (8.5% vs 7.7% in the non-OSA group, adjusted HR=0.94, 95% CI 0.51 to 1.75, p=0.85). Patients with DM without OSA had a similar 1 year MACCE rate as patients without DM. The increased risk of events was predominately isolated to patients with OSA with baseline glucose or hemoglobin A1c levels above the median. Combined OSA and longer hypoxia duration (time with arterial oxygen saturation <90%>22 min) further increased the MACCE rate to 31.0% in patients with DM. CONCLUSIONS OSA was associated with increased risk of 1 year MACCE following ACS in patients with DM, but not in non-DM patients. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and DM are warranted.
Collapse
Affiliation(s)
- Xiao Wang
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingyao Fan
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yunhui Du
- Beijing Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinliang Ma
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Shaoping Nie
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Wei
- Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
80
|
4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019; 42:S34-S45. [PMID: 30559230 DOI: 10.2337/dc19-s004] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
81
|
Characterization of abnormal sleep patterns in patients with obesity, type 2 diabetes, or combined. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
82
|
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
| |
Collapse
|
83
|
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: 83] [Impact Index Per Article: 13.8] [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.
Collapse
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
| |
Collapse
|
84
|
Muraki I, Wada H, Tanigawa T. Sleep apnea and type 2 diabetes. J Diabetes Investig 2018; 9:991-997. [PMID: 29453905 PMCID: PMC6123041 DOI: 10.1111/jdi.12823] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/05/2018] [Accepted: 02/08/2018] [Indexed: 02/02/2023] Open
Abstract
The aim of the present review was to clarify the association between obstructive sleep apnea (OSA) and type 2 diabetes, and discuss the therapeutic role of continuous positive airway pressure (CPAP) in type 2 diabetes. OSA patients are more likely than non-OSA populations to develop type 2 diabetes, while more than half of type 2 diabetes patients suffer from OSA. Similar to Western countries, in the East Asian population, the association between these two disorders has also been reported. CPAP is the primary treatment for OSA, but the effect of CPAP on comorbid diabetes has not been established. CPAP improved glucose metabolism determined by the oral glucose tolerance test in OSA patients, and several studies have shown that CPAP improves insulin resistance, particularly in obese populations undergoing long-term CPAP. Diabetes is associated with other sleep-related manifestations as well, such as snoring and excessive daytime sleepiness. Snoring is associated with the development of diabetes, and excessive daytime sleepiness appears to modify insulin resistance. Well-designed studies are required to clarify the therapeutic effect of CPAP on diabetes. As both diabetes and OSA lead to cardiovascular disease, clinicians and healthcare professionals should be aware of the association between diabetes and OSA, and should take CPAP and health-related behaviors into consideration when treating patients with diabetes and/or OSA.
Collapse
Affiliation(s)
- Isao Muraki
- Public HealthDepartment of Social and Environmental MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Hiroo Wada
- Department of Public HealthGraduate School of Juntendo UniversityTokyoJapan
| | - Takeshi Tanigawa
- Department of Public HealthGraduate School of Juntendo UniversityTokyoJapan
| |
Collapse
|
85
|
Kurinami N, Sugiyama S, Ijima H, Yoshida A, Hieshima K, Miyamoto F, Kajiwara K, Jinnouch K, Jinnouchi T, Jinnouchi H. Clinical usefulness of the body muscle-to-fat ratio for screening obstructive sleep apnea syndrome in patients with inadequately controlled type 2 diabetes mellitus. Diabetes Res Clin Pract 2018; 143:134-139. [PMID: 29990564 DOI: 10.1016/j.diabres.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 01/11/2023]
Abstract
AIMS To investigate whether body composition measures can be used for screening obstructive sleep apnea syndrome (OSAS) in patients with type 2 diabetes mellitus (T2DM) suspected of having OSAS. METHODS Subjects were 186 hospital inpatients with inadequately controlled T2DM. We measured the respiratory disturbance index (RDI) as an indicator of OSAS using a sheet-type breath detection monitor, defining OSAS as an RDI ≥ 19 events/hour. Elementary body composition was measured by bioelectrical impedance analysis using InBody770. RESULTS Simple logistic regression analysis identified body weight, body mass index (BMI), waist circumference, total body fat mass, body fat percentage, and body muscle-to-fat ratio (BMFR) as significantly associated with OSAS. The Nagelkerke R2 test showed that the BMFR was the most suitable measure for screening OSAS. Multivariate logistic regression analysis demonstrated that BMFR was significantly and independently associated with OSAS. In receiver operating characteristic curve analysis, the area under the BMFR curve was 0.70 (P < 0.001), indicating that BMFR was significantly predictive of OSAS. Furthermore, BMFR was the most suitable measure for screening OSAS in a sub-group analysis of non-obese patients with relatively low BMI (<27.5 kg/m2). CONCLUSIONS In patients with T2DM, the BMFR is useful for screening OSAS in daily clinical practice.
Collapse
Affiliation(s)
| | - Seigo Sugiyama
- Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan; Division of Cardiovascular Medicine, Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan
| | - Hiroko Ijima
- Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan
| | - Akira Yoshida
- Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan
| | - Kunio Hieshima
- Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan
| | - Fumio Miyamoto
- Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan
| | - Keizo Kajiwara
- Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan
| | | | | | - Hideaki Jinnouchi
- Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan; Division of Preventive Cardiology, Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto, Japan.
| |
Collapse
|
86
|
Abstract
PURPOSE OF REVIEW To provide an overview of the mechanistic and epidemiologic evidence linking sleep-related exposures, such as short sleep duration, obstructive sleep apnea, shift work, and insomnia, with type 2 diabetes risk in adults. RECENT FINDINGS Both poor sleep habits and sleep disorders are highly prevalent among adults with type 2 diabetes. In observational studies, short sleep duration, obstructive sleep apnea, shift work, and insomnia are all associated with higher risk of incident type 2 diabetes and may predict worse outcomes in those with existing diabetes. However, interventional studies addressing sleep abnormalities in populations with or at high risk for type 2 diabetes are scarce. Although common sleep abnormalities are associated with risk of incident type 2 diabetes and worse prognosis in those with established diabetes, there are few randomized trials evaluating the impact of sleep-focused interventions on diabetes, making it difficult to determine whether the relationship is causal.
Collapse
Affiliation(s)
- Rachel P Ogilvie
- Department of Psychiatry, University of Pittsburgh, 3471 Fifth Avenue, Suite 1216, Kaufmann Medical Building, Pittsburgh, PA, 15213, USA.
| | - Sanjay R Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 1216, Kaufmann Medical Building, Pittsburgh, PA, 15213, USA
| |
Collapse
|
87
|
Yetton BD, McDevitt EA, Cellini N, Shelton C, Mednick SC. Quantifying sleep architecture dynamics and individual differences using big data and Bayesian networks. PLoS One 2018; 13:e0194604. [PMID: 29641599 PMCID: PMC5894981 DOI: 10.1371/journal.pone.0194604] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/06/2018] [Indexed: 01/19/2023] Open
Abstract
The pattern of sleep stages across a night (sleep architecture) is influenced by biological, behavioral, and clinical variables. However, traditional measures of sleep architecture such as stage proportions, fail to capture sleep dynamics. Here we quantify the impact of individual differences on the dynamics of sleep architecture and determine which factors or set of factors best predict the next sleep stage from current stage information. We investigated the influence of age, sex, body mass index, time of day, and sleep time on static (e.g. minutes in stage, sleep efficiency) and dynamic measures of sleep architecture (e.g. transition probabilities and stage duration distributions) using a large dataset of 3202 nights from a non-clinical population. Multi-level regressions show that sex effects duration of all Non-Rapid Eye Movement (NREM) stages, and age has a curvilinear relationship for Wake After Sleep Onset (WASO) and slow wave sleep (SWS) minutes. Bayesian network modeling reveals sleep architecture depends on time of day, total sleep time, age and sex, but not BMI. Older adults, and particularly males, have shorter bouts (more fragmentation) of Stage 2, SWS, and they transition less frequently to these stages. Additionally, we showed that the next sleep stage and its duration can be optimally predicted by the prior 2 stages and age. Our results demonstrate the potential benefit of big data and Bayesian network approaches in quantifying static and dynamic architecture of normal sleep.
Collapse
Affiliation(s)
- Benjamin D. Yetton
- Department of Psychology, University of California, Irvine, Irvine, California, United States of America
| | - Elizabeth A. McDevitt
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey, United States of America
| | - Nicola Cellini
- Department of Psychology, University of California, Irvine, Irvine, California, United States of America
- Department of General Psychology, University of Padova, Padova, Italy
| | - Christian Shelton
- Department of Computer Science, University of California, Riverside, Riverside, California, United States of America
| | - Sara C. Mednick
- Department of Psychology, University of California, Irvine, Irvine, California, United States of America
| |
Collapse
|
88
|
Update of pathophysiology and management of diabetic kidney disease. J Formos Med Assoc 2018; 117:662-675. [PMID: 29486908 DOI: 10.1016/j.jfma.2018.02.007] [Citation(s) in RCA: 269] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/05/2018] [Accepted: 02/08/2018] [Indexed: 02/06/2023] Open
Abstract
Diabetic kidney disease (DKD) is a major cause of morbidity and mortality in patients with diabetes mellitus and the leading cause of end-stage renal disease in the world. The most characteristic marker of DKD is albuminuria, which is associated with renal disease progression and cardiovascular events. Renal hemodynamics changes, oxidative stress, inflammation, hypoxia and overactive renin-angiotensin-aldosterone system (RAAS) are involved in the pathogenesis of DKD, and renal fibrosis plays the key role. Intensified multifactorial interventions, including RAAS blockades, blood pressure and glucose control, and quitting smoking, help to prevent DKD development and progression. In recent years, novel agents are applied for preventing DKD development and progression, including new types of glucose-lowering agents, pentoxifylline, vitamin D analog paricalcitol, pyridoxamine, ruboxistaurin, soludexide, Janus kinase inhibitors and nonsteroidal minerocorticoid receptor antagonists. In this review, recent large studies about DKD are also summarized.
Collapse
|
89
|
Ayas NT, Laratta CR, Coleman JM, Doufas AG, Eikermann M, Gay PC, Gottlieb DJ, Gurubhagavatula I, Hillman DR, Kaw R, Malhotra A, Mokhlesi B, Morgenthaler TI, Parthasarathy S, Ramachandran SK, Strohl KP, Strollo PJ, Twery MJ, Zee PC, Chung FF. Knowledge Gaps in the Perioperative Management of Adults with Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2018; 15:117-126. [PMID: 29388810 PMCID: PMC6850745 DOI: 10.1513/annalsats.201711-888ws] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The purpose of this workshop was to identify knowledge gaps in the perioperative management of obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). A single-day meeting was held at the American Thoracic Society Conference in May, 2016, with representation from many specialties, including anesthesiology, perioperative medicine, sleep, and respiratory medicine. Further research is urgently needed as we look to improve health outcomes for these patients and reduce health care costs. There is currently insufficient evidence to guide screening and optimization of OSA and OHS in the perioperative setting to achieve these objectives. Patients who are at greatest risk of respiratory or cardiac complications related to OSA and OHS are not well defined, and the effectiveness of monitoring and other interventions remains to be determined. Centers involved in sleep research need to develop collaborative networks to allow multicenter studies to address the knowledge gaps identified below.
Collapse
|
90
|
Stevanovic A, Dekleva M. The importance of subclinical left ventricular dysfunction and blood pressure pattern in asymptomatic type-2 diabetic patients: the diagnostic and prognostic significance of Tissue Doppler parameters, left ventricular global longitudinal strain, and nighttime blood pressure during sleep. J Diabetes Complications 2018; 32:41-47. [PMID: 29137850 DOI: 10.1016/j.jdiacomp.2017.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 07/13/2017] [Accepted: 07/18/2017] [Indexed: 01/27/2023]
Abstract
UNLABELLED The primary aims of this study have been to explore the diagnostic and prognostic significance of Tissue Doppler parameters (TDI), global longitudinal strain (GLS), and blood pressure (BP) pattern in normotensive diabetic patients. METHODS The study consisted of 121 diabetic patients and 41 healthy subjects. Conventional and TDI echocardiography were performed on all patients, including E/Em (ratio of diastolic velocities). GLS was derived from two-dimensional speckle-tracking. Ambulatory BP monitoring (ABPM) was obtained over 24h. Over the three year follow up, the end points were cardiac events (myocardial infarction, coronary revascularization procedures, new-onset angina, heart failure). RESULTS GLS was found to be significantly lower (-17.5±2.1vs-24.4±2.4; p<0.001), while E/Em was significantly higher (10.3±2.24vs7.4±1.8; p<0.001) in diabetic patients. A non-dipping pattern of BP was observed in 38 diabetic patients (31.4%); 14 diabetic patients had an increase in their nocturnal BP. Significant predictors of an adverse cardiac event: a reduction of GLS value (-17%,p=0.05) increase in E/Em (>15, p=0.002) and systolic BP during nocturnal sleep (>119mmHg,p=0.020). CONCLUSION Early detection of nocturnal hypertension and subclinical LV dysfunction by TDI and 2D spackle tracking are of significant clinical and prognostic importance.
Collapse
MESH Headings
- Aged
- Asymptomatic Diseases/epidemiology
- Blood Pressure/physiology
- Blood Pressure Monitoring, Ambulatory
- Case-Control Studies
- Circadian Rhythm/physiology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/physiopathology
- Diabetic Angiopathies/complications
- Diabetic Angiopathies/diagnosis
- Diabetic Angiopathies/physiopathology
- Diabetic Cardiomyopathies/diagnosis
- Diabetic Cardiomyopathies/epidemiology
- Diabetic Cardiomyopathies/physiopathology
- Echocardiography, Doppler/methods
- Female
- Heart Ventricles/diagnostic imaging
- Heart Ventricles/physiopathology
- Humans
- Hypertension/complications
- Hypertension/diagnosis
- Hypertension/physiopathology
- Longitudinal Studies
- Male
- Middle Aged
- Prognosis
- Sleep/physiology
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left/physiology
Collapse
Affiliation(s)
- Angelina Stevanovic
- Department of Cardiology, Railway Health Care Institute, Savska 23, 11000 Belgrade, Serbia.
| | - Milica Dekleva
- Department of Cardiology, Clinical Hospital Center Zvezdara, Faculty of Medicine, University of Belgrade, Dimitrija Tucovica 161, 11000 Belgrade, Serbia
| |
Collapse
|
91
|
Westlake K, Dostalova V, Plihalova A, Pretl M, Polak J. The Clinical Impact of Systematic Screening for Obstructive Sleep Apnea in a Type 2 Diabetes Population-Adherence to the Screening-Diagnostic Process and the Acceptance and Adherence to the CPAP Therapy Compared to Regular Sleep Clinic Patients. Front Endocrinol (Lausanne) 2018; 9:714. [PMID: 30555416 PMCID: PMC6282364 DOI: 10.3389/fendo.2018.00714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/12/2018] [Indexed: 01/17/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder in Type 2 diabetes (T2D) patients further increasing their already high cardiovascular risk. As T2D patients typically not report OSA symptoms, systematic screening for OSA in this population is warranted. We aimed to determine the readiness of T2D patients to undergo screening and to compare their adherence to continuous positive airway pressure (CPAP) therapy with "regular" sleep clinic patients who typically seek medical advice on their own initiative. We therefore recruited 494 consecutive T2D patients and offered them OSA screening using home sleep monitoring (type IV device). All participants in high risk of moderate-to-severe OSA were recommended home sleep apnea testing (HSAT) followed by CPAP therapy. Patients were followed-up for 12 months and outcomes compared to 228 consecutive sleep clinic patients undergoing HSAT. Among 307 screened T2D patients, 94 (31%) were identified at high risk of moderate-to-severe OSA. Subsequently, 54 patients underwent HSAT, 51 were recommended, and 38 patients initiated CPAP (acceptance 75%). Among 228 sleep clinic patients, 92 (40%) were recommended and 74 patients initiated CPAP (acceptance 80%). After 1 year, 15 (39%) T2D and 29 (39%) sleep clinic patients showed good CPAP adherence (use ≥ 4 h/night ≥ 70% nights). In conclusion, 20 T2D patients needed to be screened in order to obtain one successfully treated patient. OSA screening in T2D patients identified 31% with moderate-to-severe OSA. Once diagnosed, their CPAP acceptance and adherence did not differ from sleep clinic patients. However, the reasons for the high dropout during the screening-diagnostic process impacting the overall success of the screening program need to be identified and addressed.
Collapse
Affiliation(s)
- Katerina Westlake
- Second Internal Medicine Department, Vinohrady Teaching Hospital, Prague, Czechia
- Diabetology Practice Diabetologie Praha, Prague, Czechia
- Department of Pathophysiology, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Veronika Dostalova
- Neurology and Sleep Laboratory, INSPAMED Ltd., Prague, Czechia
- Institute of Sleep Medicine, Prague, Czechia
- Diamant Neuropsychology Laboratory, Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czechia
| | - Andrea Plihalova
- Second Internal Medicine Department, Vinohrady Teaching Hospital, Prague, Czechia
- Department of Pathophysiology, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Martin Pretl
- Neurology and Sleep Laboratory, INSPAMED Ltd., Prague, Czechia
- Institute of Sleep Medicine, Prague, Czechia
| | - Jan Polak
- Second Internal Medicine Department, Vinohrady Teaching Hospital, Prague, Czechia
- Department of Pathophysiology, Third Faculty of Medicine, Charles University, Prague, Czechia
- *Correspondence: Jan Polak
| |
Collapse
|
92
|
3. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41:S28-S37. [PMID: 29222374 DOI: 10.2337/dc18-s003] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
93
|
Kroner T, Arzt M, Rheinberger M, Gorski M, Heid IM, Böger CA, Stadler S. Sex Differences in the Prevalence and Modulators of Sleep-Disordered Breathing in Outpatients with Type 2 Diabetes. J Diabetes Res 2018; 2018:7617524. [PMID: 29805982 PMCID: PMC5901945 DOI: 10.1155/2018/7617524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 11/18/2022] Open
Abstract
In patients with type 2 diabetes, sleep-disordered breathing is a widespread cause of deteriorated quality of life. However, robust prevalence estimates for sleep-disordered breathing in patients with type 2 diabetes are limited due to scarce data. We investigated sex differences in sleep-disordered breathing prevalence and its modulators in the DIACORE SDB substudy, a sample of outpatient type 2 diabetes. 721 participants were tested for sleep-disordered breathing using a two-channel sleep apnoea monitoring device. Patients were stratified according to the severity of sleep-disordered breathing, defined as an apnoea-hypopnoea index < 15, ≥15 to 29, and ≥30 events per hour as no/mild, moderate, and severe sleep-disordered breathing, respectively. In the 679 analysed patients (39% women, age 66 ± 9 years, body mass index 31.0 ± 5.4 kg/m2), the prevalence of sleep-disordered breathing was 34%. The prevalence of sleep-disordered breathing was higher in men than in women (41% versus 22%, p < 0.001) and increased with age (15%, 21%, and 30% in women and 35%, 40%, and 47% in men in those aged 18-59, 60-69, or ≥70, respectively; age trend p = 0.064 in women and p = 0.15 in men). In linear regression analysis, age, BMI, and waist-hip ratio were associated with apnoea-hypopnoea index. Modulators for higher apnoea-hypopnoea index seem to be similar in men and women.
Collapse
Affiliation(s)
- T. Kroner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - M. Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - M. Rheinberger
- Department of Nephrology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - M. Gorski
- Department of Genetic Epidemiology, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - I. M. Heid
- Department of Genetic Epidemiology, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - C. A. Böger
- Department of Nephrology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - S. Stadler
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| |
Collapse
|
94
|
Nazaripanah NS, Momtaz YA, Mokhtari F, Sahaf R. Urinary incontinence and sleep complaints in community dwelling older adults. ACTA ACUST UNITED AC 2018; 11:106-111. [PMID: 30083298 PMCID: PMC6056063 DOI: 10.5935/1984-0063.20180020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sleep disorder is associated with poor quality of life in old age. Therefore, it
is imperative to identify contributing factors leading to sleep disorder. The
current study aimed to examine the impact of urinary incontinence on sleep
complaint after controlling for potential sociodemographic and health
covariates. Materials and Methods: A cross-sectional study was
conducted on a sample of 184 community dwelling older adults 60 years and older
in Yazd, Iran, 2016. In order to obtain the sample a multistage proportional
random sampling technique was employed. Sociodemographic characteristics, sleep
complaint, and urinary incontinence were collected from medical records.
Statistical analyses were performed using SPSS version 24. A multiple logistic
regression analysis was used to examine the impact of urinary incontinence on
sleep complaint after controlling for potential covariates.
Findings: A total of 184 respondents with a mean age of
68.48±6.65 years (age range, 60-87 years) were included in the study.
About 70% of the respondents were women, 72.8% were married, 68.5% were not
formally educated, and 21.7% were living alone. The prevalence of sleep
complaint and urinary incontinence were 27.2% (95% CI: 21-34) and 22.3% (95% CI:
17-29), respectively. The results of the multiple logistic regression analysis
revealed respondents with urinary incontinence were four times more likely to
suffer from sleep complaint than those without urinary incontinence after
adjusting for potential covariates (AOR=4.04, 95% CI: 1.74-9.35,
p<0.001). Conclusion: Based on the results
of this present study, which showed that urinary incontinence independently
contributed to sleep complaint among older adults, it is necessary to employ
effective interventions for controlling urinary incontinence to reduce sleep
complaints.
Collapse
Affiliation(s)
- Neda Sadat Nazaripanah
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran.,Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran
| | - Yadollah Abolfathi Momtaz
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran.,Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Gerontology - Serdang - Selangor - Malaysia
| | - Farideh Mokhtari
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran.,Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran
| | - Robab Sahaf
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Gerontology - Tehran - Tehran - Iran
| |
Collapse
|
95
|
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.
Collapse
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
| |
Collapse
|
96
|
Pamidi S, Tasali E. Continuous Positive Airway Pressure for Improving Glycemic Control in Type 2 Diabetes: Where Do We Stand? Am J Respir Crit Care Med 2017; 194:397-400. [PMID: 27525459 DOI: 10.1164/rccm.201604-0698ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sushmita Pamidi
- 1 Department of Medicine McGill University Montreal, Quebec, Canada and
| | - Esra Tasali
- 2 Department of Medicine University of Chicago Chicago, Illinois
| |
Collapse
|
97
|
Donovan LM, Rueschman M, Weng J, Basu N, Dudley KA, Bakker JP, Wang R, Bertisch SM, Patel SR. The effectiveness of an obstructive sleep apnea screening and treatment program in patients with type 2 diabetes. Diabetes Res Clin Pract 2017; 134:145-152. [PMID: 29054482 PMCID: PMC5724386 DOI: 10.1016/j.diabres.2017.10.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/05/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
AIMS As recommended by current guidelines, we tested the acceptability and impact of screening patients with type 2 diabetes for obstructive sleep apnea (OSA). METHODS In a large urban primary care practice, we instituted a telephone-based OSA screening program using a validated tool (STOP-BANG) in patients with type 2 diabetes. Patients identified as high risk were referred for diagnostic sleep testing, and those diagnosed with OSA were offered positive airway pressure (PAP) therapy. We evaluated the impact of PAP on sleep-related symptoms, glycemic control, and hospitalization rates. RESULTS We identified 738 of 818 (90.1%) patients with type 2 diabetes as high risk for OSA. Only 29.2% (n = 213) of high risk patients were willing to undergo diagnostic sleep testing. The prevalence of OSA was 90.6% in this group, but only 66.0% of those with OSA initiated PAP. Patients with higher burden of sleep symptoms were more likely to pursue testing and initiate therapy. PAP use was associated with reduced sleep-related symptoms (mean Epworth sleepiness scale score declined from 8.8 to 7.3, p < .001), but did not impact hemoglobin A1c levels at one year (7.7-7.9%, p = .12). Changes in glycemic control and hospitalization rates did not differ from comparator groups. CONCLUSIONS Despite a high prevalence of OSA, willingness to pursue diagnostic testing and treatment was low in an unselected type 2 diabetes population. Furthermore, glycemic control did not improve. Future screening programs should focus on patients with substantial sleep related symptoms as this group is most likely to derive benefit from treatment.
Collapse
Affiliation(s)
- Lucas M Donovan
- University of Washington, 1959 NE Pacific St, Seattle, WA 98195, United States.
| | - Michael Rueschman
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States.
| | - Jia Weng
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States.
| | - Nisha Basu
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115, United States.
| | - Katherine A Dudley
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115, United States.
| | - Jessie P Bakker
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States.
| | - Rui Wang
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States.
| | - Suzanne M Bertisch
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115, United States.
| | - Sanjay R Patel
- University of Pittsburgh, UPMC Montefiore Hospital, NW628, 3459 Fifth Avenue, Pittsburgh, PA 15213, United States.
| |
Collapse
|
98
|
Mello M, Vasques ACJ, Pareja JC, de Oliveira MDS, Novaes FS, Chaim ÉA, Geloneze B. Effect of biliopancreatic diversion on sleep quality and daytime sleepiness in patients with obesity and type 2 diabetes. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:623-627. [PMID: 29412388 PMCID: PMC10522053 DOI: 10.1590/2359-3997000000314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/09/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The poor quality of sleep and the deprivation thereof have been associated with disruption of metabolic homeostasis, favoring the development of obesity and type 2 diabetes (T2DM). We aimed to evaluate the influence of biliopancreatic diversion (BPD) surgery on sleep quality and excessive daytime sleepiness of obese patients with T2DM, comparing them with two control groups consisting of obese and normal weight individuals, both normal glucose tolerant. SUBJECTS AND METHODS Forty-two women were divided into three groups: LeanControl (n = 11), ObeseControl (n = 13), and ObeseT2DM (n = 18). The LeanC and ObeseC groups underwent all tests and evaluations once. The ObeseT2DM underwent BPD and were reassessed after 12 months. Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were applied before and 12 months after BPD. RESULTS Before surgery, there was less daytime sleepiness in LeanC group (p = 0.013) compared with ObeseC and T2DMObese groups. The two obese groups did not differ regarding daytime sleepiness, demonstrating that the presence of T2DM had no influence on daytime sleepiness. After surgery, the daytime sleepiness (p = 0.002) and the sleep quality (p = 0.033) improved. The score for daytime sleepiness of operated T2DMObese group became similar to LeanC and lower than ObeseC (p = 0.047). CONCLUSION BPD surgery has positively influenced daytime sleepiness and sleep quality of obese patients with T2DM, leading to normalization of daytime sleepiness 12 months after surgery. These results reinforce previously identified associations between sleep, obesity and T2DM in view of the importance of sleep in metabolic homeostasis, quality of life and health.
Collapse
Affiliation(s)
- Mayra Mello
- Universidade Estadual de CampinasLaboratório de Investigação em Metabolismo e Diabetes (LIMED)CampinasSPBrasilLaboratório de Investigação em Metabolismo e Diabetes (LIMED), Gastrocentro, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Ana Carolina J. Vasques
- Universidade Estadual de CampinasLaboratório de Investigação em Metabolismo e Diabetes (LIMED)CampinasSPBrasilLaboratório de Investigação em Metabolismo e Diabetes (LIMED), Gastrocentro, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
- Universidade Estadual de CampinasFaculdade de Ciências AplicadasLimeiraSPBrasilFaculdade de Ciências Aplicadas, Universidade Estadual de Campinas (FCA/Unicamp), Limeira, SP, Brasil
| | - José C. Pareja
- Universidade Estadual de CampinasLaboratório de Investigação em Metabolismo e Diabetes (LIMED)CampinasSPBrasilLaboratório de Investigação em Metabolismo e Diabetes (LIMED), Gastrocentro, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
- Universidade Estadual de CampinasUnidade de Cirurgia DiabéticaDepartamento de CirurgiaCampinasSPBrasilDepartamento de Cirurgia, Unidade de Cirurgia Diabética, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Maria da S. de Oliveira
- Universidade Estadual de CampinasLaboratório de Investigação em Metabolismo e Diabetes (LIMED)CampinasSPBrasilLaboratório de Investigação em Metabolismo e Diabetes (LIMED), Gastrocentro, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Fernanda S. Novaes
- Universidade Estadual de CampinasLaboratório de Investigação em Metabolismo e Diabetes (LIMED)CampinasSPBrasilLaboratório de Investigação em Metabolismo e Diabetes (LIMED), Gastrocentro, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Élinton A. Chaim
- Universidade Estadual de CampinasUnidade de Cirurgia DiabéticaDepartamento de CirurgiaCampinasSPBrasilDepartamento de Cirurgia, Unidade de Cirurgia Diabética, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Bruno Geloneze
- Universidade Estadual de CampinasLaboratório de Investigação em Metabolismo e Diabetes (LIMED)CampinasSPBrasilLaboratório de Investigação em Metabolismo e Diabetes (LIMED), Gastrocentro, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| |
Collapse
|
99
|
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] [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.
Collapse
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
| |
Collapse
|
100
|
Zhu Z, Zhang F, Liu Y, Yang S, Li C, Niu Q, Niu J. Relationship of Obstructive Sleep Apnoea with Diabetic Retinopathy: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4737064. [PMID: 29230409 PMCID: PMC5694589 DOI: 10.1155/2017/4737064] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/04/2017] [Indexed: 12/27/2022]
Abstract
Until now, the relationship of obstructive sleep apnoea (OSA) with diabetic retinopathy (DR) was controversial. This meta-analysis was performed to obtain definitive conclusion on this topic. Relevant articles were searched on databases of Pubmed, Google Scholar, and Chinese National Knowledge Infrastructure (CNKI). The articles were selected according to inclusion and exclusion criteria. Odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the relationship of OSA with risk of DR. I2 and P value were used to assess the presence of heterogeneity. I2 ≥ 50% or P < 0.05 indicated significant heterogeneity. Sensitivity analysis was performed to evaluate the robustness of pooled results. Begg's funnel plot and Egger's regression analysis were adopted to assess publication bias. 6 eligible studies were selected in the present meta-analysis. The pooled results indicated that OSA was significantly associated with increased risk of DR (OR = 2.01, 95% CI = 1.49-2.72). Subgroup analysis based on type of diabetes mellitus suggested that OSA was related to DR in both Type 1 and Type 2 diabetes mellitus. Sensitivity analysis demonstrated that pooled results were robust. No significant publication bias was observed (P = 0.128). The results indicate that OSA is related to increased risk of DR.
Collapse
Affiliation(s)
- Zhenliu Zhu
- Ophthalmology Department, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen District, Weifang 261000, China
| | - Fengying Zhang
- Otorhinolaryngological Department, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen District, Weifang 261000, China
| | - Yunxia Liu
- Outpatient Operating Room, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen District, Weifang 261000, China
| | - Shuqin Yang
- Otorhinolaryngological Department, Weifang People's Hospital, 151 Guangwen Street, Kuiwen District, Weifang 261000, China
| | - Chunting Li
- Yantai KangAi Eye Hospital, 26 Zhichu Road, Zhifu District, Yantai 264000, China
| | - Qingliang Niu
- Imaging Department, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen District, Weifang 261000, China
| | - Jinming Niu
- Otorhinolaryngological Department, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen District, Weifang 261000, China
| |
Collapse
|