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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.
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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
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102
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Dai F, Cai H, Li H, Yang G, Ji BT, Zheng W, Xiang YB, Shu XO. Association of sleep duration and incidence of diabetes modified by tea consumption: a report from the Shanghai men's health study. Sleep Med 2017; 38:135-141. [PMID: 29031748 DOI: 10.1016/j.sleep.2017.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/03/2017] [Accepted: 07/24/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the association between sleep duration and the incidence of diabetes stratified by sleep-related factors among Chinese men. METHODS This study included 34,825 men who provided information on sleep-related questions in the Shanghai Men's Health Study, a population-based cohort study conducted in Shanghai, China from 2002 to 2011. Participants were excluded who had a history of diabetes or who were diagnosed with diabetes within 2 years of recruitment. Cox regression was employed to evaluate the influence of sleep duration and its interaction with sleep-related factors on diabetes risk. RESULTS A total of 1521 incident cases were documented during a median of 5.6 follow-up years. Adjusted hazard ratios and 95% confidence intervals were 1.0 (0.9-1.1) and 1.2 (1.0-1.3) for men who slept <7 and ≥8 h per day, respectively, compared with those who slept 7 h per day (ptrend = 0.01). Stratified analyses revealed that the association between sleep duration and risk of diabetes was only statistically significant among current smokers and regular drinkers, never tea drinkers, men with a high body mass index, hypertension or comorbidity, and men who did not work nightshift or who snored. A statistically significant interaction between tea drinking and sleep duration was observed (pinteraction = 0.01). The above association patterns remained when daytime nappers were excluded from the analyses. CONCLUSIONS The data suggested that longer sleep duration, particularly among individuals already exhibiting factors linked to poor quality of sleep, was associated with diabetes. The association between sleep duration and diabetes may be modified by tea drinking, especially in older men or men with more sleep-related factors.
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Affiliation(s)
- Fei Dai
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hui Cai
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Honglan Li
- Department of Epidemiology, Cancer Institute of Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, People's Republic of China
| | - Gong Yang
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bu-Tian Ji
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yong-Bing Xiang
- Department of Epidemiology, Cancer Institute of Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, People's Republic of China
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
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103
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Ahmed AE, Al-Jahdali F, AlALwan A, Abuabat F, Bin Salih SA, Al-Harbi A, Baharoon S, Khan M, Ali YZ, Al-Jahdali H. Prevalence of sleep duration among Saudi adults. Saudi Med J 2017; 38:276-283. [PMID: 28251223 PMCID: PMC5387904 DOI: 10.15537/smj.2017.3.17101] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To examine the associations between sleep duration and a variety of demographic and clinical variables in a sample of Saudi adults. Methods: A cross-sectional study among 2,095 participants was conducted at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, between May and October 2014. A questionnaire was administered to collect data related to clinical health outcomes and demographic characteristics. Participants were asked to report their average sleep duration per night in hours. Results: One-third (33.8%) reported short sleep duration of less than 7 hours/night. Short sleep duration was more prevalent in females (37.3% versus 31.4%, p=0.004). The most common medical problems reported were obesity with body mass index of >30 Kg/m2 (39.1%), hypertension (33.9%), diabetes mellitus (20.8%), depression (4.3%), asthma (17.3%), COPD (6.6%), and hyperlipidemia (2.7%). Diabetes mellitus was associated with long sleep of more than 9 hours/night (25.4%, p=0.011) and hypertension (54.2%, p=0.001). The linear regression model tend to reduce their sleep duration by roughly 22 minutes in female gender, 66 minutes in participants with hyperlipidemia, and 70 minutes in participants with poor sleep quality. Conclusions: Short sleep duration per night was prevalent, it affects one in every 3 Saudi adults. Long sleep duration of more than 9 hours was associated with increased comorbid conditions.
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Affiliation(s)
- Anwar E Ahmed
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. E-mail.
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104
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Abstract
Type 2 diabetes mellitus (T2DM) has shown to be associated with higher incidence of sleep disorders, which may be due to disease itself or because of secondary complications or associated comorbidities associated with diabetes. On the other hand, shorter sleep duration and erratic sleep behavior itself have been linked with higher incidence of obesity, metabolic syndrome, and T2DM. Assessment of sleep quality and sleep disorders as a part of the comprehensive medical evaluation is recommended based on emerging evidence suggesting a relationship between sleep quality and glycemic control in persons with T2DM. In this review, we attempt to summarize common sleep disorders associated with T2DM, their impacts on glycemic and other metabolic control, and various preventive and therapeutic strategies to tackle these problems.
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Affiliation(s)
- Deepak Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India
| | - Deep Dutta
- Department of Endocrinology, Venkateshwar Hospital, New Delhi, India
| | - Sachin Chittawar
- Department of Medicine, Division of Endocrinology, Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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105
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Full KM, Schmied EA, Parada H, Cherrington A, Horton LA, Ayala GX. The Relationship Between Sleep Duration and Glycemic Control Among Hispanic Adults With Uncontrolled Type 2 Diabetes. DIABETES EDUCATOR 2017; 43:519-529. [DOI: 10.1177/0145721717724564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose The purpose of this study was to examine the relationship between sleep duration and glycemic control in adult Hispanic patients with uncontrolled type 2 diabetes. Methods This cross-sectional study used baseline data from 317 Hispanic adults with uncontrolled type 2 diabetes who participated in a randomized controlled trial testing a peer support intervention to improve diabetes control. To be eligible, participants had to be 18 years or older and have A1C >7% in the 3 months prior to randomization. Glycemic control was assessed by A1C ascertained through medical chart review; higher A1C levels reflected poorer glycemic control. Sleep duration (hours/night), diabetes control behaviors, and demographics were obtained by interviewer-administered questionnaire. We used multivariable generalized linear models to estimate the association between sleep duration and glycemic control. Results Forty-three percent of participants reported sleeping fewer than 7 hours per night. Sleep duration (hours/night) was inversely associated with A1C levels; however, the relationship was no longer statistically significant after adjusting for insulin status. Conclusions Sleep duration was not significantly associated with glycemic control in this sample of Hispanic adults with uncontrolled type 2 diabetes when adjusting for insulin. Future research should continue to explore this relationship among Hispanic adults with diabetes using an objective measure of sleep duration and a larger sample of Hispanic adults with both controlled and uncontrolled type 2 diabetes to determine if these results hold true.
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Affiliation(s)
- Kelsie M. Full
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Emily A. Schmied
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Humberto Parada
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Andrea Cherrington
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Lucy A. Horton
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Guadalupe X. Ayala
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
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106
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Hamasaki H, Katsuyama H, Sako A, Yanai H. Short sleep duration is associated with B-type natriuretic peptide levels and predicts the death of Japanese patients with type 2 diabetes. Sleep Med 2017; 36:1-5. [DOI: 10.1016/j.sleep.2017.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
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Martínez-Cerón E, Barquiel B, Bezos AM, Casitas R, Galera R, García-Benito C, Hernanz A, Alonso-Fernández A, Garcia-Rio F. Effect of Continuous Positive Airway Pressure on Glycemic Control in Patients with Obstructive Sleep Apnea and Type 2 Diabetes. A Randomized Clinical Trial. Am J Respir Crit Care Med 2017; 194:476-85. [PMID: 26910598 DOI: 10.1164/rccm.201510-1942oc] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Obstructive sleep apnea (OSA) is a risk factor for type 2 diabetes that adversely impacts glycemic control. However, there is little evidence about the effect of continuous positive airway pressure (CPAP) on glycemic control in patients with diabetes. OBJECTIVES To assess the effect of CPAP on glycated hemoglobin (HbA1c) levels in patients with suboptimally controlled type 2 diabetes and OSA, and to identify its determinants. METHODS In a 6-month, open-label, parallel, and randomized clinical trial, 50 patients with OSA and type 2 diabetes and two HbA1c levels equal to or exceeding 6.5% were randomized to CPAP (n = 26) or no CPAP (control; n = 24), while their usual medication for diabetes remained unchanged. MEASUREMENTS AND MAIN RESULTS HbA1c levels, Homeostasis Model Assessment and Qualitative Insulin Sensitivity Check Index scores, systemic biomarkers, and health-related quality of life were measured at 3 and 6 months. After 6 months, the CPAP group achieved a greater decrease in HbA1c levels compared with the control group. Insulin resistance and sensitivity measurements (in noninsulin users) and serum levels of IL-1β, IL-6, and adiponectin also improved in the CPAP group compared with the control group after 6 months. In patients treated with CPAP, mean nocturnal oxygen saturation and baseline IL-1β were independently related to the 6-month change in HbA1c levels (r(2) = 0.510, P = 0.002). CONCLUSIONS Among patients with suboptimally controlled type 2 diabetes and OSA, CPAP treatment for 6 months resulted in improved glycemic control and insulin resistance compared with results for a control group. Clinical trial registered with www.clinicaltrials.gov (NCT01801150).
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Affiliation(s)
- Elisabet Martínez-Cerón
- 1 Servicio de Neumología.,2 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | | | - Raquel Casitas
- 1 Servicio de Neumología.,2 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Raúl Galera
- 1 Servicio de Neumología.,2 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | - Angel Hernanz
- 6 Servicio de Bioquímica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Francisco Garcia-Rio
- 1 Servicio de Neumología.,2 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain.,8 Universidad Autónoma de Madrid, Madrid, Spain
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108
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Tan ML, Tan CS, Griva K, Lee YS, Lee J, Tai ES, Khoo EY, Wee HL. Factors associated with diabetes-related distress over time among patients with T2DM in a tertiary hospital in Singapore. BMC Endocr Disord 2017; 17:36. [PMID: 28645273 PMCID: PMC5481863 DOI: 10.1186/s12902-017-0184-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Persistent diabetes-related distress (DRD) is experienced by patients with Type 2 Diabetes Mellitus. Knowing factors associated with persistent DRD will aid clinicians in prioritising interventions efforts. METHODS A total of 216 patients were recruited from a tertiary hospital in Singapore, an Asian city state, and followed for 1.5 years (2011-2014). Data was collected by self-completed questionnaires assessing DRD (measured by the Problem Areas in Diabetes score) and other psychosocial aspects such as social support, presenteeism, depression, health-related quality of life (HRQoL) and excessive daytime sleepiness (EDS) at three time points. Clinical data (body-mass-index and glycated haemoglobin) was obtained from medical records. Change score was calculated for each clinical and psychosocial variable to capture changes in these variables from baseline. Generalized Linear Model with Generalized Estimating Equation method was used to assess whether baseline and change scores in clinical and psychosocial are associated with DRD over time. RESULTS Complete data was available for 73 patients, with mean age 44 (SD 12.5) years and 67% males. Persistent DRD was experienced by 21% of the patients. In the final model, baseline HRQoL (OR = 0.56, p < 0.05) and change score of EDS (OR = 1.22, p < 0.05) was significantly associated with DRD over time. CONCLUSIONS EDS might be a surrogate marker for persistent DRD and should be explored in larger samples of population to confirm the findings from this study.
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Affiliation(s)
- Maudrene L Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Chuen S Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Yung S Lee
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Paediatric Endocrinology and Diabetes, Khoo-Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Jeannette Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - E S Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Eric Y Khoo
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
- Department of Pharmacy, National University of Singapore, 10 Kent Ridge Crescent, Singapore, 119260, Singapore.
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Pham LV, Miele CH, Schwartz NG, Arias RS, Rattner A, Gilman RH, Miranda JJ, Polotsky VY, Checkley W, Schwartz AR. Cardiometabolic correlates of sleep disordered breathing in Andean highlanders. Eur Respir J 2017; 49:49/6/1601705. [PMID: 28619952 DOI: 10.1183/13993003.01705-2016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/05/2017] [Indexed: 12/15/2022]
Abstract
Associations between sleep disordered breathing (SDB) and cardiometabolic outcomes have not been examined in highlanders.We performed nocturnal polygraphy in Peruvian highlanders (3825 m). Multivariable linear regression models examined associations between SDB metrics and haemoglobin, glucose tolerance (haemoglobin A1c (HbA1c)), fasting glucose, homeostatic model-based assessments of insulin resistance and β-cell function (HOMA-IR and HOMA-β, respectively), blood pressure, and lipids, while adjusting for age, sex, body mass index (BMI) and wake oxygenation.Participants (n=187; 91 men) were (median (interquartile range)) 52 (45-62) years old, and had a BMI of 27.0 (24.3-29.5) kg·m-2 and 87% (85-88%) oxyhaemoglobin (arterial oxygen) saturation during wakefulness. In fully adjusted models, worsening nocturnal hypoxaemia was associated with haemoglobin elevations in men (p=0.03), independent of wake oxygenation and apnoea-hypopnoea index (AHI), whereas worsening wake oxygenation was associated with haemoglobin elevations in older women (p=0.02). In contrast, AHI was independently associated with HbA1c elevations (p<0.05). In single-variable models, nocturnal hypoxaemia was associated with higher HbA1c, HOMA-IR and HOMA-β (p<0.001, p=0.02 and p=0.04, respectively), whereas AHI was associated with HOMA-IR, systolic blood pressure and triglyceride elevations (p=0.02, p=0.01 and p<0.01, respectively). These associations were not significant in fully adjusted models.In highlanders, nocturnal hypoxaemia and sleep apnoea were associated with distinct cardiometabolic outcomes, conferring differential risk for excessive erythrocytosis and glucose intolerance, respectively.
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Affiliation(s)
- Luu V Pham
- Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine H Miele
- Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Noah G Schwartz
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Rafael S Arias
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Adi Rattner
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Robert H Gilman
- Program in Global Disease, Epidemiology and Control, Dept of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Program in Global Disease, Epidemiology and Control, Dept of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Alan R Schwartz
- Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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110
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Reutrakul S, Mokhlesi B. Obstructive Sleep Apnea and Diabetes: A State of the Art Review. Chest 2017; 152:1070-1086. [PMID: 28527878 DOI: 10.1016/j.chest.2017.05.009] [Citation(s) in RCA: 332] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/21/2017] [Accepted: 05/02/2017] [Indexed: 12/31/2022] Open
Abstract
OSA is a chronic treatable sleep disorder and a frequent comorbidity in patients with type 2 diabetes. Cardinal features of OSA, including intermittent hypoxemia and sleep fragmentation, have been linked to abnormal glucose metabolism in laboratory-based experiments. OSA has also been linked to the development of incident type 2 diabetes. The relationship between OSA and type 2 diabetes may be bidirectional in nature given that diabetic neuropathy can affect central control of respiration and upper airway neural reflexes, promoting sleep-disordered breathing. Despite the strong association between OSA and type 2 diabetes, the effect of treatment with CPAP on markers of glucose metabolism has been conflicting. Variability with CPAP adherence may be one of the key factors behind these conflicting results. Finally, accumulating data suggest an association between OSA and type 1 diabetes as well as gestational diabetes. This review explores the role of OSA in the pathogenesis of type 2 diabetes, glucose metabolism dysregulation, and the impact of OSA treatment on glucose metabolism. The association between OSA and diabetic complications as well as gestational diabetes is also reviewed.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Babak Mokhlesi
- Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, The University of Chicago, Chicago, IL.
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111
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Amin A, Ali A, Altaf QA, Piya MK, Barnett AH, Raymond NT, Tahrani AA. Prevalence and Associations of Obstructive Sleep Apnea in South Asians and White Europeans with Type 2 Diabetes: A Cross-Sectional Study. J Clin Sleep Med 2017; 13:583-589. [PMID: 28162147 DOI: 10.5664/jcsm.6548] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/02/2017] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES To assess and compare obstructive sleep apnea (OSA) prevalence in South Asians and White Europeans with type 2 diabetes mellitus (T2DM). Secondary aims included exploring possible causes for observed ethnic differences. METHODS A cross-sectional study of patients with T2DM recruited from secondary care diabetes clinics. OSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/h using home-based, multi-channel respiratory monitoring. RESULTS Two hundred thirty-four patients (105 South Asian and 129 White Europeans) were studied. The prevalence of mild, moderate, and severe OSA in South Asians was 36.2% (n = 38/105), 9.5% (n = 10/105), and 5.7% (n = 6/105) respectively. After adjustment, OSA was associated with a higher body mass index in South Asians. OSA was significantly less common in South Asians compared to White Europeans (51.4% [54/105] versus 75.2% [97/129], P < .001). OSA was also less severe in South Asians compared to White Europeans (median [interquartile range]: AHI 5.1 [1.4-11.5] versus 8.5 [5.0-20.7] events/h, P < .001; time spent with oxygen saturations < 90% 0.5 [0.0-2.9]% versus 4.0 [0.7-14.4]%, P < .001). Logistic regression showed that only obesity measures explained the ethnic differences in OSA. CONCLUSIONS South Asians with T2DM are at considerable risk of OSA. OSA in South Asians was associated with obesity. However, OSA prevalence was lower in South Asians than in White Europeans. Obesity measures accounted for the observed ethnic differences. Examining factors contributing to ethnic differences will be important to inform screening and treatment strategies.
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Affiliation(s)
- Amin Amin
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Asad Ali
- Department of Respiratory Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Quratul A Altaf
- Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Milan K Piya
- Department of Diabetes, Derby Teaching Hospitals NHS Foundation NHS Trust, Derby, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Anthony H Barnett
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.,Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Neil T Raymond
- Independent Epidemiology and Statistical Consultant, Epidemiology, Research Design and Statistical Consulting (ERDASC), Leicestershire, United Kingdom
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
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112
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Zhang LC, Jin X, Huang Z, Yan ZN, Li PB, Duan RF, Feng H, Jiang JH, Peng H, Liu W. Protective effects of choline against hypoxia-induced injuries of vessels and endothelial cells. Exp Ther Med 2017; 13:2316-2324. [PMID: 28565844 PMCID: PMC5443310 DOI: 10.3892/etm.2017.4276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/06/2017] [Indexed: 01/08/2023] Open
Abstract
The current study aimed to lay a theoretical foundation for further development of choline as an anti-hypoxia damage drug. Wild-type, 3- to 5-month-old male Sprague-Dawley rats, weighing 180-220 g, were used in this study. The rats were randomly divided into a normoxic control group (n=16) and a chronic intermittent hypoxia (CIH) group (n=16). The effects of CIH on acetylcholine (ACh)-mediated endothelium-dependent vasodilatation in the rat cerebral basilar arterioles and mesenteric arterioles, as well as the protective effects of choline on the arterioles damaged by hypoxia were observed. Moreover, the effects of choline on endothelial cell proliferation during hypoxia were observed, and choline's functional mechanism further explored. The ACh-mediated vasodilatation of rat cerebral basilar and mesenteric arterioles significantly reduced during hypoxia (P<0.01). Choline significantly increased dilation in the rat cerebral basilar (P<0.01) and mesenteric arterioles (P<0.05) damaged by CIH compared with those in the control group. In addition, under hypoxic conditions, choline significantly promoted the proliferation of rat aortic endothelial cells (P<0.05) and significantly reduced lactate dehydrogenase activity in the cell culture supernatant in vitro (P<0.05). Furthermore, the effect of choline could be related to its ability to significantly increase the secretion of vascular endothelial growth factor (P<0.01) and activation of α7 non-neuronal nicotinic acetylcholine receptors under hypoxia (P<0.01). This study demonstrated that choline could have protective effects against hypoxic injuries.
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Affiliation(s)
- Lian-Cheng Zhang
- Department of Environment and Pharmacy, Tianjin Institute of Health and Environmental Medicine, Tianjin 300050, P.R. China
| | - Xin Jin
- Department of Environment and Pharmacy, Tianjin Institute of Health and Environmental Medicine, Tianjin 300050, P.R. China
| | - Zhao Huang
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Tianjin University of Sport, Tianjin 300381, P.R. China
| | - Zhen-Nan Yan
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Tianjin University of Sport, Tianjin 300381, P.R. China
| | - Pei-Bing Li
- Department of Environment and Pharmacy, Tianjin Institute of Health and Environmental Medicine, Tianjin 300050, P.R. China
| | - Rui-Feng Duan
- Department of Environment and Pharmacy, Tianjin Institute of Health and Environmental Medicine, Tianjin 300050, P.R. China
| | - Hong Feng
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Tianjin University of Sport, Tianjin 300381, P.R. China
| | - Jian-Hua Jiang
- Department of Environment and Pharmacy, Tianjin Institute of Health and Environmental Medicine, Tianjin 300050, P.R. China
| | - Hui Peng
- Department of Environment and Pharmacy, Tianjin Institute of Health and Environmental Medicine, Tianjin 300050, P.R. China
| | - Wei Liu
- Department of Environment and Pharmacy, Tianjin Institute of Health and Environmental Medicine, Tianjin 300050, P.R. China
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113
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Kaur A, Mokhlesi B. The Effect of OSA Therapy on Glucose Metabolism: It's All about CPAP Adherence! J Clin Sleep Med 2017; 13:365-367. [PMID: 28212697 DOI: 10.5664/jcsm.6480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Amanpreet Kaur
- Division of Pulmonary and Critical Care Medicine, Alpert Medical School at Brown University, Providence, RI
| | - Babak Mokhlesi
- Department of Medicine, Section of Pulmonary and Critical Care, Sleep Disorders Center, The University of Chicago, Chicago, IL
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Sokwalla SMR, Joshi MD, Amayo EO, Acharya K, Mecha JO, Mutai KK. Quality of sleep and risk for obstructive sleep apnoea in ambulant individuals with type 2 diabetes mellitus at a tertiary referral hospital in Kenya: a cross-sectional, comparative study. BMC Endocr Disord 2017; 17:7. [PMID: 28166768 PMCID: PMC5294825 DOI: 10.1186/s12902-017-0158-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 02/01/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Sleep disorders are common and associated with multiple metabolic and psychological derangements. Obstructive sleep apnoea (OSA) is among the most common sleep disorders and an inter-relationship between OSA, insulin resistance, obesity, type 2 diabetes (T2DM) and cardiovascular diseases has been established. Prevalence of sleep disorders in Kenyans, particularly in individuals with T2DM is unknown. We thus aimed to determine prevalence of poor quality of sleep (QOS) and high risk for OSA, among persons with T2DM and determine their associations with socio-demographic and anthropometric variables. METHODS Utilising a Cross- Sectional Descriptive design, QOS and risk for OSA were determined in a randomly selected sample of patients with T2DM (cases) and an age and sex matched comparison group. The validated Pittsburgh Sleep Quality Index (PSQI) and Berlin Questionnaire (BQ) were used to measure QOS and risk for OSA respectively. Associations between poor QOS, high risk for OSA, and socio-demographic and anthropometric variables in cases were evaluated. RESULTS From 245 randomly selected persons with T2DM attending outpatient clinics, aged over 18 years, 22 were excluded due to ineligibility thus 223 were included in the analysis; 53.8% were females, mean age was 56.8 (SD 12.2) years and mean BMI was 28.8 kg/m2 (SD 4.4). Among them, 119 (53%, CI 95% 46.5-60.2) had poor QOS and 99 (44% CI 95% 37.8-50.9) were at high risk for OSA. Among 112 individuals in comparison group, 33 (29.5%, CI 95% 20.9-38.3) had poor QOS and 9 (8%, CI 95% 3.3-13.4) had high risk for OSA. Cases had a significantly higher probability for poor QOS [OR 2.76 (95% CI 1.7-4.4))] and high risk for OSA [OR 9.1 (95% CI 4.4-19.0)]. Higher waist circumference was independently associated with a high risk for OSA in cases. CONCLUSIONS We demonstrate a high burden of sleep disturbances in patients with T2DM. Our findings may have implications for clinicians to screen for sleep disorders when assessing patients with T2DM and warranting further attention by practitioners and researches in this field.
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Affiliation(s)
- Sairabanu Mohammed Rashid Sokwalla
- Department of Clinical Medicine and Therapeutics, University of Nairobi (UoN), Nairobi, Kenya
- Kenyatta National Hospital (KNH), Nairobi, Kenya
| | - Mark David Joshi
- Department of Clinical Medicine and Therapeutics, University of Nairobi (UoN), Nairobi, Kenya
- Kenyatta National Hospital (KNH), Nairobi, Kenya
- Clinical Epidemiology Unit, University of Nairobi, Nairobi, Kenya
| | - Erastus Olonde Amayo
- Department of Clinical Medicine and Therapeutics, University of Nairobi (UoN), Nairobi, Kenya
- Kenyatta National Hospital (KNH), Nairobi, Kenya
| | - Kirtida Acharya
- Department of Clinical Medicine and Therapeutics, University of Nairobi (UoN), Nairobi, Kenya
- Kenyatta National Hospital (KNH), Nairobi, Kenya
| | - Jared Ongechi Mecha
- Department of Clinical Medicine and Therapeutics, University of Nairobi (UoN), Nairobi, Kenya
- Kenyatta National Hospital (KNH), Nairobi, Kenya
| | - Kenneth Kipyegon Mutai
- Department of Clinical Medicine and Therapeutics, University of Nairobi (UoN), Nairobi, Kenya
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Ebrahimi M, Guilan-Nejad TN, Pordanjani AF. Effect of yoga and aerobics exercise on sleep quality in women with Type 2 diabetes: a randomized controlled trial. ACTA ACUST UNITED AC 2017; 10:68-72. [PMID: 28966742 DOI: 10.5935/1984-0063.20170012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was investigating the effect of 12 weeks of yoga and aerobic exercise (running on a treadmill) on the sleep quality in women with Type 2 diabetes. MATERIALS AND METHODS 39 diabetic women were selected from Semnan city with the mean age of 46.85±3.35 years, weight of 69.79±17.18 kg, height of 155.03±5.00, BMI of 29.64±5.00 kg/m2 who had a background of diabetes for 6.46±2.69 years. They were then randomly divided into yoga exercise (n=15), aerobic exercise (n=13), and control group (n=11). The exercise program was performed for 12 weeks, three sessions per each week. In order to measure the sleep quality, the Pittsburgh Sleep Quality Index (PSQI) was used. The data were analyzed by non-parametric wilcoxon and Kruskal-Wallis Test at significance level of p<0.05. RESULTS Overall score of sleep quality improved after six (p=0.001) and 12 (p=0.001) weeks of yoga exercise. Also, significant effect was observed after 6 weeks of aerobic exercise (p=0.039). However, the positive effect was diminished to under significant levels after 12 weeks of aerobic exercise (p=0.154). Kruskal-Wallis Test showed significant differences between yoga and aerobic groups after 12 weeks of exercise (p=0.002). No significant differences were observed in control groups in all situation. CONCLUSIONS It can be concluded that yoga exercise is more effective in improving the sleep quality in comparison with the same course of aerobic exercise in women suffering from diabetes Type 2. Thus, yoga exercise can be suggested to these patients.
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Affiliation(s)
- Mohsen Ebrahimi
- Department of Sports Sciences, Semnan University, Semnan, Iran
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116
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Lecube A, Romero O, Sampol G, Mestre O, Ciudin A, Sánchez E, Hernández C, Caixàs A, Vigil L, Simó R. Sleep biosignature of Type 2 diabetes: a case-control study. Diabet Med 2017; 34:79-85. [PMID: 27278263 DOI: 10.1111/dme.13161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 01/30/2023]
Abstract
AIM To determine whether or not the sleep disturbances associated with Type 2 diabetes affect the structure of sleep. METHODS We designed a case-control study in 76 patients with Type 2 diabetes and 76 control subjects without Type 2 diabetes, matched by age, gender, BMI and waist and neck circumferences. A subgroup of 32 patients with Type 2 diabetes was also matched with 64 control subjects without Type 2 diabetes according to apnoea-hypopnoea index score. Examination included an overnight full polysomnography. RESULTS No differences in the percentage of time spent in either rapid eye movement or non-rapid eye movement sleep were observed between groups; however, patients with Type 2 diabetes had more microarousal events during sleep than control subjects [41.4 (total range 4.0-104.4) vs 20.7 (total range 1.3-94.5) events/h; P < 0.001]. These differences were mainly observed during the non-rapid eye movement sleep [7.4 (total range 0-107.2) vs 0.2 (total range 0-65.2) events/h; P < 0.001]. In addition, sleep variables related to oxygen saturation measures, such as the percentage of time spent with oxygen saturation ≤90%, were significantly greater during the rapid eye movement sleep in patients with Type 2 diabetes [20.3 (total range 0-99.2) vs. 10.5 (total range 0-94.0)%; P = 0.047]. This pattern was maintained in the subgroup of patients matched by apnoea-hypopnaea index. Finally, stepwise regression analyses showed that apnoea-hypopnoea index, the presence of Type 2 diabetes and fasting plasma glucose value were independently associated with the number of microarousals (R2 =0.667). CONCLUSIONS Type 2 diabetes is associated with an altered sleep structure, with different effects according to rapid eye movement (increase in nocturnal hypoxia) or non-rapid eye movement (increase in sleep fragmentation) sleep.
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Affiliation(s)
- A Lecube
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Universitat de Lleida, Lleida, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Romero
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Sleep Unit, Department of Neurophysiology, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Sampol
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Sleep Unit, Department of Pneumology, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Mestre
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Ciudin
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Sánchez
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Universitat de Lleida, Lleida, Spain
| | - C Hernández
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Caixàs
- Department of Endocrinology and Nutrition, Corporació Sanitària Parc Taulí, Parc Taulí, Spain
| | - L Vigil
- Sleep Unit, Department of Pneumology, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - R Simó
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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117
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Malik JA, Masoodi SR, Shoib S. Obstructive sleep apnea in Type 2 diabetes and impact of continuous positive airway pressure therapy on glycemic control. Indian J Endocrinol Metab 2017; 21:106-112. [PMID: 28217508 PMCID: PMC5240049 DOI: 10.4103/2230-8210.196005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) are two interacting epidemics both with high prevalence and morbidity. Both epidemiologic and clinical studies suggest that the majority of patients with T2DM also have OSA and untreated OSA in these patients results in poor glycemic control leading to acceleration of diabetes-related complications. OBJECTIVES To assess the prevalence and severity of OSA in T2DM patients and to assess the impact of OSA treatment on presenting symptoms and hemoglobin A1c (HbA1c). METHODS We performed polysomnography (PSG) studies and measured HbA1c in 62 consecutive patients with T2DM that were referred from various subspecialty clinics from July 2011 to August 2013. RESULTS In our 62 diabetic patients, 59 (95.2%) had abnormal PSG. Based on Apnea-Hypopnea Index (AHI) score, 3 (5.1%) patients had mild, 28 (47.5%) had moderate, and 28 (47.5%) had severe OSA. The mean AHI of diabetic patients was significantly more than nondiabetic patients, i.e., 25.7 versus 19.7 (P = 0.001). Variables that significantly correlated with the presence of OSA include age, gender, body mass index (BMI), hypertension, diabetes, and cardiovascular disease (P < 0.05); however, on logistic regression only BMI, hypertension, and nocturia correlated with OSA. Overall, 59% of diabetic patients showed improvement in their glycemic control as measured by HbA1c with continuous positive airway pressure (CPAP) treatment. Significant, moderate, and mild categories of treatment response were respectively observed in 7%, 20%, and 32% of patients. CONCLUSION Treatment of OSA with CPAP reduces HbA1c in a significant number of diabetics.
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Affiliation(s)
- Javid Ahmad Malik
- Department of Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Shariq Rashid Masoodi
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sheikh Shoib
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
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Randerath W, Verbraecken J, Andreas S, Arzt M, Bloch KE, Brack T, Buyse B, De Backer W, Eckert DJ, Grote L, Hagmeyer L, Hedner J, Jennum P, La Rovere MT, Miltz C, McNicholas WT, Montserrat J, Naughton M, Pepin JL, Pevernagie D, Sanner B, Testelmans D, Tonia T, Vrijsen B, Wijkstra P, Levy P. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J 2016; 49:13993003.00959-2016. [DOI: 10.1183/13993003.00959-2016] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/25/2016] [Indexed: 02/07/2023]
Abstract
The complexity of central breathing disturbances during sleep has become increasingly obvious. They present as central sleep apnoeas (CSAs) and hypopnoeas, periodic breathing with apnoeas, or irregular breathing in patients with cardiovascular, other internal or neurological disorders, and can emerge under positive airway pressure treatment or opioid use, or at high altitude. As yet, there is insufficient knowledge on the clinical features, pathophysiological background and consecutive algorithms for stepped-care treatment. Most recently, it has been discussed intensively if CSA in heart failure is a “marker” of disease severity or a “mediator” of disease progression, and if and which type of positive airway pressure therapy is indicated. In addition, disturbances of respiratory drive or the translation of central impulses may result in hypoventilation, associated with cerebral or neuromuscular diseases, or severe diseases of lung or thorax. These statements report the results of an European Respiratory Society Task Force addressing actual diagnostic and therapeutic standards. The statements are based on a systematic review of the literature and a systematic two-step decision process. Although the Task Force does not make recommendations, it describes its current practice of treatment of CSA in heart failure and hypoventilation.
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120
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Singh R, Teel C, Sabus C, McGinnis P, Kluding P. Fatigue in Type 2 Diabetes: Impact on Quality of Life and Predictors. PLoS One 2016; 11:e0165652. [PMID: 27824886 PMCID: PMC5100935 DOI: 10.1371/journal.pone.0165652] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/14/2016] [Indexed: 01/15/2023] Open
Abstract
Fatigue is a persistent symptom, impacting quality of life (QoL) and functional status in people with type 2 diabetes, yet the symptom of fatigue has not been fully explored. The purpose of this study was to explore the relationship between fatigue, QoL functional status and to investigate the predictors of fatigue. These possible predictors included body mass index (BMI), Hemoglobin A1C (HbA1C), sleep quality, pain, number of complications from diabetes, years since diagnosis and depression. Forty-eight individuals with type 2 diabetes (22 females, 26 males; 59.66±7.24 years of age; 10.45 ±7.38 years since diagnosis) participated in the study. Fatigue was assessed by using Multidimensional Fatigue Inventory (MFI-20). Other outcomes included: QoL (Audit of Diabetes Dependent QoL), and functional status (6 minute walk test), BMI, HbA1c, sleep (Pittsburg sleep quality index, PSQI), pain (Visual Analog Scale), number of complications, years since diagnosis, and depression (Beck's depression Inventory-2). The Pearson correlation analysis followed by multivariable linear regression model was used. Fatigue was negatively related to quality of life and functional status. Multivariable linear regression analysis revealed sleep, pain and BMI as the independent predictors of fatigue signaling the presence of physiological (sleep, pain, BMI) phenomenon that could undermine health outcomes.
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Affiliation(s)
- Rupali Singh
- Department of Physical Therapy, The Sage Colleges, Troy, New York, United States of America
- * E-mail:
| | - Cynthia Teel
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Carla Sabus
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Patricia McGinnis
- Department of Physical Therapy, Stockton University, Galloway, New Jersey, United States of America
| | - Patricia Kluding
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States of America
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Al-Abri MA, Jaju D, Al-Sinani S, Al-Mamari A, Albarwani S, Al-Resadi K, Bayoumi R, Hassan M, Al-Hashmi K. Habitual Sleep Deprivation is Associated with
Type 2 Diabetes: A Case-Control Study. Oman Med J 2016; 31:399-403. [PMID: 27974953 DOI: 10.5001/omj.2016.81] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES It is suggested that a minimum of eight hours of sleep per night is needed for metabolism to work normally. The aim of the study was to determine the association of habitual sleep deprivation and type 2 diabetes mellitus (T2DM). METHODS We conducted a case-control study comparing patients with T2DM with age and sex matched healthy controls. Standard sleep questionnaires (the Berlin and Epworth Sleepiness Scale) and a weekly diary were used by patients to self-report habitual sleep. RESULTS A total of 172 diabetics and 188 healthy controls were enrolled in the study. There was a significant difference between T2DM and healthy controls in nocturnal sleep duration (p = 0.033). There was a significant association between nocturnal sleep duration of fewer than six hours and T2DM (χ2 = 14.0; p = 0.0001). There was no significant difference in daytime sleepiness and daytime naps between the T2DM and control groups (p = 0.452; p = 0.581, respectively). CONCLUSIONS A nocturnal sleep duration < 6 hours is associated with T2DM.
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Affiliation(s)
- Mohammed A Al-Abri
- Department of Clinical Physiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Deepali Jaju
- Department of Clinical Physiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sawsan Al-Sinani
- Department of Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ali Al-Mamari
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sulayma Albarwani
- Department of Clinical Physiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khalid Al-Resadi
- Department of Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Riyadh Bayoumi
- Department of Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohammed Hassan
- Department of Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khamis Al-Hashmi
- Department of Clinical Physiology, Sultan Qaboos University Hospital, Muscat, Oman
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Haraguchi M, Miyaaki H, Ichikawa T, Shibata H, Honda T, Ozawa E, Miuma S, Taura N, Takeshima F, Nakao K. Glucose fluctuations reduce quality of sleep and of life in patients with liver cirrhosis. Hepatol Int 2016; 11:125-131. [PMID: 27624504 DOI: 10.1007/s12072-016-9762-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/18/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sleep disturbance and decreased health-related quality of life (HRQOL) are significant complaints in patients with liver cirrhosis. Although the etiology of these complications is unclear, we propose that glucose intolerance may be a predisposing factor. Therefore, our aim was to investigate the relationship between glucose intolerance and these complications. METHODS We assessed continuous glucose monitoring in 43 patients with chronic liver disease. Among these patients, 36 completed the Pittsburgh Sleep Quality Index (PSQI), the 36-Item Short-form Health Survey (SF-36), and the Neuropsychological Test (NPT). We also assessed the change in glucose fluctuations between preoperative periods and 1 year after liver transplantation in 13 patients. RESULTS Standard deviation (SD) of blood glucose was 24.15 ± 13.52. SD values correlated to glucose metabolism measures, including HbA1c and glycoalbumin. SD values also correlated to markers of liver fibrosis, including type IV collagen. Twenty-one patients (58.3 %) were classified as "poor" sleepers, with a global PSQI score ≥6. Glucose fluctuations correlated with the global PSQI score (r = 0.456, p = 0.008) and the SF-36 score (r = 0.434, p = 0.013). Multivariate regression analysis identified SD values as an independent risk factor for sleep disturbance (r = 0.12, p = 0.039) and decreased HRQOL (r = -0.32, p = 0.024). SD values did not correlate with the NPT. SD values were also improved in 11 (84.6 %) patients 1 year after liver transplantation. CONCLUSION Abnormal glucose fluctuations are a risk factor for sleep disturbance and decrease of HRQOL in patients with cirrhosis.
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Affiliation(s)
- Masafumi Haraguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biochemical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Hisamitsu Miyaaki
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biochemical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
| | - Tatsuki Ichikawa
- Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, 6-39 Shinchi, Nagasaki, Nagasaki, 850-8555, Japan
| | - Hidetaka Shibata
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biochemical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Takuya Honda
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biochemical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Eisuke Ozawa
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biochemical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Satoshi Miuma
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biochemical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Naota Taura
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biochemical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Fuminao Takeshima
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biochemical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biochemical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
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123
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Westlake K, Plihalova A, Pretl M, Lattova Z, Polak J. Screening for obstructive sleep apnea syndrome in patients with type 2 diabetes mellitus: a prospective study on sensitivity of Berlin and STOP-Bang questionnaires. Sleep Med 2016; 26:71-76. [PMID: 27613528 DOI: 10.1016/j.sleep.2016.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/06/2016] [Accepted: 07/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is highly prevalent in patients with Type 2 diabetes mellitus representing an additional risk factor for already increased cardiovascular mortality. As cardiovascular diseases are the main cause of death in this population, there is a need to identify patients with moderate to severe OSA indicated for treatment. We aimed to evaluate the performance of the Berlin, STOP, and STOP-Bang screening questionnaires in a population of patients with Type 2 diabetes mellitus. METHODS 294 consecutive patients with Type 2 diabetes mellitus filled in the questionnaires and underwent overnight home sleep monitoring using a type IV sleep monitor. RESULTS Severe, moderate, and mild OSA was found in 31 (10%), 61 (21%), and 121 (41%) patients, respectively. The questionnaires showed a similar sensitivity and specificity for AHI ≥ 15: 0.69 and 0.50 for Berlin, 0.65 and 0.49 for STOP, and 0.59 and 0.68 for STOP-Bang. However, the performance of the STOP-Bang questionnaire was different in men vs. women, sensitivity being 0.74 vs. 0.29 (p < 0.05) and specificity 0.56 vs. 0.82 (p < 0.05). CONCLUSIONS Even the best-performing Berlin questionnaire failed to identify 31% of patients with moderate to severe OSA as being at high risk of OSA, thus preventing them from receiving a correct diagnosis and treatment. Considering that patients with Type 2 diabetes mellitus are at high risk of cardiovascular mortality and also have a high prevalence of moderate to severe OSA, we find screening based on the questionnaires suboptimal and suggest that OSA screening should be performed using home sleep monitoring devices.
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Affiliation(s)
- Katerina Westlake
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Diabetology Practice Diainmed s.r.o., Slunecna 2, Prague, Czech Republic
| | - Andrea Plihalova
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague, Czech Republic
| | - Martin Pretl
- Neurology and Sleep Laboratory, INSPAMED s.r.o., Kubelikova 46, Prague, Czech Republic
| | - Zuzana Lattova
- Sleep Medicine Department, National Institute of Mental Health, Topolová 748, Klecany, Czech Republic
| | - Jan Polak
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague, Czech Republic.
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125
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Javaheri S, Blackwell T, Ancoli-Israel S, Ensrud KE, Stone KL, Redline S. Sleep-disordered Breathing and Incident Heart Failure in Older Men. Am J Respir Crit Care Med 2016; 193:561-8. [PMID: 26502092 DOI: 10.1164/rccm.201503-0536oc] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
RATIONALE The directionality of the relationship between sleep-disordered breathing and heart failure is controversial. OBJECTIVES We assessed whether elevations in the obstructive or central sleep apnea index or the presence of Cheyne-Stokes breathing are associated with decompensated and/or incident heart failure. METHODS We conducted a prospective, longitudinal study of 2,865 participants derived from the Osteoporotic Fractures in Men Study, a prospective multicenter observational study of community-dwelling older men. Participants underwent baseline polysomnography and were followed for a mean 7.3 years for development of incident or decompensated heart failure. Our main exposures were the obstructive apnea-hypopnea index (AHI), central apnea index (CAI ≥ 5), and Cheyne-Stokes breathing. Covariates included age, race, clinic site, comorbidities, physical activity, and alcohol and tobacco use. MEASUREMENTS AND MAIN RESULTS CAI greater than or equal to five and presence of Cheyne-Stokes breathing but not obstructive AHI were significant predictors of incident heart failure (adjusted hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.16-2.77 for CAI ≥ 5) (HR, 2.23; 95% CI, 1.45-3.43 for Cheyne-Stokes breathing). After excluding those with baseline heart failure, the incident risk of heart failure was attenuated for those with CAI greater than or equal to five (HR, 1.57; 95% CI, 0.92-2.66) but remained significantly elevated for those with Cheyne-Stokes breathing (HR, 1.90; 95% CI, 1.10-3.30). CONCLUSIONS An elevated CAI/Cheyne-Stokes breathing, but not an elevated obstructive AHI, is significantly associated with increased risk of decompensated heart failure and/or development of clinical heart failure in a community-based cohort of older men.
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Affiliation(s)
| | - Terri Blackwell
- 2 California Pacific Medical Center Research Institute and San Francisco Coordinating Center, San Francisco, California
| | | | | | - Katie L Stone
- 2 California Pacific Medical Center Research Institute and San Francisco Coordinating Center, San Francisco, California
| | - Susan Redline
- 1 Brigham and Women's Hospital, Boston, Massachusetts.,5 Beth Israel Deaconess Medical Center, Boston, Massachusetts
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126
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Bin YS, Cistulli PA, Ford JB. Population-Based Study of Sleep Apnea in Pregnancy and Maternal and Infant Outcomes. J Clin Sleep Med 2016; 12:871-7. [PMID: 27070246 DOI: 10.5664/jcsm.5890] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/03/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the association between sleep apnea and pregnancy outcomes in a large population-based cohort. METHODS Population-based cohort study using linked birth and hospital records was conducted in New South Wales, Australia. Participants were all women who gave birth from 2002 to 2012 (n = 636,227). Sleep apnea in the year before pregnancy or during pregnancy was identified from hospital records. Outcomes of interest were gestational diabetes, pregnancy hypertension, planned delivery, caesarean section, preterm birth, perinatal death, 5-minute Apgar score, admission to neonatal intensive care or special care nursery, and infant size for gestational age. Maternal outcomes were identified using a combination of hospital and birth records. Infant outcomes came from the birth record. Modified Poisson regression models were used to examine associations between sleep apnea and each outcome taking into account maternal age, country of birth, socioeconomic disadvantage, smoking, obesity, parity, pre-existing diabetes and hypertension. RESULTS Sleep apnea was significantly associated with pregnancy hypertension (adjusted RR 1.43; 95% CI 1.18-1.73), planned delivery (1.15; 1.07-1.23), preterm birth (1.50; 1.21-1.84), 5-minute Apgar < 7 (1.60; 1.07-2.38), admission to neonatal intensive care/special care nursery (1.26; 1.11-1.44), large-for-gestational-age infants (1.27; 1.04-1.55) but not with gestational diabetes (1.09; 0.82-1.46), caesarean section (1.06; 0.96-1.17), perinatal death (1.73; 0.92-3.25), or small-for-gestational-age infants (0.81; 0.61-1.08). CONCLUSIONS Sleep apnea is associated with higher rates of obstetric complications and intervention, as well as preterm delivery. Future research should examine if these are independent of obstetric history.
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Affiliation(s)
- Yu Sun Bin
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Peter A Cistulli
- Northern Clinical School, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jane B Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
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127
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Frija-Orvoën E. Syndrome d’apnées obstructives du sommeil : complications métaboliques. Rev Mal Respir 2016; 33:474-83. [DOI: 10.1016/j.rmr.2015.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/16/2015] [Indexed: 01/14/2023]
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128
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Sommerwerck U, Kleibrink BE, Kruse F, Scherer MJ, Wang Y, Kamler M, Teschler H, Weinreich G. Predictors of obstructive sleep apnea in lung transplant recipients. Sleep Med 2016; 21:121-5. [DOI: 10.1016/j.sleep.2016.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 12/15/2015] [Accepted: 01/08/2016] [Indexed: 11/30/2022]
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Guo LX, Zhao X, Pan Q, Sun X, Li H, Wang XX, Zhang LN, Wang Y. Effect of Continuous Positive Airway Pressure Therapy on Glycemic Excursions and Insulin Sensitivity in Patients with Obstructive Sleep Apnea-hypopnea Syndrome and Type 2 Diabetes. Chin Med J (Engl) 2016; 128:2301-6. [PMID: 26315076 PMCID: PMC4733805 DOI: 10.4103/0366-6999.163382] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: For patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and type 2 diabetes mellitus (T2DM), the night sleep interruption and intermittent hypoxia due to apnea or hypopnea may induce glycemic excursions and reduce insulin sensitivity. This study aimed to investigate the effect of continuous positive airway pressure (CPAP) therapy in patients with OSAHS and T2DM. Methods: Continuous glucose monitoring system (CGMS) was used in 40 patients with T2DM and newly diagnosed OSAHS. The measurements were repeated after 30 days of CPAP treatment. Subsequently, insulin sensitivity and glycohemoglobin (HbA1c) were measured and compared to the pretreatment data. Results: After CPAP therapy, the CGMS indicators showed that the 24-h mean blood glucose (MBG) and the night time MBG were significantly reduced (P < 0.05 and P = 0.03, respectively). The mean ambulatory glucose excursions (MAGEs) and the mean of daily differences were also significantly reduced (P < 0.05 and P = 0.002, respectively) compared to pretreatment levels. During the night, MAGE also significantly decreased (P = 0.049). The differences between the highest and lowest levels of blood glucose over 24 h and during the night were significantly lower than prior to CPAP treatment (P < 0.05 and P = 0.024, respectively). The 24 h and night time durations of high blood glucose (>7.8 mmol/L and > 11.1 mmol/L) decreased (P < 0.05 and P < 0.05, respectively) after the treatment. In addition, HbA1c levels were also lower than those before treatment (P < 0.05), and the homeostasis model assessment index of insulin resistance was also significantly lower than before CPAP treatment (P = 0.034). Conclusions: CPAP therapy may have a beneficial effect on improving not only blood glucose but also upon insulin sensitivity in T2DM patients with OSAHS. This suggests that CPAP may be an effective treatment for T2DM in addition to intensive diabetes management.
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Affiliation(s)
- Li-Xin Guo
- Department of Endocrinology, Beijing Hospital, Beijing 100730, China
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130
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Terjung S, Wang Y, Werther S, Zaffaroni A, Teschler H, Weinreich G. Validierung von SleepMinder® zur Erfassung der Schlafqualität bei Patienten mit OSAS. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0043-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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131
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Abstract
IN BRIEF Obstructive sleep apnea (OSA) alters glucose metabolism, promotes insulin resistance, and is associated with development of type 2 diabetes. Obesity is a key moderator of the effect of OSA on type 2 diabetes. However, chronic exposure to intermittent hypoxia and other pathophysiological effects of OSA affect glucose metabolism directly, and treatment of OSA can improve glucose homeostasis.
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Affiliation(s)
- Jimmy Doumit
- Jesse Brown VA Medical Center and University of Illinois at Chicago, Chicago, IL
| | - Bharati Prasad
- Jesse Brown VA Medical Center and University of Illinois at Chicago, Chicago, IL
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132
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Leong WB, Jadhakhan F, Taheri S, Chen YF, Adab P, Thomas GN. Effect of obstructive sleep apnoea on diabetic retinopathy and maculopathy: a systematic review and meta-analysis. Diabet Med 2016; 33:158-68. [PMID: 26031931 DOI: 10.1111/dme.12817] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 02/06/2023]
Abstract
AIMS To summarize the association between obstructive sleep apnoea and diabetic retinopathy and diabetic maculopathy, and to examine the effects of oxygen desaturation index, mean and minimum oxygen saturation and time spent with < 90% oxygen saturation on diabetic retinopathy and diabetic maculopathy. METHODS A systematic search was performed for papers published from inception to January 2014 in MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews using indexed terms and free text. Additional searches were carried out for grey literature. Two authors conducted the study selection and quality assessment. Data extraction was performed by the main author and checked by the other authors. RESULTS One cohort study and 15 cross-sectional studies were included for narrative synthesis and three for meta-analyses. There was no convincing evidence that obstructive sleep apnoea was associated with diabetic retinopathy, although some evidence suggested that obstructive sleep apnoea was associated with greater severity of diabetic retinopathy and advanced diabetic retinopathy in people with Type 2 diabetes. Only six studies examined the impact of obstructive sleep apnoea on diabetic maculopathy and our narrative review suggests there is an association in Type 2 diabetes. Oxygen desaturation index, mean oxygen saturation or time spent with < 90% oxygen saturation were not associated with diabetic retinopathy, and insufficient evidence was available to draw conclusions on their effects on diabetic maculopathy; however, there was evidence from both narrative synthesis and meta-analysis that minimum oxygen saturation had an impact on diabetic retinopathy (pooled odds ratio 0.91, 95% CI 0.87-0.95; I(2) = 0%). CONCLUSIONS There is a need for large cohort studies with long-term follow-up data to examine the long-term effects of obstructive sleep apnoea and other sleep variables on advanced retinal disease in diabetes.
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Affiliation(s)
- W B Leong
- School of Clinical and Experimental Medicine and Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, UK
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
| | - F Jadhakhan
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - S Taheri
- Department of Medicine, Weill Cornell Medical College in New York, NY, USA and Doha, Qatar
- Department of Medicine, King's College London, London, UK
| | - Y F Chen
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - P Adab
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - G N Thomas
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
- Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
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133
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Chasens ER, Luyster FS. Effect of Sleep Disturbances on Quality of Life, Diabetes Self-Care Behavior, and Patient-Reported Outcomes. Diabetes Spectr 2016; 29:20-3. [PMID: 26912961 PMCID: PMC4755460 DOI: 10.2337/diaspect.29.1.20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
IN BRIEF Poor sleep quality and sleep disorders, particularly insomnia, obstructive sleep apnea, and restless legs syndrome, are prevalent among people with type 2 diabetes. Evidence suggests that coexisting diabetes and sleep disturbances are associated with decreases in quality of life, diabetes self-care behaviors, and patient-reported outcomes. Additional research is required to determine the effect of treatment of sleep disorders on patient-centered outcomes in people with type 2 diabetes.
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134
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Leong WB, Jadhakhan F, Taheri S, Thomas GN, Adab P. The Association between Obstructive Sleep Apnea on Diabetic Kidney Disease: A Systematic Review and Meta-Analysis. Sleep 2016; 39:301-8. [PMID: 26414891 DOI: 10.5665/sleep.5432] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 08/28/2015] [Indexed: 01/29/2023] Open
Abstract
STUDY OBJECTIVE This systematic review aims to investigate the association between obstructive sleep apnea (OSA) and diabetic kidney disease (DKD). METHODS MeSH terms and free text searches were performed on MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception to April 2015. Zetoc and OpenGrey databases were queried for grey literature, and lastly, hand searches were carried out. Study selection and quality assessment were conducted by two authors. One author carried out data extraction, which was checked by other authors. The relationships between apneahypopnea index (AHI), oxygen desaturation index (ODI), time spent under 90% oxygen saturation (%TST < 90), and minimum and mean oxygen saturation (O2) on DKD were examined. RESULTS Two longitudinal and ten cross-sectional studies were included for our narrative synthesis, and seven studies for meta-analysis. Studies that performed multi-variable analysis demonstrated significant associations between OSA (assessed using either apnea-hypopnea index or ODI) and DKD in type 2 diabetes mellitus (T2DM). This was confirmed by meta-analysis (pooled OR 1.73, 95% CI: 1.13-2.64). There was some evidence to suggest that %TST < 90 may have an association with DKD. There was insufficient evidence to conclude on the relationship between minimum and mean oxygen saturation on DKD. There was no evidence available on the associations between OSA and other respiratory parameters in type 1 diabetes mellitus populations. CONCLUSIONS There is moderate evidence that OSA is associated with DKD in patients with T2DM. Large prospective studies with long-term follow up are needed to assess the possible bi-directional mechanisms between OSA and DKD.
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Affiliation(s)
- Wen Bun Leong
- School of Health and Population Sciences, University of Birmingham
| | | | - Shahrad Taheri
- Department of Medicine and Clinical Research Core, Weill Cornell Medical College, New York and Doha Qatar.,Department of Medicine, King's College London, London, UK
| | - G Neil Thomas
- Public Health, Epidemiology and Biostatistics, University of Birmingham, UK.,Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Peymané Adab
- Public Health, Epidemiology and Biostatistics, University of Birmingham, UK
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135
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Mansor LS, Mehta K, Aksentijevic D, Carr CA, Lund T, Cole MA, Le Page L, Sousa Fialho MDL, Shattock MJ, Aasum E, Clarke K, Tyler DJ, Heather LC. Increased oxidative metabolism following hypoxia in the type 2 diabetic heart, despite normal hypoxia signalling and metabolic adaptation. J Physiol 2016; 594:307-20. [PMID: 26574233 PMCID: PMC4713751 DOI: 10.1113/jp271242] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/10/2015] [Indexed: 01/13/2023] Open
Abstract
KEY POINTS Adaptation to hypoxia makes the heart more oxygen efficient, by metabolising more glucose. In contrast, type 2 diabetes makes the heart metabolise more fatty acids. Diabetes increases the chances of the heart being exposed to hypoxia, but whether the diabetic heart can adapt and respond is unknown. In this study we show that diabetic hearts retain the ability to adapt their metabolism in response to hypoxia, with functional hypoxia signalling pathways. However, the hypoxia-induced changes in metabolism are additive to abnormal baseline metabolism, resulting in hypoxic diabetic hearts metabolising more fat and less glucose than controls. This stops the diabetic heart being able to recover its function when stressed. These results demonstrate that the diabetic heart retains metabolic flexibility to adapt to hypoxia, but is hindered by the baseline effects of the disease. This increases our understanding of how the diabetic heart is affected by hypoxia-associated complications of the disease. ABSTRACT Hypoxia activates the hypoxia-inducible factor (HIF), promoting glycolysis and suppressing mitochondrial respiration. In the type 2 diabetic heart, glycolysis is suppressed whereas fatty acid metabolism is promoted. The diabetic heart experiences chronic hypoxia as a consequence of increased obstructive sleep apnoea and cardiovascular disease. Given the opposing metabolic effects of hypoxia and diabetes, we questioned whether diabetes affects cardiac metabolic adaptation to hypoxia. Control and type 2 diabetic rats were housed for 3 weeks in normoxia or 11% oxygen. Metabolism and function were measured in the isolated perfused heart using radiolabelled substrates. Following chronic hypoxia, both control and diabetic hearts upregulated glycolysis, lactate efflux and glycogen content and decreased fatty acid oxidation rates, with similar activation of HIF signalling pathways. However, hypoxia-induced changes were superimposed on diabetic hearts that were metabolically abnormal in normoxia, resulting in glycolytic rates 30% lower, and fatty acid oxidation 36% higher, in hypoxic diabetic hearts than hypoxic controls. Peroxisome proliferator-activated receptor α target proteins were suppressed by hypoxia, but activated by diabetes. Mitochondrial respiration in diabetic hearts was divergently activated following hypoxia compared with controls. These differences in metabolism were associated with decreased contractile recovery of the hypoxic diabetic heart following an acute hypoxic insult. In conclusion, type 2 diabetic hearts retain metabolic flexibility to adapt to hypoxia, with normal HIF signalling pathways. However, they are more dependent on oxidative metabolism following hypoxia due to abnormal normoxic metabolism, which was associated with a functional deficit in response to stress.
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Affiliation(s)
- Latt S Mansor
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Keshavi Mehta
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Dunja Aksentijevic
- British Heart Foundation Centre of Research Excellence, King's College London, The Rayne Institute, London, UK
| | - Carolyn A Carr
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Trine Lund
- Department of Medical Biology, University of Tromso, Norway
| | - Mark A Cole
- University of Nottingham Medical School, Queens Medical Centre, Nottingham, UK
| | - Lydia Le Page
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | | | - Michael J Shattock
- British Heart Foundation Centre of Research Excellence, King's College London, The Rayne Institute, London, UK
| | - Ellen Aasum
- Department of Medical Biology, University of Tromso, Norway
| | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Damian J Tyler
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Lisa C Heather
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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136
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Westlake K, Polak J. Screening for Obstructive Sleep Apnea in Type 2 Diabetes Patients - Questionnaires Are Not Good Enough. Front Endocrinol (Lausanne) 2016; 7:124. [PMID: 27679608 PMCID: PMC5020099 DOI: 10.3389/fendo.2016.00124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 08/30/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katerina Westlake
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Prague, Czech Republic
| | - Jan Polak
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Prague, Czech Republic
- Third Faculty of Medicine, Center for Research on Diabetes, Metabolism and Nutrition, Charles University in Prague, Prague, Czech Republic
- *Correspondence: Jan Polak,
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137
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Gomez-Peralta F, Abreu C, Castro JC, Alcarria E, Cruz-Bravo M, Garcia-Llorente MJ, Albornos C, Moreno C, Cepeda M, Almodóvar F. An association between liraglutide treatment and reduction in excessive daytime sleepiness in obese subjects with type 2 diabetes. BMC Endocr Disord 2015; 15:78. [PMID: 26637348 PMCID: PMC4669657 DOI: 10.1186/s12902-015-0074-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/30/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The main purpose of the present study is to evaluate whether treatment with long-acting human glucagon-like peptide-1 liraglutide was associated with an improvement of excessive daytime sleepiness (EDS) in obese subjects with type-2 diabetes. METHODS This single-centre retrospective study included 158 obese (body mass index [BMI] ≥ 30 kg/m(2)) adult subjects with type-2 diabetes who were initiated with liraglutide treatment at least 3 months before study inclusion. Data of the Epworth Sleepiness Scale (ESS), anthropometric parameters, glucose-control and metabolic parameters were collected at liraglutide initiation (baseline) and at months 1 and 3 after liraglutide initiation. RESULTS Significant reductions in ESS score were achieved at months 1 (-1.3 ± 2.8, p < 0.001) and 3 (-1.5 ± 3.0, p < 0.001) after liraglutide introduction. After 3 months of treatment with liraglutide, significant changes in body weight (p < 0.001), BMI (p < 0.001), waist (p < 0.001) and neck circumferences (p < 0.005), HbA1c (p < 0.001), mean blood glucose (p < 0.001), fasting plasma glucose (p < 0.001), triglycerides (p < 0.01) and total cholesterol (p < 0.001) were achieved. CONCLUSIONS After 3 months of treatment with liraglutide a significant reduction in EDS was observed in obese subjects with type-2 diabetes. Besides this, significant changes in body weight and metabolic parameters of diabetes control were also accomplished. Further investigation is required to determine whether liraglutide could improve other abnormal sleep patterns and obstructive sleep apnoea.
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Affiliation(s)
- Fernando Gomez-Peralta
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, C/ Miguel Servet s/n, 40002, Segovia, Spain.
| | - Cristina Abreu
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, C/ Miguel Servet s/n, 40002, Segovia, Spain
| | - Jose Carlos Castro
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, C/ Miguel Servet s/n, 40002, Segovia, Spain
| | - Elvira Alcarria
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, C/ Miguel Servet s/n, 40002, Segovia, Spain
| | - Margarita Cruz-Bravo
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, C/ Miguel Servet s/n, 40002, Segovia, Spain
| | - Maria Jesús Garcia-Llorente
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, C/ Miguel Servet s/n, 40002, Segovia, Spain
| | - Cristina Albornos
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, C/ Miguel Servet s/n, 40002, Segovia, Spain
| | - Concepción Moreno
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, C/ Miguel Servet s/n, 40002, Segovia, Spain
| | - María Cepeda
- Servicio de Medicina Interna, Hospital General de Segovia, Segovia, Spain
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138
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Abstract
Pre-diabetes and diabetes occur secondary to a constellation of pathophysiological abnormalities that culminate in insulin resistance, which results in reduced cellular glucose uptake and increased glucose production. Although pre-diabetes and diabetes have a strong genetic basis, they are largely environmentally driven through lifestyle factors. Traditional lifestyle factors such as diet and physical activity do not fully explain the dramatic rise in the incidence and prevalence of diabetes mellitus. Sleep has emerged as an additional lifestyle behavior, important for metabolic health and energy homeostasis. In this article, we review the current evidence surrounding the sleep-diabetes association.
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Affiliation(s)
- Teresa Arora
- Department of Medicine, Weill Cornell Medical College in Qatar, Room C008, Qatar Foundation, Education City, PO Box 24144, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Shahrad Taheri
- Department of Medicine, Weill Cornell Medical College in Qatar, Room C008, Qatar Foundation, Education City, PO Box 24144, Doha, Qatar.
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Sullivan SS, Guilleminault C. Emerging drugs for common conditions of sleepiness: obstructive sleep apnea and narcolepsy. Expert Opin Emerg Drugs 2015; 20:571-82. [PMID: 26558298 DOI: 10.1517/14728214.2015.1115480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) and narcolepsy are sleep disorders associated with high prevalence and high symptomatic burden including prominent sleepiness, daytime dysfunction and poor nocturnal sleep. Both have elevated risk of poor health outcomes. Current therapies are often underutilized, cumbersome, costly or associated with residual symptoms. AREAS COVERED This review covers current available therapies for OSA and narcolepsy as well as discusses areas for potential drug development, and agents in the therapeutic pipeline, including the cannabinoid dronabinol (OSA), the histamine inverse agonist/ antagonist pitolisant (narcolepsy), and stimulants with uncertain and/or multiple activities such as JZP-110 and JZP-386 (narcolepsy, possibly OSA). Finally it addresses new approaches and uses for therapies currently on the market such as the carbonic anhydrase inhibitor acetazolamide (OSA). EXPERT OPINION Both OSA and narcolepsy are conditions of sleepiness for which lifelong treatments are likely to be required. In OSA, while continuous positive airway pressure will likely remain the gold standard therapy for the foreseeable future, there is plenty of room for integrating phenotypes and variants of OSA into therapeutic strategies to lead to better, more personalized disease modification. In narcolepsy, unlike OSA, drug therapy is the current mainstay of treatment. Advances using novel mechanisms to treat targeted symptoms such as sleepiness and/or novel agents that can treat more than one symptom of narcolepsy, hold promise. However, cost, convenience and side effects remain challenges.
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Affiliation(s)
- Shannon S Sullivan
- a Division of Sleep Medicine , Stanford University School of Medicine , 450 Broadway MC 5704, Redwood City , CA 94063 , USA
| | - Christian Guilleminault
- a Division of Sleep Medicine , Stanford University School of Medicine , 450 Broadway MC 5704, Redwood City , CA 94063 , USA
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Abstract
Obstructive sleep apnea (OSA) may manifest in a number of ways from subtle intrusion into daily life to profound sleepiness, snoring, witnessed apneas and other classic symptoms. Although there is increasing evidence suggesting OSA can adversely affect health in a variety of ways, this disorder remains underdiagnosed. The most well-escribed health consequences of OSA relate to the cardiovascular system. Hypertension and arrhythmias have a strong association with OSA, and evidence suggests that treatment of OSA in patients with refractory hypertension and in patients planning cardioversion for atrial fibrillation may be of particularly importance. Significant associations between heart failure and OSA as well as complex sleep apnea have also been well-described. Cerebrovascular insult, impaired neurocognition, and poorly controlled mood disorder are also associated with in OSA. Therapy for OSA may ameliorate atherosclerotic progression and improve outcomes post-cerebrovascular accident (CVA). OSA should be considered in patients complaining of poor concentration at work, actual or near-miss motor vehicle accidents, and patients with severe sleepiness as a component of their co-morbid mood disorders. The metabolic impact of OSA has also been studied, particularly in relation to glucose homeostasis. Also of interest is the potential impact OSA has on lipid metabolism. The adverse effect untreated OSA has on glucose tolerance and lipid levels has led to the suggestion that OSA is yet another constituent of the metabolic syndrome. Some of these metabolic derangements may be related to the adverse effects untreated OSA has on hepatic health. The cardiovascular, neurocognitive, and metabolic manifestations of OSA can have a significant impact on patient health and quality of life. In many instances, evidence exists that therapy not only improves outcomes in general, but also modifies the severity of co-morbid disease. To mitigate the long-term sequela of this disease, providers should be aware of the subtle manifestations of OSA and order appropriate testing as necessary.
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Affiliation(s)
- Robert C Stansbury
- 1 Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA ; 2 Division of Pulmonary, Allergy, and Critical Care Medicine, UPMC Sleep Medicine Center, Montefiore Hospital, Pittsburgh, PA, USA
| | - Patrick J Strollo
- 1 Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA ; 2 Division of Pulmonary, Allergy, and Critical Care Medicine, UPMC Sleep Medicine Center, Montefiore Hospital, Pittsburgh, PA, USA
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141
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Tahrani AA. Obstructive sleep apnea in patients with diabetes: implications for clinical practice. ACTA ACUST UNITED AC 2015. [DOI: 10.2217/dmt.15.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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142
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Czech SJ, Orsillo SM, Pirraglia PA, English TM, Connell AJ. Association Between Specific Depression Symptoms and Glycemic Control Among Patients With Comorbid Type 2 Diabetes and Provisional Depression. Prim Care Companion CNS Disord 2015; 17:14m01754. [PMID: 26835160 DOI: 10.4088/pcc.14m01754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 05/28/2015] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To determine whether specific depression symptoms are associated with glycemic control independent of potential demographic and clinical covariates among primary care patients with comorbid type 2 diabetes and provisional threshold or subthreshold depression. METHOD We examined a convenience sample of patients diagnosed with type 2 diabetes and provisional threshold or subthreshold depression (N = 82) at 2 family health centers. Cases were identified using a population-based registry of patients diagnosed with type 2 diabetes (ICD-9 codes 250.00 for controlled type 2 diabetes and 250.02 for uncontrolled type 2 diabetes). Data from patients with a primary care provider appointment from the beginning of April 2011 through the end of June 2012 and with at least one 9-item Patient Health Questionnaire (PHQ-9) depression screener and a glycated hemoglobin A1c (HbA1c) laboratory test between 2 weeks before and 10 weeks after PHQ-9 screening were eligible for inclusion. We defined provisional threshold or subthreshold depression using PHQ-9 scoring criteria, which were designed to yield provisional diagnostic information about major depressive disorder based on DSM-5 diagnostic criteria. RESULTS Patients reporting higher severity of sleep problems on the PHQ-9 had significantly higher HbA1c levels (mean = 8.48, SD = 2.17) compared to patients reporting lower severity or absence of this symptom (mean = 7.19, SD = 1.34, t 48.88 = -3.13, P = .003). Problems with sleep contributed unique variance on glycemic control (β = 0.27, P = .02) when controlling for potential clinical and demographic covariates, with those reporting more sleep difficulties having higher HbA1c levels. CONCLUSIONS For patients with type 2 diabetes and provisional threshold or subthreshold depression, it may be prudent to aggressively address sleep problems as a potential mechanism toward improving diabetes control.
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Affiliation(s)
| | - Susan M Orsillo
- Department of Psychology, Suffolk University, Boston, Massachusetts
| | - Paul A Pirraglia
- Primary Care, Providence VA Medical Center and Alpert Medical School, Brown University, Providence, Rhode Island
| | - Thomas M English
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Alexa J Connell
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester
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143
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Disturbed sleep in type 2 diabetes mellitus independent of chronic complications, pain, and nocturia. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0314-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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144
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Affiliation(s)
- A Nouwen
- School of Science and Technology, Middlesex University, London, UK
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145
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Morgenthaler TI, Croft JB, Dort LC, Loeding LD, Mullington JM, Thomas SM. Development of the National Healthy Sleep Awareness Project Sleep Health Surveillance Questions. J Clin Sleep Med 2015; 11:1057-62. [PMID: 26235156 DOI: 10.5664/jcsm.5026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVES For the first time ever, as emphasized by inclusion in the Healthy People 2020 goals, sleep health is an emphasis of national health aims. The National Healthy Sleep Awareness Project (NHSAP) was tasked to propose questions for inclusion in the next Behavioral Risk Factor Surveillance System (BRFSS), a survey that includes a number of questions that target behaviors thought to impact health, as a means to measure community sleep health. The total number of questions could not exceed five, and had to include an assessment of the risk for obstructive sleep apnea (OSA). METHODS An appointed workgroup met via teleconference and face-to-face venues to develop an inventory of published survey questions being used to identify sleep health, to develop a framework on which to analyze the strengths and weaknesses of current survey questions concerning sleep, and to develop recommendations for sleep health and disease surveillance questions going forward. RESULTS The recommendation was to focus on certain existing BRFSS questions pertaining to sleep duration, quality, satisfaction, daytime alertness, and to add to these other BRFSS existing questions to make a modified STOP-BANG questionnaire (minus the N for neck circumference) to assess for risk of OSA. CONCLUSIONS Sleep health is an important dimension of health that has previously received less attention in national health surveys. We believe that 5 questions recommended for the upcoming BRFSS question banks will assist as important measures of sleep health, and may help to evaluate the effectiveness of interventions to improve sleep health in our nation.
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Affiliation(s)
| | - Janet B Croft
- Centers for Disease Control and Prevention, Atlanta, GA
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146
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Colbay G, Cetin M, Colbay M, Berker D, Guler S. Type 2 diabetes affects sleep quality by disrupting the respiratory function. J Diabetes 2015; 7:664-71. [PMID: 25266369 DOI: 10.1111/1753-0407.12225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/11/2014] [Accepted: 09/21/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The effects of diabetes on the respiratory system were investigated with arterial blood gas, sleep quality index and respiratory functions tests. METHODS Fifty-three patients with type II diabetes and 41 healthy cases were included. Their biochemical data, demographic characteristics, anthropometric measurements and echocardiographic findings were collected from polyclinic records. Respiratory function tests were performed for all subjects and Pittsburgh Sleep Quality Index questionnaire was conducted. Aforementioned data were compared between these two groups. RESULTS The age, body weight and body mass index were similar but oxygen pressure, oxygen saturation, forced vital capacity (FVC; %), and sleep quality were decreased in patients with diabetes. Sleep quality was correlated with the presence of diabetes and hypertension, duration of diabetes, fasting and postprandial blood glucose levels, homeostasis model of assessment-insulin resistance, Glycosylated hemoglobin levels, and FVC. Half of the diabetic patients exhibited respiratory failure during sleep. Especially diabetic patients with autonomic neuropathy, experienced a more severe and prolonged decrease in oxygen saturation. CONCLUSIONS Blood gas, respiratory functions and sleep quality, which need to be evaluated as a whole, were affected in patients with diabetes. Assessment of sleep and its quality requires special attention in patients with diabetes.
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Affiliation(s)
| | - Mustafa Cetin
- Department of Cardiology, Ankara Numune Hospital, Ankara, Turkey
| | - Mehmet Colbay
- Department of Endocrinology and Metabolism, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Dilek Berker
- Department of Endocrinology and Metabolism, Ankara Numune Hospital, Ankara, Turkey
| | - Serdar Guler
- Department of Endocrinology and Metabolism, Ankara Numune Hospital, Ankara, Turkey
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147
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Zhang P, Zhang R, Zhao F, Heeley E, Chai-Coetzer CL, Liu J, Feng B, Han P, Li Q, Sun L, Li Y, Dong S, Jiang X, Zhang C, Lu J, Guo X, Guo L, Mcevoy RD, Ji L. The prevalence and characteristics of obstructive sleep apnea in hospitalized patients with type 2 diabetes in China. J Sleep Res 2015; 25:39-46. [PMID: 26268508 DOI: 10.1111/jsr.12334] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/17/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center; Beijing China
| | - Rui Zhang
- Peking University People's Hospital; Beijing China
| | - Fang Zhao
- The George Institute for Global Health at Peking University Health Science Center; Beijing China
| | - Emma Heeley
- The George Institute for Global Health; Sydney Medical School; University of Sydney; Sydney NSW Australia
| | | | - Jing Liu
- Gansu Provincial Hospital; Lanzhou China
| | - Bo Feng
- Shanghai East Hospital; Tongji University School of Medicine; Shanghai China
| | - Ping Han
- Shengjing Hospital of China Medical University; Shenyang China
| | - Qifu Li
- The First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Liao Sun
- The Fifth Affiliated Hospital; Sun Yat-sen University; Zhuhai China
| | - Yufeng Li
- Beijing Pinggu Hospital; Beijing China
| | - Shengying Dong
- The Third People's Hospital of Gansu Province; Lanzhou China
| | - Xiaozhen Jiang
- Shanghai Pudong New Area People's Hospital; Shanghai China
| | | | - Jinhui Lu
- Chongqing Donghua Hospital; Chongqing China
| | - Xingduan Guo
- The Second Hospital of Zhanjiang City; Zhanjiang China
| | - Lixin Guo
- Beijing Hospital of Ministry of Health; Beijing China
| | - R. Doug Mcevoy
- Adelaide Institute for Sleep Health; Flinders University; Adelaide SA Australia
| | - Linong Ji
- The George Institute for Global Health at Peking University Health Science Center; Beijing China
- Peking University People's Hospital; Beijing China
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148
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Nishimura A, Kasai T, Tamura H, Yamato A, Yasuda D, Nagasawa K, Okubo M, Narui K, Mori Y. Relationship between sleep disordered breathing and diabetic retinopathy: Analysis of 136 patients with diabetes. Diabetes Res Clin Pract 2015; 109:306-11. [PMID: 26028572 DOI: 10.1016/j.diabres.2015.05.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 09/04/2014] [Accepted: 05/03/2015] [Indexed: 01/19/2023]
Abstract
AIMS Sleep disordered breathing (SDB) is associated with poor glycemic control. However, whether SDB contributes to diabetic microangiopathies, especially diabetic retinopathy (DR), is unknown. The aim of this study was to assess the relationship between SDB and DR. METHODS Between January 2010 and November 2012, 136 patients underwent a sleep test and were divided into two groups according to the presence or absence of DR. Sleep test results and known risk factors for DR were compared between groups. Optic fundi were examined using indirect ophthalmoscope or retinal photographs and diagnosed by experienced ophthalmologists. Multivariate stepwise (backward) logistic regression analysis was performed to assess factors associated with DR. RESULTS Ninety-nine patients without DR (NDR) and 37 patients with DR were assessed. Patients in the DR group had significantly longer duration of diabetes, were more likely to have hypertension and cardiovascular disease (CVD), and were more likely to be taking angiotensin converting enzyme inhibitors or angiotensin receptor blockers (p=0.000 for each). In the multivariate backward logistic regression analysis, minimum SO2 (odds ratio [OR], 0.89; p=0.001), HbA1c (OR, 1.40; p=0.021), duration of diabetes (OR, 1.23; p<0.001), and history of CVD (OR, 8.96; p=0.008) remained significant. CONCLUSIONS Minimum SO2 values were associated with DR independent from glycemic control level, duration of diabetes, and history of CVD. This finding suggests that SDB may contribute to the development of DR not through frequency, but due to the degree of intermittent hypoxia.
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Affiliation(s)
- Akihiro Nishimura
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan.
| | - Takatoshi Kasai
- Sleep Center, Toranomon Hospital, Tokyo, Japan; Cardio-Respiratory Sleep Medicine, Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Azusa Yamato
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Daijiro Yasuda
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Kaoru Nagasawa
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Minoru Okubo
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Yasumichi Mori
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
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149
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Limberg JK, Dube S, Kuijpers M, Farni KE, Basu A, Rizza RA, Curry TB, Basu R, Joyner MJ. Effect of hypoxia on heart rate variability and baroreflex sensitivity during hypoglycemia in type 1 diabetes mellitus. Clin Auton Res 2015; 25:243-50. [PMID: 26141615 PMCID: PMC4569520 DOI: 10.1007/s10286-015-0301-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Patients with type 1 diabetes mellitus exhibit impairments in autonomic and cardiovascular control which are worsened with acute hypoglycemia--thus increasing the risk of adverse cardiovascular events. Hypoxia, as seen with the common comorbidity of sleep apnea, may lead to further autonomic dysfunction and an increased risk of ventricular arrhythmias. Therefore, we hypothesized that heart rate variability (HRV) and baroreflex sensitivity (BRS) would be reduced during hypoglycemia in adults with type 1 diabetes, with a further decline when combined with hypoxia. METHODS Subjects with type 1 diabetes (n = 13; HbA1c = 7.5 ± 0.3 %, duration of diabetes = 17 ± 5 yrs) completed two 180 min hyperinsulinemic (2 mU/kg TBW/min), hypoglycemic (~3.3 µmol/mL) clamps separated by a minimum of 1 week and randomized to normoxia (SpO2 ~98 %) or hypoxia (SpO2 ~85 %). Heart rate (electrocardiogram) and blood pressure (finger photoplethysmography) were analyzed at baseline and during the hypoglycemic clamp for measures of HRV and spontaneous cardiac BRS (sCBRS). RESULTS Hypoglycemia resulted in significant reductions in HRV and sCBRS when compared with baseline levels (main effect of hypoglycemia: p < 0.05). HRV and sCBRS were further impaired during hypoxia (main effect of hypoxia: p < 0.05). CONCLUSIONS Acute hypoxia worsens hypoglycemia-mediated impairments in autonomic and cardiovascular control in patients with type 1 diabetes and may increase the risk of cardiovascular mortality. These results highlight the potential cumulative dangers of hypoglycemia and hypoxia in this vulnerable population.
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Affiliation(s)
- Jacqueline K Limberg
- Department of Anesthesiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55901, USA.
| | - Simmi Dube
- Department of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Myrthe Kuijpers
- Department of Anesthesiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55901, USA
| | - Kathryn E Farni
- Department of Anesthesiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55901, USA
| | - Ananda Basu
- Department of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Rizza
- Department of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Timothy B Curry
- Department of Anesthesiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55901, USA
| | - Rita Basu
- Department of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Michael J Joyner
- Department of Anesthesiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55901, USA
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150
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Sharma S, Mather PJ, Efird JT, Kahn D, Shiue KY, Cheema M, Malloy R, Quan SF. Obstructive Sleep Apnea in Obese Hospitalized Patients: A Single Center Experience. J Clin Sleep Med 2015; 11:717-23. [PMID: 25766715 DOI: 10.5664/jcsm.4842] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/03/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is an important health problem associated with significant morbidity and mortality. This condition often is underrecognized in hospitalized patients. The aim of this study was to conduct a clinical pathway evaluation (CPE) among obese patients admitted to a tertiary care hospital. We also assessed oxygen desaturation index (ODI, measured by overnight pulse oximetry) as a potential low-cost screening tool for identifying OSA. METHODS This was a prospective study of 754 patients admitted to an academic medical center between February 2013 and February 2014. Consecutive obese patients (body mass index ≥ 30) admitted to the hospital (medical services) were screened and evaluated for OSA with the snoring, tiredness during daytime, observed apnea, high blood pressure (STOP) questionnaire. The admitting team was advised to perform follow-up evaluation, including polysomnography, if the test was positive. RESULTS A total of 636 patients were classified as high risk and 118 as low risk for OSA. Within 4 w of discharge, 149 patients underwent polysomnography, and of these, 87% (129) were shown to have OSA. An optimal screening cutoff point for OSA (apnea-hypopnea index ≥ 10/h) was determined to be ODI ≥ 10/h [Matthews correlation coefficient = 0.36, 95% confidence interval = 0.24-0.47]. Significantly more hospitalized patients were identified and underwent polysomnography compared with the year prior to introduction of the CPE. CONCLUSIONS Our results indicate that the CPE increased the identification of OSA in this population. Furthermore, ODI derived from overnight pulse oximetry may be a cost-effective strategy to screen for OSA in hospitalized patients.
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Affiliation(s)
- Sunil Sharma
- Pulmonary and Critical Care Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Paul J Mather
- Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Jimmy T Efird
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC.,Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Daron Kahn
- Pulmonary and Critical Care Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Kristin Y Shiue
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC.,Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Mohammed Cheema
- Pulmonary and Critical Care Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Raymond Malloy
- Pulmonary and Critical Care Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Stuart F Quan
- Division of Sleep Medicine, Harvard Medical School, Boston, MA.,Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ
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