Sleep Apnea, Obesity, and Diabetes - an Intertwined Trio

Interplay between gut microbiota and exosome dynamics in sleep apnea

Sleep-disordered breathing (SDB) is characterized by recurrent reductions or interruptions in airflow during sleep, termed hypopneas and apneas, respectively. SDB impairs sleep quality and is linked to substantive health issues including cardiovascular and metabolic disorders, as well as cognitive decline. Recent evidence suggests a link between gut microbiota (GM) composition and sleep apnea. Indeed, GM, a community of microorganisms residing in the gut, has emerged as a potential player in various diseases, and several studies have identified associations between sleep apnea and GM diversity along with shifts in bacterial populations. Additionally, the concept of "leaky gut," a compromised intestinal barrier with potentially increased inflammation, has emerged as another key player in the potential bidirectional relationship between GM and sleep apnea. One of the potential effectors could be extracellular vesicles (EVs) underlying gut-brain communication pathways that are relevant to sleep regulation and function. Thus, therapeutic implications afforded by targeting the GM or exosomes for sleep apnea management have surfaced as promising areas of research. This review explores current understanding of the relationship between GM, exosomes and sleep apnea, highlighting key research dynamics and potential mechanisms. A comprehensive review of the literature was conducted, focusing on studies investigating GM composition, intestinal barrier function and gut-brain communication in relation to sleep apnea.

Multidimensional sleep impairment predicts steatotic liver disease spectrum risk

To evaluate the correlation between various sleep and the risk of NAFLD\MAFLD\MASLD. This study included 4772 subjects from the National Health and Nutrition Examination Survey data from 2017 to 2020. Poor sleep factors were defined as: ①abnormal sleep duration (< 7 h or > 8 h); ②snoring; ③sleep apnea; ④self-reported sleep disorder; ⑤ daytime sleepiness. The frequency of each sleep factor was scored, and the scores of all components were summed to obtain a sleep score ranging from 0 to 12. The higher the score, the less healthy the sleep pattern. Then we divided the overall sleep pattern into mild (sleep score 0-3 points), moderate (sleep score 4-7 points) or severe (sleep score 8-12 points) sleep pattern according to the distribution of sleep scores. Multiple logistic regression and restricted cubic spline graph analysis were used to determine the association between sleep and NAFLD\MAFLD\MASLD. In Model 1 and Model 2, sleep score as a continuous or categorical variable had an effect on NAFLD\MAFLD\MASLD(p <0.05). The risk of NAFLD\MAFLD\MASLD was higher in subjects with severe sleep patterns (p < 0.05). Snoring and sleepy during day was associated with NAFLD\MAFLD\MASLD (p < 0.05). We then drew a restricted cubic spline plot and found that sleep duration was nonlinearly associated with MAFLD\MASLD (p < 0.01), and the risk of MAFLD\MASLD was lower when the sleep duration was 7.5 ~ 9.5 h/d. In this nationally representative survey, severe sleep patterns were associated with an increased risk of NAFLD/MAFLD/MASLD. It is worth noting that sleep duration was nonlinearly associated with MAFLD and MASLD.

Metabolic Syndrome and Insulin Resistance in Romania

Metabolic syndrome (MetS) represents a huge burden on the health system. This study aimed to investigate the association between MetS and certain indirect insulin resistance (IR) indicators according to gender. The triglyceride-glucose index (TyG), TyG-body mass index (TyG-BMI), the TyG-waist-to-height ratio (TyG-WHtR), TyG-waist circumference (TyG-WC), the triglyceride to high-density-lipoprotein cholesterol index (TG/HDL-c) and recently proposed indicators such as the metabolic score for IR (MetS-IR), TyG-neck circumference (TyG-NC) and the TyG-neck-circumference-to-height ratio (TyG-NHtR) were evaluated in 2594 subjects enrolled in the PREDATORR study. Univariate and multivariate logistic regression was performed to identify the association between MetS and the indirect IR indicators, as well as the risk factors. The participants were divided into two groups, according to gender. Data were analyzed using SPSS version 26.0. TyG, TyG-WC, TyG-NC, TyG-NHtR and TG/HDL-c had higher values in the male group, while TyG-BMI, TyG-WHtR and MetS-IR had approximately equal values in the two studied groups, but also statistically significantly higher values in MetS (+) vs. MetS (-) subjects (p < 0.001). For both studied groups, the multivariate logistic regression analysis demonstrated that TyG and MetS-IR were independent predictors for MetS. Both in the female and in the male group, TyG had the largest area under the receiver operating characteristic (AUROC) curve. Thus, in females, the TyG AUROC curve was 0.890; 95% CI 0.873-0.907; p < 0.001; cut-off value 8.51, with 81.4% sensitivity and 80.0% specificity. In males, the TyG AUROC curve was 0.880; 95% CI 0.861-0.899; p < 0.001; cut-off value 8.69, with 78.5% sensitivity and 84.6% specificity. All of the analyzed indirect IR indicators had statistically significantly higher values in MetS (+) vs. MetS (-) subjects. TyG and MetS-IR are independent predictive factors for MetS, regardless of the subject's gender.

Evaluating sleep's role in type 2 diabetes mellitus: Evidence from NHANES

Background

Evidence is limited regarding the relationship between sleep factors (self-reported sleep disorder diagnosis, subjective sleep difficulties, and sleep duration), sleep patterns, and risk of type 2 diabetes mellitus (T2D). Thus, this study aims to investigate the relationship between sleep factors, sleep patterns, and the risk of T2D using data from the National Health and Nutrition Examination Survey (NHANES).

Methods

A total of 14,652 individuals aged ≥18 years from the NHANES (2005-2014) were enrolled with complete data on sleep factors, T2D, and covariates. Information on self-reported sleep disorder diagnosis, subjective sleep difficulties, and sleep duration was collected during in-home visits by trained interviewers using the Computer-Assisted Personal Interviewing system. The sleep pattern was derived from scoring three mentioned factors: no self-reported sleep disorder diagnosis, no subjective sleep difficulties, and sleep duration of 7-9 h were classified as low-risk (score 0), while the presence of self-reported sleep disorder diagnosis, subjective sleep difficulties, or sleep duration <7 or >9 h were classified as high-risk (score 1). Cumulative scores range from 0 to 3, with 0 indicating a healthy sleep pattern, 1 an intermediate sleep pattern, and 2-3 a poor sleep pattern, respectively. Weighted logistic regression was conducted to assess the association of sleep factors and sleep patterns with the risk of T2D.

Results

Self-reported sleep disorder diagnosis (odds ratio (OR) = 1.32, P = 0.01), subjective sleep difficulties (OR = 1.29, P = 0.001), and sleep deprivation (<7 h; OR = 1.20, P = 0.01) were significantly positive with T2D. Poor sleep pattern also significantly increased T2D risk (OR = 1.52, P < 0.0001). Moreover, subgroup analyses stratified by age and BMI (body mass index) further confirmed that the positive association between sleep patterns and T2D was consistent and robust across groups.

Conclusion

Our findings indicate that poorer sleep patterns are associated with an increased risk of T2D. These results emphasize the importance of sleep management in T2D prevention. Further prospective studies are needed to investigate the causal or bidirectional relationship between sleep and T2D risk, as well as the underlying molecular mechanisms.

Genetic QT score as a predictor of sudden cardiac death in participants with sleep-disordered breathing in the UK Biobank

STUDY OBJECTIVES

The goal of this study was to evaluate the association between a polygenic risk score (PRS) for QT prolongation (QTc-PRS), corrected QT intervals (QTc) and sudden cardiac death (SCD) in participants enrolled in the UK Biobank with and without sleep-disordered breathing (SDB).

METHODS

The QTc-PRS was calculated using allele copy number and previously reported effect estimates for each single nuclear polymorphism. Competing-risk regression models adjusting for age, sex, body mass index, QT prolonging medication, race, and comorbid cardiovascular conditions were used for SCD analyses.

RESULTS

A total of 500,584 participants were evaluated (56.5 ± 8 years, 54% female, 1.4% diagnosed with sleep apnea). A higher QTc-PRS was independently associated with the increased QTc interval duration (P < .0001). The mean QTc for the top QTc-PRS quintile was 15 msec longer than the bottom quintile (P < .001). SDB was found to be an effect modifier in the relationship between QTc-PRS and SCD. The adjusted hazard ratio per 5-unit change in QTc-PRS for SCD was 1.64 (95% confidence interval 1.16-2.31, P = .005) among those with SDB and 1.04 (95% confidence interval 0.95-1.14, P = .44) among those without SDB (P for interaction = .01). Black participants with SDB had significantly elevated adjusted risk of SCD (hazard ratio = 9.6, 95% confidence interval 1.24-74, P = .03).

CONCLUSIONS

In the UK Biobank population, the QTc-PRS was associated with SCD among participants with SDB but not among those without SDB, indicating that SDB is a significant modifier of the genetic risk. Black participants with SDB had a particularly high risk of SCD.

CITATION

Arora A, Zareba W, Woosley RL, et al. Genetic QT score as a predictor of sudden cardiac death in participants with sleep-disordered breathing in the UK Biobank. J Clin Sleep Med. 2025;21(3):549-557.

The association of objective daytime sleepiness with impaired glucose metabolism in patients with obstructive sleep apnea: a multi-omics study

STUDY OBJECTIVES

To examine the joint effect of obstructive sleep apnea (OSA) and objective excessive daytime sleepiness (EDS) on glucose metabolism and the underlying mechanisms.

METHODS

We included 127 patients with OSA. The multiple sleep latency test (MSLT) and Epworth sleepiness scale (ESS) were used to assess objective and subjective EDS, respectively. Disordered glucose metabolism was defined as either a physician diagnosis or having fasting blood glucose levels ≥5.6 mmol/L. Values of fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) higher than the median values of our sample were defined as high fasting insulin and insulin resistance. Serum metabolomics and fecal microbiota were used to explore underlying mechanisms.

RESULTS

Lower MSLT values were associated with higher levels of fasting blood glucose, fasting insulin, and HOMA-IR. Furthermore, objective EDS was associated with increased odds of disordered glucose metabolism, elevated fasting insulin, and insulin resistance. Dysregulation of serum valine degradation and dysbiosis of fecal Bacteroides thetaiotaomicron were associated with impaired glucose metabolism in OSA with objective EDS. No association between subjective EDS and impaired glucose metabolism was observed.

CONCLUSIONS

OSA with objective, but not subjective, EDS is associated with an increased risk of disordered glucose metabolism and insulin resistance. Dysregulation of valine degradation and dysbiosis of B. thetaiotaomicron appear to link objective EDS and disordered glucose metabolism in OSA.

Predictive Value of Complete Blood Count (CBC)-Derived Indices-C-Reactive-Protein-Albumin-Lymphocyte index (CALLY), Glucose-to-Lymphocyte Ratio (GLR), Prognostic Nutritional Index (PNI), Hemoglobin, Albumin, Lymphocyte, Platelet (HALP), and Controlling Nutritional Status (COUNT)-on Body Composition Changes After Bariatric Surgery

BACKGROUND/OBJECTIVE

Obesity is linked to increased risks of cardiovascular disease, diabetes, and certain cancers. Bariatric surgery (BS) aids in weight management, significantly altering body composition. This study evaluates the predictive value of five complete blood count (CBC)-derived indices [C-reactive-protein-albumin-lymphocyte (CALLY), glucose-to-lymphocyte ratio (GLR), prognostic nutritional index (PNI), hemoglobin, albumin, lymphocyte, platelet (HALP), and controlling nutritional status (COUNT)] on body composition changes post-BS.

METHOD

A retrospective study was conducted on 240 patients undergoing BS at Sina Hospital, Tehran, Iran. Indices were calculated using routine laboratory tests, and body composition changes were measured using bioelectrical impedance analysis at 3 and 6 months post-surgery.  RESULTS: Higher pre-surgical GLR values positively correlated with increased fat-free mass (FFM) (p = 0.005 1, p = 0.003 2), muscle mass (MM) (p = 0.011 1, p = 0.008 2), and total body water (TBW) (p = 0.005 1, p = 0.005 2) post-surgery. In contrast, higher PNI was negatively associated with changes in FM (p = 0.029 1, p = 0.015 2), FFM (p = 0.002 1, p = 0.018 2), TBW (p = 0.002 1, p = 0.015 2) and MM (p = 0.003 2), particularly after laparoscopic sleeve gastrectomy (LSG). Furthermore, there was a significant correlation between pre-surgical HALP score and changes in FFM (p = 0.002 1, p = 0.042 2), TBW (p = 0.002 1) and MM (p = 0.011 1, p = 0.041 2). In addition, the modified HALP score showed a more significant correlation compared to the HALP score to predict the changes FM (p = 0.002 1, p = 0.002 2), FFM (p = 0.001 1, p = 0.006 2), TBW (p = 0.001 1, p = 0.003 2) and MM (p = 0.001 1, p = 0.023 2) particularly, after 6 months.

CONCLUSION

Our findings suggest that pre-surgical assessment of GLR, PNI, and HALP indices may provide valuable insights into predicting changes in body composition after bariatric surgery. Specifically, these indices could serve as tools for tailoring preoperative nutritional strategies and post-surgical interventions. However, as this study is retrospective, further prospective research with longer follow-ups is required to validate these findings and evaluate their utility in clinical practice. 1 3 months after metabolic bariatric surgery. 2 6 months after metabolic bariatric surgery.

The role of tissue oxygenation in obesity-related cardiometabolic complications

Obesity is a complex, multifactorial, chronic disease that acts as a gateway to a range of other diseases. Evidence from recent studies suggests that changes in oxygen availability in the microenvironment of metabolic organs may exert an important role in the development of obesity-related cardiometabolic complications. In this review, we will first discuss results from observational and controlled laboratory studies that examined the relationship between reduced oxygen availability and obesity-related metabolic derangements. Next, the effects of alterations in oxygen partial pressure (pO2) in the adipose tissue, skeletal muscle and the liver microenvironment on physiological processes in these key metabolic organs will be addressed, and how this might relate to cardiometabolic complications. Since many obesity-related chronic diseases, including type 2 diabetes mellitus, cardiovascular diseases, chronic kidney disease, chronic obstructive pulmonary disease and obstructive sleep apnea, are characterized by changes in pO2 in the tissue microenvironment, a better understanding of the metabolic impact of altered tissue oxygenation can provide valuable insights into the complex interplay between environmental and biological factors involved in the pathophysiology of metabolic impairments. This may ultimately contribute to the development of novel strategies to prevent and treat obesity-related cardiometabolic diseases.

Essential dataset features in a successful obesity registry: a systematic review

BACKGROUND

The prevalence of obesity and the diversity of available treatments makes the development of a national obesity registry desirable. To do this, it is essential to design a minimal dataset to meet the needs of a registry. This review aims to identify the essential elements of a successful obesity registry.

METHODS

We conducted a systematic literature review adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis recommendations. Google Scholar, Scopus and PubMed databases and Google sites were searched to identify articles containing obesity or overweight registries or datasets of obesity. We included English articles up to January 2023.

RESULTS

A total of 82 articles were identified. Data collection of all registries was carried out via a web-based system. According to the included datasets, the important features were as follows: demographics, anthropometrics, medical history, lifestyle assessment, nutritional assessment, weight history, clinical information, medication history, family medical history, prenatal history, quality-of-life assessment and eating disorders.

CONCLUSIONS

In this study, the essential features in the obesity registry dataset were demographics, anthropometrics, medical history, lifestyle assessment, nutritional assessment, weight history and clinical analysis items.

Back to Roots: Dysbiosis, Obesity, Metabolic Syndrome, Type 2 Diabetes Mellitus, and Obstructive Sleep Apnea-Is There an Objective Connection? A Narrative Review

In recent decades, it has become clear that the gut is more than just a digestive organ; it also functions as an immune organ with regulatory capabilities and acts as a "second brain" that influences brain function due to the presence and regulatory roles of the gut microbiota (GM). The GM is a crucial component of its host and significantly impacts human health. Dysbiosis, or microbial imbalance, has been closely linked to various diseases, including gastrointestinal, neurological, psychiatric, and metabolic disorders. The aim of this narrative review is to highlight the roles of the GM in maintaining metabolic health. Sleep is a vital biological necessity, with living organisms having evolved an internal sleep-wake rhythm that aligns with a roughly 24 h light/dark cycle, and this is known as the circadian rhythm. This cycle is essential for tissue repair, restoration, and overall optimal body functioning. Sleep irregularities have become more prevalent in modern society, with fast-paced lifestyles often disrupting normal sleep patterns. Urban living factors, such as fast food consumption, shift work, exposure to artificial light and nighttime noise, medications, and social activities, can adversely affect circadian rhythms, with dysbiosis being one of the many factors incriminated in the etiology of sleep disorders.

Pharmacologic Treatment of Obesity in adults and its impact on comorbidities: 2024 Update and Position Statement of Specialists from the Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso) and the Brazilian Society of Endocrinology and Metabolism (SBEM)

Pharmacological treatment of obesity is passing through many changes in the last decades; different agents have been approved, and newer options are leaning towards higher efficacy and a more favourable safety profile; however, medications approved for a longer time are still available and useful for many patients. This document is an 2024 Update Position Statement of Specialists from the Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso) and the Brazilian Society of Endocrinology and Metabolism (SBEM), with the aim of reviewing all the approved medications for the management of obesity in Brazil (sibutramine, orlistat, liraglutide, semaglutide and bupropion/naltrexone fixed dose), with the addition of tirzepatide, that is approved in other countries and likely approved soon in Brazil. The review is focused on efficacy, safety profile and the impact of drugs (based on existing studies) on different comorbidities.

Influence of Comorbidity and Obesity on the Occurrence of Vascular Events in Obstructive Apnoea Treated with CPAP

BACKGROUND

Obesity has increased cardiovascular morbidity and mortality. It is the leading risk factor for obstructive sleep apnoea (OSA). The relationship between obesity-OSA and vascular disease seems clear. There is no consensus on whether CPAP (continuous positive airway pressure) treatment prevents vascular events.

OBJECTIVE

The aim of this study was to determine the effect of comorbidity and obesity on the risk of vascular events in patients with OSA treated with CPAP.

METHOD

This study was a prospective study of historical cohorts of adult patients with OSA and CPAP. The sample was 3017 patients. Descriptive, survival (Kaplan-Meier) and Cox regression analyses were performed, calculating crude and adjusted association relationships to explain the risk of vascular events.

RESULTS

A total of 1726 patients were obese, 782 were diabetics, and 1800 were hypertensive. The mean adherence was 6.2 (±1.8 h/day), and the mean follow-up time was 2603 days (±953.3). In the COX regression analysis, the event-related variables were baseline age (HR: 1.025: 1.012-1.037; p < 0.001), pre-treatment vascular event (HR; 2.530: 1.959-3.266; p < 0.001), hypertension (HR; 1.871: 1.187-2.672; p = 0.005) and abbreviated Charlson comorbidity index (HR; 1.289: 1.100-1.510; p = 0.002).

CONCLUSIONS

The occurrence of vascular events in OSA patients on CPAP treatment is related to hypertension, having a vascular event before treatment, age at the start of CPAP use and abbreviated Charlson comorbidity index.

Exploring the association between hypocretin-1 levels and bone mineral content in patients with narcolepsy: A cross-sectional study

INTRODUCTION

Recent studies suggest the existence of a physiologic basis for bone rarefaction and increased risk for fractures. This study aimed to address anthropometric differences between patients with narcolepsy type 1 (NT1) and type 2 (NT2) and discrepancies in bone mineral content (BMC) as a function of hypocretin-1 (Hcrt-1) measured in cerebrospinal fluid (CSF).

METHODS

We have evaluated 31 adult patients (aged 18-65 years) with NT1 and 18 patients with NT2, comparing the groups in terms of anthropometric variables - body mass index (BMI) and waist-to-hip ratio (WHR) - and percentage of bone mineral content (%BMC), measured by bioelectrical impedance analysis (BIA). Statistical analysis assessed the effects of Hcrt-1 levels on CSF, dietary intake, and medication use over these variables. Statistical significance was achieved with a confidence interval of 95 % and p < 0.05.

RESULTS

Patients with NT1 presented with higher BMI (32.04 ± 6.95 vs. 25.38 ± 4.26 kg/m2; p < 0.01) and WHR (0.89 ± 0.09 vs. 0.83 ± 0.09; p = 0.02) compared to NT2, in detriment of %BMC, which was lower for NT1 (4.1 ± 1.02 vs. 4.89 ± 0.59; p < 0.01). Hcrt-1 in CSF showed a positive correlation with %BMC (r = +0.48, p < 0.01) and a negative correlation with anthropometric features (BMI: r = -0.54, p < 0.01; WHR: r = -0.37, p = 0.01). There was a correlation between WHR and diary caloric intake (r = +0.42, p < 0.01).

CONCLUSION

The evaluation of patients with narcolepsy presupposes a syndromic approach comprising symptoms that go far beyond excessive daytime sleepiness. The integrated follow-up, including nutritional profile and anthropometric features, should add value in reducing morbidity in this population.

Mechanisms, consequences and role of interventions for sleep deprivation: Focus on mild cognitive impairment and Alzheimer's disease in elderly

Sleep is established as an essential physiological need that impacts physical, emotional, and cognitive functions profoundly. Physiologically, inadequate sleep weakens immune function, heightening susceptibility to infections and chronic illnesses such as obesity, diabetes, and cardiovascular diseases. Hormonal disruptions due to sleep loss further exacerbate metabolic dysregulation, contributing to weight gain and other health complications. Emotionally, sleep deprivation leads to mood disturbances, including increased irritability, heightened stress responses, and a greater likelihood of mood disorders like depression and anxiety. These effects are compounded by cognitive impairments such as reduced alertness, impaired memory consolidation, and compromised decision-making abilities, akin to the impairments caused by alcohol consumption. Motor skills and coordination also suffer, elevating the risk of accidents, particularly in high-stress environments. For older adults, sleep quality is closely linked to cognitive function and overall longevity. Optimal sleep patterns are associated with slower brain aging and improved health outcomes. However, sleep disorders exacerbate existing conditions such as epilepsy and asthma, necessitating interventions like cognitive behavioral therapy (CBT) and medications such as melatonin to mitigate their impact. Education emerges as a crucial tool in promoting healthier sleep habits across all age groups. Addressing misconceptions about sleep and integrating sleep health into public health policies are essential steps toward improving overall well-being. Additionally, lifestyle factors such as diet and physical activity play significant roles in regulating sleep patterns, further emphasizing the interconnectedness of sleep with broader health outcomes. In summary, the articles underscore the intricate mechanisms through which sleep influences physiological functions and advocate for comprehensive approaches to enhance sleep hygiene and mitigate the adverse effects of sleep deprivation on human health.

Screening of preoperative obstructive sleep apnea by cardiopulmonary coupling and its risk factors in patients with plans to receive surgery under general anesthesia: a cross-sectional study

Objective

Preoperative obstructive sleep apnea (OSA) is supposed to be the abnormally high occurrence of OSA the night before surgery under general anesthesia. This study aimed to evaluate the prevalence preoperative OSA using cardiopulmonary coupling (CPC) and its correlation with imbalance of sympathetic/parasympathetic nervous system.

Methods

A total of 550 patients with plans to receive surgery under general anesthesia were enrolled. All patients were assigned to wear CPC on the night before surgery until the next day. Sleep quality characteristics, heart rate variation parameters, and apnea-hypopnea index were acquired. The diagnosis of pre-existing OSA was not considered in the current study.

Results

According to apnea-hypopnea index, 28.4%, 32.2%, 26.2%, and 13.3% patients were assessed as no, mild, moderate, and severe operative OSA, respectively. Multivariate logistic regression model revealed that higher age [p < 0.001, odds ratio (OR) = 1.043] was independently and positively associated with preoperative OSA; heart rate variation parameters representing the imbalance of sympathetic/parasympathetic nervous system, such as higher low-frequency (p < 0.001, OR = 1.004), higher low-frequency/high-frequency ratio (p = 0.028, OR = 1.738), lower NN20 count divided by the total number of all NN intervals (pNN20; p < 0.001, OR = 0.950), and lower high-frequency (p < 0.001, OR = 0.998), showed independent relationships with a higher probability of preoperative OSA. Higher age (p = 0.005, OR = 1.024), higher very-low-frequency (p < 0.001, OR = 1.001), and higher low-frequency/high-frequency ratio (p = 0.003, OR = 1.655) were associated with a higher probability of moderate-to-severe preoperative OSA, but higher pNN10 (p < 0.001, OR = 0.951) was associated with a lower probability of moderate-to-severe preoperative OSA.

Conclusion

Preoperative OSA is prevalent. Higher age and imbalance of sympathetic/parasympathetic nervous system are independently and positively associated with a higher occurrence of preoperative OSA. CPC screening may promote the management of preoperative OSA.

Obstructive sleep apnea: Overlooked comorbidity in patients with diabetes

In this review article, we explore the interplay between obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM), highlighting a significant yet often overlooked comorbidity. We delve into the pathophysiological links between OSA and diabetes, specifically how OSA exacerbates insulin resistance and disrupts glucose metabolism. The research examines the prevalence of OSA in diabetic patients and its role in worsening diabetes-related complications. Emphasizing the importance of comprehensive management, including weight control and positive airway pressure therapy, the study advocates integrated approaches to improve outcomes for patients with T2DM and OSA. This review underscores the necessity of recognizing and addressing OSA in diabetes care to ensure more effective treatment and better patient outcomes.

Evaluation of bi-directional causal association between obstructive sleep apnoea syndrome and diabetic microangiopathy: a Mendelian randomization study

Background

The relationship between obstructive sleep apnea syndrome (OSAS) and diabetic microangiopathy remains controversial.

Objective

This study aimed to use bidirectional two-sample Mendelian Randomization (MR) to assess the causal relationship between OSAS and diabetic microangiopathy.

Methods

First, we used the Linkage Disequilibrium Score Regression(LDSC) analysis to assess the genetic correlation. Then, the bidirectional two-sample MR study was conducted in two stages: OSAS and lung function-related indicators (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)) were investigated as exposures, with diabetic microangiopathy as the outcome in the first stage, and genetic tools were used as proxy variables for OSAS and lung function-related measures in the second step. Genome-wide association study data came from the open GWAS database. We used Inverse-Variance Weighted (IVW), MR-Egger regression, Weighted median, Simple mode, and Weighted mode for effect estimation and pleiotropy testing. We also performed sensitivity analyses to test the robustness of the results. Furthermore, we performed multivariate and mediation MR analyses.

Results

In the LDSC analysis, We found a genetic correlation between OSAS, FVC, FEV 1, and diabetic microangiopathy. In the MR analysis, based on IVW analysis, genetically predicted OSAS was positively correlated with the incidence of diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN). In the subgroup analysis of DR, there was a significant causal relationship between OSAS and background diabetic retinopathy (BDR) and proliferative diabetic retinopathy (PDR). The reverse MR did not show a correlation between the incidence of diabetic microangiopathy and OSAS. Reduced FVC had a potential causal relationship with increased incidence of DR and PDR. Reduced FEV1 had a potential causal relationship with the increased incidence of BDR, PDR, and DKD. Multivariate MR analysis showed that the association between OSAS and diabetic microangiopathy remained significant after adjusting for confounding factors. However, we did not find the significant mediating factors.

Conclusion

Our results suggest that OSAS may be a cause of the development of diabetic microangiopathy, and OSAS may also be associated with a high risk of diabetic microangiopathy, providing a reference for a better understanding of the prevention of diabetic microangiopathy.

Chronic intermittent hypoxia reveals role of the Postinspiratory Complex in the mediation of normal swallow production

Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder that results in multiple bouts of intermittent hypoxia. OSA has many neurological and systemic comorbidities, including dysphagia, or disordered swallow, and discoordination with breathing. However, the mechanism in which chronic intermittent hypoxia (CIH) causes dysphagia is unknown. Recently, we showed the postinspiratory complex (PiCo) acts as an interface between the swallow pattern generator (SPG) and the inspiratory rhythm generator, the preBötzinger complex, to regulate proper swallow-breathing coordination (Huff et al., 2023). PiCo is characterized by interneurons co-expressing transporters for glutamate (Vglut2) and acetylcholine (ChAT). Here we show that optogenetic stimulation of ChATcre:Ai32, Vglut2cre:Ai32, and ChATcre:Vglut2FlpO:ChR2 mice exposed to CIH does not alter swallow-breathing coordination, but unexpectedly disrupts swallow behavior via triggering variable swallow motor patterns. This suggests that glutamatergic-cholinergic neurons in PiCo are not only critical for the regulation of swallow-breathing coordination, but also play an important role in the modulation of swallow motor patterning. Our study also suggests that swallow disruption, as seen in OSA, involves central nervous mechanisms interfering with swallow motor patterning and laryngeal activation. These findings are crucial for understanding the mechanisms underlying dysphagia, both in OSA and other breathing and neurological disorders.

Association between body roundness index and prevalence of kidney stone in the U.S: a study based on the NHANES database

OBJECTIVE

This study aimed to evaluate the potential association between the body roundness index (BRI) and kidney stone prevalence in adults in the United States.

METHODS

A cohort of participants from the National Health and Nutrition Examination Survey (NHANES) database spanning 2007-2018 were gathered for analysis. Logistic regression analyses, subgroup assessments, and calculations were employed to examine the potential link between BRI and kidney stone prevalence.

RESULTS

The study included 30,990 participants aged > 20 years, of which 2,891 declared a kidney stone history. After modulating all relevant confounding factors, each unit increase in the BRI was linked to a 65% increase in kidney stone prevalence (OR = 1.65, 95% CI: 1.47, 1.85). Sensitivity analyses conducted by categorizing the BRI into three groups revealed a 59% increase in kidney stone prevalence in the highest tertile BRI group compared to the lowest one (OR = 1.59, 95% CI: 1.42, 1.79). Furthermore, dose-response curves depicted a positive near-linear correlation between the BRI and the risk of kidney stone prevalence.

CONCLUSION

These findings suggest a clinically noteworthy positive correlation between higher BRI values and kidney stone prevalence among the studied US adult population. However, it is essential to acknowledge that the observed relationship does not establish a causal link.

Chronic Intermittent Hypoxia reveals role of the Postinspiratory Complex in the mediation of normal swallow production

Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder that results in multiple bouts of intermittent hypoxia. OSA has many neurologic and systemic comorbidities including dysphagia, or disordered swallow, and discoordination with breathing. However, the mechanism in which chronic intermittent hypoxia (CIH) causes dysphagia is unknown. Recently we showed the Postinspiratory complex (PiCo) acts as an interface between the swallow pattern generator (SPG) and the inspiratory rhythm generator, the preBötzinger Complex, to regulate proper swallow-breathing coordination (Huff et al., 2023). PiCo is characterized by interneurons co-expressing transporters for glutamate (Vglut2) and acetylcholine (ChAT). Here we show that optogenetic stimulation of ChATcre:Ai32, Vglut2cre:Ai32, and ChATcre:Vglut2FlpO:ChR2 mice exposed to CIH does not alter swallow-breathing coordination, but unexpectedly disrupts swallow behavior via triggering variable swallow motor patterns. This suggests, glutamatergic-cholinergic neurons in PiCo are not only critical for the regulation of swallow-breathing coordination, but also play an important role in the modulation of swallow motor patterning. Our study also suggests that swallow disruption, as seen in OSA, involves central nervous mechanisms interfering with swallow motor patterning and laryngeal activation. These findings are crucial for understanding the mechanisms underlying dysphagia, both in OSA and other breathing and neurological disorders.