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Golshah A, Sadeghi M, Sadeghi E. Evaluation of Serum/Plasma Levels of Interleukins (IL-6, IL-12, IL-17, IL-18, and IL-23) in Adults and Children with Obstructive Sleep Apnea: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis. J Interferon Cytokine Res 2024; 44:300-315. [PMID: 38757606 DOI: 10.1089/jir.2024.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic inflammatory disease characterized by partial or complete upper airway obstruction during sleep. We aimed to evaluate serum/plasma levels of several cytokines (interleukin [IL]-6, IL-12, IL-17, IL-18, and IL-23) in a systematic review meta-analysis in both adults and children with OSA compared with controls. We conducted a comprehensive search of 4 digital databases (PubMed, Web of Science, Scopus, and Cochrane Library) up until October 19, 2023, without any limitations. For our meta-analysis, we used Review Manager, version 5.3, and displayed the data as the standardized mean difference (SMD) and 95% confidence interval (CI) to assess the correlation between cytokine levels and OSA. We utilized Comprehensive Meta-Analysis version 3.0 software to conduct bias analyses, meta-regression, and sensitivity analyses. From 1881 records, 84 articles were included in the systematic review and meta-analysis. In adults, the pooled SMDs for IL-6 level were 0.79 (P value < 0.00001), for IL-17 level were 0.74 (P value = 0.14), and for IL-18 level were 0.43 (P value = 0.00002). In children, the pooled SMD for IL-6 was 1.10 (P value < 0.00001), for IL-12 was 0.47 (P value = 0.10), for IL-17 was 2.21 (a P value = 0.24), for IL-18 was 0.19 (P value = 0.07), and for IL-23 was 2.46 (P value < 0.0001). The subgroup analysis showed that the ethnicity, mean body mass index, and mean apnea-hypopnea index for IL-6 levels in adults and the ethnicity for IL-6 levels in children were effective factors in the pooled SMD. The findings of the trial sequential analysis revealed that adequate evidence has been obtained. The analysis of IL levels in adults and children with OSA compared with those without OSA revealed significant differences. In adults, IL-6 and IL-18 levels were significantly higher in the OSA group, while in children, only IL-6 and IL-23 levels were significantly elevated.
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Affiliation(s)
- Amin Golshah
- Department of Orthodontics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Edris Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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AL-asiri IS, Almatrafi FG, Al-thagafi SD, AlQarni AM, Aljubran HJ, Aljamaan AK, Al-Zahrani N. The Prevalence of Sleep Disorders in People with Type 2 Diabetes and Obesity in Saudi Arabia: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2024; 17:2075-2083. [PMID: 38799281 PMCID: PMC11122321 DOI: 10.2147/dmso.s455945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose Difficulty falling or staying asleep are considered sleep disorders, and these are common among people with type 2 diabetes mellitus (T2DM) and obesity. The presence of sleep disorders may cause poor glycemic control among this population. We therefore designed this study to assess sleep disorders among patients with T2DM and obesity. Patients and Methods This cross-sectional study examined the prevalence of sleep disorders in 148 patients with T2DM and obesity at a hospital in Taif, Saudi Arabia using a validated questionnaire. Results Among those patients who have been involved in this study, we found a moderate level of sleep disorders and disturbances. The average sleep disorder assessment score for the patients with T2DM and obesity was 2.8 ± 1.4. Additionally, the average score for the sleep pattern assessment was 2.7 ± 1.3 and 2.9 ± 1.5 for symptoms of lack of sleep. Our study also revealed that those patients also had suboptimal weight and glycemic control. Conclusion These findings demonstrate that patients with T2DM and obesity are at a higher risk of developing sleep disorders. Therefore, these patients need to be screened for sleep disorders to avoid further diabetes-related complications and to have an early lifestyle intervention.
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Affiliation(s)
- Ibrahim S AL-asiri
- Diabetes and Endocrine Specialist Centre, Prince Mansour Military Hospital, Taif, Saudi Arabia
| | - Fahad G Almatrafi
- Diabetes and Endocrine Specialist Centre, Prince Mansour Military Hospital, Taif, Saudi Arabia
| | - Saja D Al-thagafi
- Diabetes and Endocrine Specialist Centre, Prince Mansour Military Hospital, Taif, Saudi Arabia
| | - Amani M AlQarni
- Family and Community Medicine Department, King Fahd Hospital of the University, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Hussain J Aljubran
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah K Aljamaan
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Noura Al-Zahrani
- Diabetes and Endocrine Center, Hera General Hospital, Ministry of Health, Makkah, Saudi Arabia
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Cusi K, Ekhlaspour L, Fleming TK, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Napoli N, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Verduzco-Gutierrez M, Younossi ZM, Gabbay RA. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S52-S76. [PMID: 38078591 PMCID: PMC10725809 DOI: 10.2337/dc24-s004] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Burlaka I. Apoptosis-Controlling, Clinical, Laboratory, Anamnestic Factors in Prediction of the Early Stage of Diabetic Nephropathy in Children. Glob Pediatr Health 2023; 10:2333794X231214456. [PMID: 38106637 PMCID: PMC10722950 DOI: 10.1177/2333794x231214456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Background. The most prevalent microvascular consequence of type 1 diabetes (T1D) is diabetic nephropathy (DN). Aim of the Study. To find the clinical, anamnestic, and genetic markers that characterize and forecast early diabetic nephropathy in T1D children. Methods. One hundred four children with T1D and DN between the ages of 2 and 17 were surveyed. Stepwise logistic regression models and linear regression models were used. Results. BMI, systolic blood pressure, concurrent kidney pathology, anamnesis viral infections, ESR level, serum cholesterol, blood urea, number of DKA episodes/year, and GFR were determined to be predictors of early DN in children with T1D. Bcl-xL, caspase-3, and HIF-1alfa were discovered to predict DN among all previously identified variables influencing apoptosis. Conclusion. BMI, systolic blood pressure, concurrent kidney disease, anamnesis viral infections, ESR level, serum cholesterol, blood urea, number of DKA episodes/year, GFR, apoptotic and hypoxia markers were discovered as variables predicting early DN.
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Man J, Zhang J, Chen G, Xue N, Chen J. A tactile and airflow motion sensor based on flexible double-layer magnetic cilia. MICROSYSTEMS & NANOENGINEERING 2023; 9:12. [PMID: 36688091 PMCID: PMC9845383 DOI: 10.1038/s41378-022-00478-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Inspired by the concept of bionics, a tactile and airflow motion sensor based on flexible double-layer magnetic cilia is developed, showing extremely high sensitivity in both force and airflow detection. The upper layer of the magnetic cilia is a flexible material mixed with magnetic particles, while the lower layer is a pure flexible material. This double-layer structure significantly improves magnetism while maintaining cilia flexibility. In addition, a metal tube pressing (MTP) method is proposed to overcome the difficulties in preparing large aspect ratio (over 30:1) cilia, offering simplicity and avoiding the use of large-scale MEMS instruments. The developed sensor has a detection range between 0 and 60 µN with a resolution of 2.1 µN for micro forces. It also shows great detection ability for airflow velocity with a sensitivity of 1.43 µT/(m/s). Experiments show that the sensor could be applied in surface roughness characterization and sleep apnea monitoring.
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Affiliation(s)
- Jiandong Man
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, 100190 Beijing, People’s Republic of China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, 100049 Beijing, People’s Republic of China
| | - Junjie Zhang
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, 100190 Beijing, People’s Republic of China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, 100049 Beijing, People’s Republic of China
| | - Guangyuan Chen
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, 100190 Beijing, People’s Republic of China
| | - Ning Xue
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, 100190 Beijing, People’s Republic of China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, 100049 Beijing, People’s Republic of China
| | - Jiamin Chen
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, 100190 Beijing, People’s Republic of China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, 100049 Beijing, People’s Republic of China
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Cusi K, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S49-S67. [PMID: 36507651 PMCID: PMC9810472 DOI: 10.2337/dc23-s004] [Citation(s) in RCA: 82] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Walter JR, Lee JY, Snoll B, Park JB, Kim DH, Xu S, Barnhart K. Pregnancy outcomes in infertility patients diagnosed with sleep disordered breathing with wireless wearable sensors. Sleep Med 2022; 100:511-517. [PMID: 36306629 DOI: 10.1016/j.sleep.2022.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the feasibility of home-based assessment of sleep disordered breathing (SDB) on early pregnancy success after in vitro fertilization with novel wearable sensors. DESIGN Prospective observational study. SETTING Patients 18 to 45 years old undergoing autologous IVF at an academic infertility center. PATIENTS 30 women (24-44 years old) INTERVENTION: Participants provided medical history, completed sleep surveys, and a single night of home sleep monitoring prior to IVF with a novel, FDA-cleared wireless sensor system (ANNE® Sleep, Sibel Health), to collect continuous measurements of heart rate, respiratory rate, pulse oxygenation, respiratory effort/snoring, peripheral arterial tonometry, pulse arrival time, and pulse transit time, an accepted surrogate of continuous blood pressure generated by pulse arrival time and pulse transit time. Sleep nights were reviewed to derive the apnea hypopnea index (AHI), defined as the average number of apnea or hypopnea events per hour. An AHI of greater than or equal to 5 events/hour was considered abnormal. MAIN OUTCOME MEASURE Rate of clinical pregnancy (defined as intrauterine gestational sac with a yolk sac) after IVF. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio. RESULTS The overall rate of sleep disordered breathing of any severity was 57%. Participants with SDB had a mean AHI of 13.4 compared to 2.7 events/hr (p<0.01), were younger, and more likely to have polycystic ovary syndrome. Of the 29 patients undergoing an embryo transfer, clinical pregnancy and livebirth occurred in 35% of women with SDB compared to 58% without SDB (p = 0.22). After adjusting for age, SDB reduced pregnancy rates but was not statistically significant (aOR 0.23, 95% CI: 0.04-1.5, p = 0.12). Though polycystic ovary syndrome was associated with higher rates of SDB it was not independently associated with lower pregnancy rates. CONCLUSION Screening for sleep disordered breathing using home-based wireless, wearable sensors was well accepted and easily performed by infertile patients in this cohort. Sleep disordered breathing of any severity was associated with an 77% (95% CI: 0.08-1.8) lower likelihood of clinical pregnancy and live birth independent of underlying diagnosis. Future larger studies will be needed to understand the role of sleep disordered breathing and IVF outcomes.
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Affiliation(s)
- Jessica R Walter
- University of Pennsylvania, Division of Reproductive Endocrinology and Infertility, Philadelphia, PA, USA.
| | | | | | | | | | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, IL, USA; Northwestern University, Department of Dermatology, Chicago, IL, USA
| | - Kurt Barnhart
- University of Pennsylvania, Division of Reproductive Endocrinology and Infertility, Philadelphia, PA, USA
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Davies C, Lee JY, Walter J, Kim D, Yu L, Park J, Blake S, Kalluri L, Cziraky M, Stanek E, Miller J, Harty BJ, Schauer J, Rangel SM, Serao A, Edel C, Ran DS, Olagbenro MO, Lim A, Gill K, Cooksey J, Toloui O, Power T, Xu S, Zee P. A single-arm, open-label, multicenter, and comparative study of the ANNE sleep system vs polysomnography to diagnose obstructive sleep apnea. J Clin Sleep Med 2022; 18:2703-2712. [PMID: 35934926 PMCID: PMC9713912 DOI: 10.5664/jcsm.10194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Evaluate per-patient diagnostic performance of a wireless dual-sensor system (ANNE sleep) compared with reference standard polysomnography (PSG) for the diagnosis of moderate and severe obstructive sleep apnea (OSA) with a minimum prespecified threshold of 80% for both sensitivity and specificity. METHODS A multicenter clinical trial was conducted to evaluate ANNE sleep vs PSG to diagnose moderate and severe OSA in individuals 22 years or older. For each testing approach, apnea-hypopnea index (AHI) was manually scored and averaged by 3 registered sleep technologists blinded to the other system. Average variations > 15% were adjudicated by a sleep medicine physician. RESULTS In a total of n = 225 participants (mean age 53 years, range 22-88 years), PSG diagnosed 30% (n = 68) of participants with moderate or severe OSA (AHI ≥ 15 events/h) compared to 29% (n = 65) diagnosed by ANNE sleep (P = .55). The sensitivity and specificity for ANNE sleep were 90% (95% confidence interval: 80-96%) and 98% (95% confidence interval: 94-99%), respectively. Strong correlation was shown in terms of final AHI (r = .93), with an average AHI bias of 0.5 (95% limits of agreement: -12.8 to 11.8). The majority of users noted comfort with using the ANNE sleep in the home setting. No adverse events were noted. CONCLUSIONS Using PSG as the gold standard, ANNE sleep demonstrated high sensitivity and specificity for the diagnosis of moderate or severe OSA. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Comparative Study of the ANNE™ One System to Diagnose Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT04643782; Identifier: NCT04643782. CITATION Davies C, Lee JY, Walter J et al. A single-arm, open-label, multicenter, and comparative study of the ANNE sleep system vs polysomnography to diagnose obstructive sleep apnea. J Clin Sleep Med. 2022;18(12):2703-2712.
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Affiliation(s)
- Charles Davies
- Carle Neuroscience Institute, Division of Sleep Medicine, Carle Foundation Hospital, Urbana, Illinois
| | - Jong Yoon Lee
- Sibel Health, Niles, Illinois
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
| | - Jessica Walter
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | | | - Lian Yu
- Sibel Health, Niles, Illinois
| | | | | | | | | | | | | | | | - Jacob Schauer
- Department of Preventative Medicine, Northwestern University, Chicago, Illinois
| | - Stephanie M. Rangel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexa Serao
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Claire Edel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Davina S. Ran
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew O. Olagbenro
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew Lim
- Division of Sleep Medicine, Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kuljeet Gill
- Central DuPage Hospital, Northwestern Medicine, Winfield, Illinois
- Division of Sleep Medicine, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Jessica Cooksey
- Division of Sleep Medicine, Department of Neurology, Northwestern University, Chicago, Illinois
- Lake Forest Hospital, Northwestern Medicine, Lake Forest, Illinois
| | - Omid Toloui
- Anthem, Inc. Elevance Health, Indianapolis, Indiana
| | | | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
- Department of Pediatrics (Division of Dermatology), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Phyllis Zee
- Division of Sleep Medicine, Department of Neurology, Northwestern University, Chicago, Illinois
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Monda VM, Gentile S, Porcellati F, Satta E, Fucili A, Monesi M, Strollo F. Heart Failure with Preserved Ejection Fraction and Obstructive Sleep Apnea: A Novel Paradigm for Additional Cardiovascular Benefit of SGLT2 Inhibitors in Subjects With or Without Type 2 Diabetes. Adv Ther 2022; 39:4837-4846. [PMID: 36112311 PMCID: PMC9525351 DOI: 10.1007/s12325-022-02310-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/24/2022] [Indexed: 01/30/2023]
Abstract
After examining the complex interplay between heart failure (HF) in its various clinical forms, metabolic disorders like nonalcoholic fatty liver disease (NAFLD), and obstructive sleep apnea (OSA) syndrome, in this mini-review we described possible favorable effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) on HF with preserved (i.e., ≥ 50%) ejection fraction (HFpEF) through enhanced cardiorenal function and visceral-subcutaneous body fat redistribution. In greater detail, on the basis of pathophysiological mechanisms underlying OSA onset and the direct positive SGLT2i effect on renal function benefiting chronic kidney disease, we emphasized the promising role of SGLT2is in prevention, rehabilitation, and treatment of patients with OSA regardless of coexisting type 2 diabetes (T2DM). Indeed, SGLT2is enhance lipolysis and fatty acid beta-oxidation. These phenomena might prevent OSA by reducing the size of visceral and subcutaneous adipose tissue and, as proven in humans and animals with T2DM, counteract NAFLD onset and progression. The aforementioned mechanisms may represent an additional SGLT2i cardioprotective effect in terms of HFpEF prevention in patients with OSA, whose NAFLD prevalence is estimated to be over 50%.
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Affiliation(s)
| | - Sandro Gentile
- Department of Precision Medicine, Campania University “Luigi Vanvitelli”, Naples, Italy
- Nefrocenter Research Network, Cava dé Tirreni, Italy
| | - Francesca Porcellati
- Section of Internal Medicine, Endocrinology and Metabolism, Department of Medicine, Perugia University School of Medicine, Perugia, Italy
| | - Ersilia Satta
- Polyspecialistic Nephrologic Center CNP Srl, Fratta Maggiore, Italy
- Nefrocentre Research Network, Cava dé Tirreni, Italy
| | | | | | - Felice Strollo
- Department of Endocrinology and Diabetes, IRCCS San Raffaele Pisana, Rome, Italy
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Shah AS, Zeitler PS, Wong J, Pena AS, Wicklow B, Arslanian S, Chang N, Fu J, Dabadghao P, Pinhas-Hamiel O, Urakami T, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents. Pediatr Diabetes 2022; 23:872-902. [PMID: 36161685 DOI: 10.1111/pedi.13409] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
Since the 2018 ISPAD guidelines on this topic, follow-up of large cohorts from around the globe have continued informing the current incidence and prevalence of co-morbidities and complications in young adults with youth-onset type 2 diabetes (T2D). This chapter focuses on the risk factors, diagnosis and presentation of youth-onset T2D, the initial and subsequent management of youth-onset T2D, and management of co-morbidities and complications. We include key updates from the observational phase of the multi-center Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial, the SEARCH for Diabetes in Youth (SEARCH) study and new data from the Restoring Insulin Secretion (RISE) study, a head-to-head comparison of youth onset vs adult-onset T2D. We also include an expanded section on risk factors associated with T2D, algorithms and tables for treatment, management, and assessment of co-morbidities and complications, and sections on recently approved pharmacologic therapies for the treatment of youth-onset T2D, social determinants of health, and settings of care given COVID-19 pandemic.
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Affiliation(s)
- Amy S Shah
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio, USA
| | - Philip S Zeitler
- Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jencia Wong
- Department of Endocrinology, Royal Prince Alfred Hospital and Central Clinical School, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Alexia S Pena
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Brandy Wicklow
- Division of Endocrinology, Winnipeg Children's Hospital and University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy Chang
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Junfen Fu
- Division of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Orit Pinhas-Hamiel
- Edmond and Lily Safra Children's Hospital, Sackler School of Medicine, Tel-Aviv, Israel
| | - Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Maria E Craig
- The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Pediatrics & Child Health, School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
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Wondie A, Taderegew MM, Girma B, Getawey A, Tsega D, Terefe TF, Mitiku S, Berhanu H. Obstructive sleep apnea risk and its associated factors among type 2 diabetes mellitus patients at wolkite university specialized hospital, Wolkite, Southern Ethiopia, 2021. A comparative cross-sectional study. Diabetol Metab Syndr 2022; 14:157. [PMID: 36303199 PMCID: PMC9607780 DOI: 10.1186/s13098-022-00931-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea is a syndrome characterized by recurrent partial, or complete upper airway collapse during sleep. Although obstructive sleep apnea is common in type 2 diabetes mellitus, the majority of patients remain undiagnosed because of the prohibitive cost of the test and paucity of the sleep clinic, especially in developing nations. The study aimed to assess high-risk obstructive sleep apnea and its associated factors among type 2 diabetes mellitus patients at Wolkite University Specialized Hospital. METHODS A Hospital-based comparative cross-sectional study was employed from October 15 to December 5, 2021, among 204 participants. Data collection was done by semi-structured interviewer-administered questionnaires. Data was entered into the Epi data version 4.6 and exported to SPSS version 25.0 for analysis. Independent t-test and chi-square test were used to compare continuous and categorical variables accordingly. Binary and multiple logistic regression analysis was used to assess factors associated with high-risk obstructive sleep apnea. Statistical significance was set at P-value < 0.05. RESULTS A total of 204 participants with an equal proportion of the two groups were included with a 100% response rate. About 56.9% of the participants were males. The mean age of type 2 diabetes mellitus patients was 57.1 (± 12.0) years and the non-diabetic group was 55.3 (± 10.9) years. The prevalence of high-risk obstructive sleep apnea among type 2 diabetes mellitus was 42.2%, and that of non-diabetics was 13.7% (p < 0.001). Age (AOR: 1.13; 95%CI: 1.04, 1.22), neck grasp (AOR: 6.48; 95%CI: 1.56, 26.96), waist circumference (AOR: 4.44; 95%CI: 1.12, 17.61) and the presence of diabetes-related complications (AOR: 4.18; 95%CI: 1.13, 15.43) were independently associated with high-risk obstructive sleep apnea among type 2 diabetes mellitus patients. CONCLUSION The prevalence of high-risk obstructive sleep apnea among type 2 diabetes mellitus was higher with a significant difference from their comparison group. Age, neck grasp, waist circumference, and diabetes-related complications were significantly associated with high-risk obstructive sleep apnea among type 2 diabetes mellitus patients. Therefore, type 2 diabetes mellitus patients should be screened for obstructive sleep apnea in the early course of their follow-up to take preventive measures and early treatments.
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Affiliation(s)
- Alemayehu Wondie
- Department of Biomedical Sciences, College of Medicine and Health Science, Wolkite University, P.O. Box 07, Wolkite, Ethiopia.
| | - Mitku Mammo Taderegew
- Department of Biomedical Sciences, College of Medicine and Health Science, Wolkite University, P.O. Box 07, Wolkite, Ethiopia
| | - Betemariam Girma
- Department of Biomedical Sciences, College of Medicine and Health Science, Wolkite University, P.O. Box 07, Wolkite, Ethiopia
| | - Atsede Getawey
- Department of Biomedical Sciences, College of Medicine and Health Science, Wolkite University, P.O. Box 07, Wolkite, Ethiopia
| | - Daniel Tsega
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Tamene Fetene Terefe
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Shimelis Mitiku
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Hiwot Berhanu
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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12
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Obesity as a mediator linking sleep-disordered breathing to both impaired fasting glucose and type 2 diabetes. Sleep Breath 2022; 27:1067-1080. [DOI: 10.1007/s11325-022-02705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
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A Prediction Nomogram Combining Epworth Sleepiness Scale and Other Clinical Parameters to Predict Obstructive Sleep Apnea in Patients with Hypertension. Int J Hypertens 2022; 2022:3861905. [PMID: 36034887 PMCID: PMC9411005 DOI: 10.1155/2022/3861905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/25/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is common in patients with hypertension. Nonetheless, OSA is underdiagnosed despite considerable evidence of the association between OSA and adverse health outcomes. This study developed and validated a clinical nomogram to predict OSA in patients with hypertension based on the Epworth Sleepiness Scale (ESS) score and OSA-related parameters. Methods A total of 347 hypertensive patients with suspected OSA were retrospectively enrolled and randomly assigned to a training set and a validation set at 70 : 30 (N = 242/N = 105) ratio. OSA was diagnosed through sleep monitoring and was defined as an apnea-hypopnea index ≥5 events/h. Using the least absolute shrinkage and selection operator regression model, we identified potential predictors of OSA and constructed a nomogram model in the training set. The predictive performance of the nomogram was assessed and validated by discrimination and calibration. The nomogram was also compared with ESS scores according to decision curve analysis (DCA), integrated discrimination index (IDI), and net reclassification index (NRI). Results ESS scores, body mass index, neck circumference, snoring, and observed apnea predicted OSA are considered. The nomogram showed similar discrimination between the training set (AUC: 0.799, 95% CI: 0.743–0.847) and validation set (AUC: 0.766, 95% CI: 0.673–0.843) and good calibration in the training (P=0.925 > 0.05) and validation (P=0.906 > 0.05) sets. Compared with the predictive value of the ESS, the nomogram was clinically useful and significantly improved reclassification accuracy (NRI: 0.552, 95% CI: 0.282–0.822, P < 0.001; IDI: 0.088, 95% CI: 0.045–0.133, P < 0.001) at a probability threshold of >42%. Conclusions We developed a novel OSA prediction nomogram based on ESS scores and OSA-related parameters. This nomogram may help improve clinical decision-making, especially in communities and primary clinics, where polysomnography is unavailable.
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Alshehri Z, Subramanian A, Adderley NJ, Gokhale KM, Karamat MA, Ray CJ, Kumar P, Nirantharakumar K, Tahrani AA. Risk of incident obstructive sleep apnoea in patients with type 1 diabetes: a population-based retrospective cohort study. Diabetologia 2022; 65:1353-1363. [PMID: 35608616 PMCID: PMC9283161 DOI: 10.1007/s00125-022-05714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS People with type 2 diabetes are at increased risk of developing obstructive sleep apnoea. However, it is not known whether people with type 1 diabetes are also at an increased risk of obstructive sleep apnoea. This study aimed to examine whether people with type 1 diabetes are at increased risk of incident obstructive sleep apnoea compared with a matched cohort without type 1 diabetes. METHODS We used a UK primary care database, The Health Improvement Network (THIN), to perform a retrospective cohort study between January 1995 and January 2018 comparing sleep apnoea incidence between patients with type 1 diabetes (exposed) and without type 1 diabetes (unexposed) (matched for age, sex, BMI and general practice). The outcome was incidence of obstructive sleep apnoea. Baseline covariates and characteristics were assessed at the start of the study based on the most recent value recorded prior to the index date. The Cox proportional hazards regression model was used to estimate unadjusted and adjusted hazard ratios, based on a complete-case analysis. RESULTS In total, 34,147 exposed and 129,500 matched unexposed patients were included. The median follow-up time was 5.43 years ((IQR 2.19-10.11), and the mean BMI was 25.82 kg/m2 (SD 4.33). The adjusted HR for incident obstructive sleep apnoea in patients with type 1 diabetes vs those without type 1 diabetes was 1.53 (95% CI 1.25, 1.86; p<0.001). Predictors of incident obstructive sleep apnoea in patients with type 1 diabetes were older age, male sex, obesity, being prescribed antihypertensive or lipid-lowering drugs, atrial fibrillation and depression. CONCLUSIONS/INTERPRETATION Individuals with type 1 diabetes are at increased risk of obstructive sleep apnoea compared with people without diabetes. Clinicians should suspect obstructive sleep apnoea in patients with type 1 diabetes if they are old, have obesity, are male, have atrial fibrillation or depression, or if they are taking lipid-lowering or antihypertensive drugs.
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Affiliation(s)
- Ziyad Alshehri
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
- Respiratory Therapy Department, Taibah University, Medina, Saudi Arabia.
| | | | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishna M Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Muhammad Ali Karamat
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Clare J Ray
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Prem Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | | | - Abd A Tahrani
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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15
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Olivares MJ, Toledo C, Ortolani D, Ortiz FC, Díaz HS, Iturriaga R, Del Río R. Sleep dysregulation in sympathetic-mediated diseases: implications for disease progression. Sleep 2022; 45:6649852. [DOI: 10.1093/sleep/zsac166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/18/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
The autonomic nervous system (ANS) plays an important role in the coordination of several physiological functions including sleep/wake process. Significant changes in ANS activity occur during wake-to-sleep transition maintaining the adequate cardiorespiratory regulation and brain activity. Since sleep is a complex homeostatic function, partly regulated by the ANS, it is not surprising that sleep disruption trigger and/or evidence symptoms of ANS impairment. Indeed, several studies suggest a bidirectional relationship between impaired ANS function (i.e. enhanced sympathetic drive), and the emergence/development of sleep disorders. Furthermore, several epidemiological studies described a strong association between sympathetic-mediated diseases and the development and maintenance of sleep disorders resulting in a vicious cycle with adverse outcomes and increased mortality risk. However, which and how the sleep/wake control and ANS circuitry becomes affected during the progression of ANS-related diseases remains poorly understood. Thus, understanding the physiological mechanisms underpinning sleep/wake-dependent sympathetic modulation could provide insights into diseases involving autonomic dysfunction. The purpose of this review is to explore potential neural mechanisms involved in both the onset/maintenance of sympathetic-mediated diseases (Rett syndrome, congenital central hypoventilation syndrome, obstructive sleep apnoea, type 2 diabetes, obesity, heart failure, hypertension, and neurodegenerative diseases) and their plausible contribution to the generation of sleep disorders in order to review evidence that may serve to establish a causal link between sleep disorders and heightened sympathetic activity.
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Affiliation(s)
- María José Olivares
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Camilo Toledo
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes , Punta Arenas , Chile
| | - Domiziana Ortolani
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Fernando C Ortiz
- Mechanisms of Myelin Formation and Repair Laboratory, Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile , Santiago , Chile
| | - Hugo S Díaz
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes , Punta Arenas , Chile
| | - Rodrigo Iturriaga
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes , Punta Arenas , Chile
| | - Rodrigo Del Río
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes , Punta Arenas , Chile
- Centro de Envejecimiento y Regeneración (CARE), Pontificia Universidad Católica de Chile , Santiago , Chile
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16
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Ding S, Zhang P, Wang L, Wang D, Sun K, Ma Y, Wang H, Xu C, Zhang R, Zhang X, Wang H, Zhao F, Li X, Ji L, Guo L. Prevalence of obstructive sleep apnoea syndrome in hospitalized patients with type 2 diabetes in Beijing, China. J Diabetes Investig 2022; 13:1889-1896. [PMID: 35778970 PMCID: PMC9623507 DOI: 10.1111/jdi.13868] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
Aims/Introduction To estimate the prevalence, and patient clinical and demographic profile, as well as risk factors associated with obstructive sleep apnea syndrome (OSAS) in hospitalized patients with type 2 diabetes mellitus in Beijing, China. Materials and Methods Hospitalized adult patients with type 2 diabetes mellitus were consecutively screened and invited for an overnight polysomnography from four hospitals in Beijing, China, from May 2016 to February 2017. We used the American Academy of Sleep Medicine 2012 polysomnography recording techniques and scoring criteria to identify the type of apnea and the severity of OSAS. The χ2‐test was used to evaluate differences between groups regarding the prevalence, and demographic and other clinical parameters. Results A total of 735 patients were found eligible for the study, of whom 309 patients completed the overnight polysomnography. The mean age of the patients was 58.2 ± 10.9 years, and most (67.3%) were men. The prevalence of overall (apnea hypopnea index ≥5/h), moderate‐to‐severe (apnea hypopnea index ≥15/h) and severe (apnea hypopnea index ≥30/h) OSAS was 66.3% (95% confidence interval 60.8–71.6%), 35.6% (95% confidence interval 30.3–41.2%) and 16.5% (95% confidence interval 12.5–21.1%), respectively. Central and mixed apnea contributed 12% to all sleep‐disordered breathing. With the aggravation of OSAS, the combined prevalence for central, mixed and obstructive apnea increased from 57% to 70%. We found OSAS to be associated with older age, obesity, self‐reported snoring and apnea, and diabetes complications. Conclusions Guidelines on screening and treatment of OSAS among hospitalized patients with diabetes are needed to direct the routine practice for diabetes endocrinologists for optimal clinical care of such patients.
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Affiliation(s)
- Shan Ding
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Sciences Beijing P.R. China
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center Beijing P.R. China
- Faculty of Medicine University of New South Wales Sydney Australia
| | - Li Wang
- Department of Endocrinology, Xuanwu Hospital Capital Medical University Beijing P.R. China
| | - Du Wang
- The George Institute for Global Health at Peking University Health Science Center Beijing P.R. China
| | - Kaige Sun
- The George Institute for Global Health at Peking University Health Science Center Beijing P.R. China
| | - Yahui Ma
- Department of Endocrinology, Xuanwu Hospital Capital Medical University Beijing P.R. China
| | - Hongbing Wang
- Sleep Center Lab, Beijing Hospital, National Center of Gerontology Beijing P.R. China
| | - Chun Xu
- Department of Endocrinology, The Third Medical Center of Chinese Hospital of People’s Liberation Army Beijing P.R. China
| | - Rui Zhang
- Department of Endocrinology and Metabolism Peking University People’s Hospital No. 11, Xizhimen Nan Da Jie, Xicheng District Beijing China
| | - Xianbo Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Sciences Beijing P.R. China
| | - Hongyu Wang
- Department of Endocrinology, The Third Medical Center of Chinese Hospital of People’s Liberation Army Beijing P.R. China
| | - Fang Zhao
- The George Institute for Global Health at Peking University Health Science Center Beijing P.R. China
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center Beijing P.R. China
| | - Linong Ji
- Department of Endocrinology and Metabolism Peking University People’s Hospital No. 11, Xizhimen Nan Da Jie, Xicheng District Beijing China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Sciences Beijing P.R. China
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A portrait of obstructive sleep apnea risk factors in 27,210 middle-aged and older adults in the Canadian Longitudinal Study on Aging. Sci Rep 2022; 12:5127. [PMID: 35332170 PMCID: PMC8948183 DOI: 10.1038/s41598-022-08164-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/22/2022] [Indexed: 01/03/2023] Open
Abstract
Determining the prevalence and characteristics of individuals susceptible to present with obstructive sleep apnea (OSA) is essential for developing targeted and efficient prevention and screening strategies. We included 27,210 participants aged ≥45 years old (50.3% women) from the Canadian Longitudinal Study on Aging. Using the STOP questionnaire combined to the percentage of body fat (%BF), we estimated the prevalence of individuals at high-risk for OSA in a sex and age-specific manner, and tested the relation with comorbidities, menopause and systemic inflammation. The prevalence was 17.5%, and was lower in women (13.1%) than in men (21.9%). A high level of high-sensitivity C-reactive protein was the strongest factor associated with OSA risk and this association was 1.3-2.3 times higher in women than in men. OSA risk increased with age, cardiovascular diseases, diabetes mellitus, anxio-depressive symptoms, asthma and arthritis. In women, post-menopausal status was associated with a high OSA risk. Nearly 1 adult out of 5 older than 45 is at risk for OSA in Canada. Comorbidities, menopause and systemic inflammation, more than age, explain increased OSA prevalence. Considering this high prevalence and associations with medical and mental comorbidities, health care practitioners should incorporate systematic OSA screening in their clinical procedures.
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Prediabetes Is Associated with Increased Prevalence of Sleep-Disordered Breathing. J Clin Med 2022; 11:jcm11051413. [PMID: 35268504 PMCID: PMC8910907 DOI: 10.3390/jcm11051413] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 02/04/2023] Open
Abstract
Type 2 diabetes leads to severe nocturnal hypoxemia, with an increase in apnea events and daytime sleepiness. Hence, we assessed sleep breathing parameters in the prediabetes stage. A cross-sectional study conducted on 966 middle-aged subjects without known pulmonary disease (311 patients with prediabetes and 655 controls with normal glucose metabolism) was conducted. Prediabetes was defined by glycated hemoglobin (HbA1c), and a nonattended overnight home sleep study was performed. Participants with prediabetes (n = 311) displayed a higher apnea−hypopnea index (AHI: 12.7 (6.1;24.3) vs. 9.5 (4.2;19.6) events/h, p < 0.001) and hypopnea index (HI: 8.4 (4.0;14.9) vs. 6.0 (2.7;12.6) events/h, p < 0.001) than controls, without differences in the apnea index. Altogether, the prevalence of obstructive sleep apnea was higher in subjects with prediabetes than in controls (78.1 vs. 69.9%, p = 0.007). Additionally, subjects with prediabetes presented impaired measurements of the median and minimum nocturnal oxygen saturation, the percentage of time spent with oxygen saturations below 90%, and the 4% oxygen desaturation index in comparison with individuals without prediabetes (p < 0.001 for all). After adjusting for age, sex, and the presence of obesity, HbA1c correlated with the HI in the entire population (r = 0.141, p < 0.001), and the presence of prediabetes was independently associated with the AHI (B = 2.20 (0.10 to 4.31), p = 0.040) as well as the HI (B = 1.87 (0.61 to 3.14), p = 0.004) in the multiple linear regression model. We conclude that prediabetes is an independent risk factor for an increased AHI after adjusting for age, sex, and obesity. The enhanced AHI is mainly associated with increments in the hypopnea events.
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19
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Dash S, Thakur A. To assess the risk of obstructive sleep apnea in type 2 diabetes mellitus patients in a tertiary care center in Eastern India. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_54_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Nozawa S, Urushihata K, Machida R, Hanaoka M. The positional characteristics of patients with obstructive sleep apnea: a single institute retrospective study in Japan. Sleep Biol Rhythms 2022; 20:115-121. [PMID: 38469073 PMCID: PMC10899958 DOI: 10.1007/s41105-021-00347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
Obstructive sleep apnea (OSA) causes sleep-disordered breathing (SDB) due to upper airway obstruction. The severity of OSA changes with position during sleep. Patients with marked significant improvement in apnea-hypopnea index (AHI) level by sleep position change are defined as ''positional patients'' (PP), while those without improvement are defined as ''non-positional patients'' (NPP). We aimed to verify their clinical characteristics. Between May 2008 and May 2020, 237 patients with OSA were registered retrospectively and classified into two groups: PP (n = 158) and NPP (n = 79). The differences in clinical background and full-night polysomnography (PSG) between the two groups were observed. A logistic regression analysis was conducted to identify the risk factors for severe AHI (≥ 30 events/h) in the PP group. Moreover, confounding factor-adjusted sub-analysis by a propensity score matching method was performed, and the PSG results were compared between the two groups. The PP group was older than the NPP group. Furthermore, the PP group had lower body mass index (BMI) and AHI levels compared with the NPP group. The independent risk factors for severe AHI in the PP group were BMI and being in the supine position during sleep. The PP group had a significantly milder nocturnal hypoxemia despite having no significant difference in AHI levels between the two groups. The characteristics of PP were old age, low BMI, and low AHI associated with milder nocturnal hypoxemia. Moreover, they were less likely to worsen with nocturnal hypoxemia compared with NPP having similar severity.
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Affiliation(s)
- Shuhei Nozawa
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Kazuhisa Urushihata
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Ryosuke Machida
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
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21
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4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022; 45:S46-S59. [PMID: 34964869 PMCID: PMC8935396 DOI: 10.2337/dc22-s004] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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22
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Evidence of an Association of Obstructive Sleep Apnea with Diabetes and Diabetic Complications. CURRENT SLEEP MEDICINE REPORTS 2021. [DOI: 10.1007/s40675-021-00217-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gabryelska A, Chrzanowski J, Sochal M, Kaczmarski P, Turkiewicz S, Ditmer M, Karuga FF, Czupryniak L, Białasiewicz P. Nocturnal Oxygen Saturation Parameters as Independent Risk Factors for Type 2 Diabetes Mellitus among Obstructive Sleep Apnea Patients. J Clin Med 2021; 10:jcm10173770. [PMID: 34501217 PMCID: PMC8432118 DOI: 10.3390/jcm10173770] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a recognized independent risk factor for metabolic disorders, type 2 diabetes mellites (DM2) in particular. Therefore, the study aimed to assess the influence of nocturnal oxygen saturation parameters on the onset of DM2 among OSA patients. The study consisted of 549 participants, who underwent polysomnography examination. Based on apnea hypopnea index (AHI), 465 patients were diagnosed with OSA. One hundred and seven individuals had comorbid DM2. Cox regression models were used to assess the effect of oxygen saturation parameters on the onset of DM2. Classification and regression trees (CART) analysis was used to assess the onset of the DM2 in the study group in context of oxygen saturation variables. One-way Cox regression showed higher risk of earlier DM2 for increased values of BMI, AHI, decreased basal O2 and O2 nadir value, while lowered mean O2 desaturation has not shown statistical significance. In the CART analysis, the following cut-off points 92.2%, 81.7%, 87.1% were determined for basal O2, O2 nadir and mean O2 desaturation, respectively, with the first two parameters being statistically significant. Therefore, basal O2 is independent from AHI, BMI and age is a risk factor of DM2 among OSA patients.
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Affiliation(s)
- Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.S.); (P.K.); (S.T.); (M.D.); (F.F.K.); (P.B.)
- Correspondence: ; Tel.: +48-660-796-004
| | - Jędrzej Chrzanowski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215 Lodz, Poland;
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.S.); (P.K.); (S.T.); (M.D.); (F.F.K.); (P.B.)
| | - Piotr Kaczmarski
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.S.); (P.K.); (S.T.); (M.D.); (F.F.K.); (P.B.)
| | - Szymon Turkiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.S.); (P.K.); (S.T.); (M.D.); (F.F.K.); (P.B.)
| | - Marta Ditmer
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.S.); (P.K.); (S.T.); (M.D.); (F.F.K.); (P.B.)
| | - Filip Franciszek Karuga
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.S.); (P.K.); (S.T.); (M.D.); (F.F.K.); (P.B.)
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Warsaw Medical University, 02-097 Warsaw, Poland;
| | - Piotr Białasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (M.S.); (P.K.); (S.T.); (M.D.); (F.F.K.); (P.B.)
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Bouloukaki I, Schiza S, Tsiligianni I. Obstructive sleep apnea as an additive or even synergistic risk factor for cardiovascular disease in patients with type 2 Diabetes: A call for action in primary care? Diabetes Res Clin Pract 2021; 178:108940. [PMID: 34242716 DOI: 10.1016/j.diabres.2021.108940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/06/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece.
| | - Sophia Schiza
- Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
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Possible Preventative/Rehabilitative Role of Gliflozins in OSA and T2DM. A Systematic Literature Review-Based Hypothesis. Adv Ther 2021; 38:4195-4214. [PMID: 34273093 PMCID: PMC8342338 DOI: 10.1007/s12325-021-01791-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea (OSA) is characterized by frequent apnoea episodes during sleep due to upper airway obstruction. The present review summarizes current knowledge on inter-relationships between OSA and type 2 diabetes mellitus (T2DM) and suggests the former as a possible target for sodium-glucose co-transporter-2 inhibitors (SGLT-2i). Based on pathophysiological mechanisms underlying OSA onset and renal SGLT-2 effects, we suggest that SGLT-2i indications might expand beyond current ones, including glucose, lipids, uric acid, blood pressure, and body weight control as well as chronic heart failure and kidney disease prevention.
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Obstructive Sleep Apnea and Periodontal Disease: A Systematic Review. ACTA ACUST UNITED AC 2021; 57:medicina57060640. [PMID: 34205812 PMCID: PMC8235051 DOI: 10.3390/medicina57060640] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 01/11/2023]
Abstract
Background and Objectives: The objective of this study was to evaluate the association between periodontal disease and obstructive sleep apnea syndrome (OSAS). Materials and Methods: Electronic search using PubMed, Scopus, LILACS, and Cochrane library was carried out for randomized controlled trials, cohort, case-control, longitudinal and epidemiological studies on humans published from January 2009 until September 2020. The participants had to be male and female adults who were diagnosed with OSAS either by overnight polysomnography (carried out at a sleep laboratory or at home) or by a home sleep testing monitor (Apnea Risk Evaluation System). Methodological quality assessment was carried out using the Newcastle-Ottawa Quality Assessment Scale (NOS) for case-control studies while an adapted form of NOS was used for cross-sectional studies. Results: Ten studies fulfilled the inclusion criteria of our review, 5 were case-control studies, and 5 cross-sectional. Sample size ranged from 50 to 29,284 subjects, for a total of 43,122 subjects, 56% of them were male, their age ranged from 18 to 85 years old. The heterogeneity among the studies regarding the classification of periodontal disease, and the different methods for OSAS severity assessment, complicated the comparison among the studies. Conclusions: There is low evidence of a possible association between OSAS and periodontitis. The pathophysiological mechanism, cause-effect, or dose-response relationship are still unclear. Further studies are needed and should use a precise classification of OSAS subjects, while the new classification of periodontitis from the World Workshop of Chicago 2017 should be used for the periodontal assessment.
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Shahid MLUR, Mir J, Shaukat F, Saleem MK, Tariq MAUR, Nouman A. Classification of Pharynx from MRI Using a Visual Analysis Tool to Study Obstructive Sleep Apnea. Curr Med Imaging 2021; 17:613-622. [PMID: 33213336 DOI: 10.2174/1573405616666201118143935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/24/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a chronic sleeping disorder. The analysis of the pharynx and its surrounding tissues can play a vital role in understanding the pathogenesis of OSA. Classification of the pharynx is a crucial step in the analysis of OSA. METHODS A visual analysis-based classifier is developed to classify the pharynx from MRI datasets. The classification pipeline consists of different stages, including pre-processing to select the initial candidates, extraction of categorical and numerical features to form a multidimensional features space, and a supervised classifier trained by using visual analytics and silhouette coefficient to classify the pharynx. RESULTS The pharynx is classified automatically and gives an approximately 86% Jaccard coefficient by evaluating the classifier on different MRI datasets. The expert's knowledge can be utilized to select the optimal features and their corresponding weights during the training phase of the classifier. CONCLUSION The proposed classifier is accurate and more efficient in terms of computational cost. It provides additional insight to better understand the influence of different features individually and collectively. It finds its applications in epidemiological studies where large datasets need to be analyzed.
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Affiliation(s)
| | - Junaid Mir
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford,, United Kingdom
| | - Furqan Shaukat
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, United Kingdom
| | | | | | - Ahmed Nouman
- Department of Mechatronics Engineering, Sabanci University, Istanbul, Turkey
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Shoji S, Inaba M, Yoda K, Okazaki H, Toyokawa M, Norimine K, Yamakawa T, Okuno S. REM sleep latency as an independent risk for cardiovascular events in hemodialysis patients. Physiol Rep 2021; 9:e14837. [PMID: 33991438 PMCID: PMC8123536 DOI: 10.14814/phy2.14837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/10/2023] Open
Abstract
Background Clinical significance of objectively measured poor sleep quality (SQ) as a risk for cardiovascular disease (CVD) events is not well known in hemodialysis (HD) patients, independently of sleep‐related breathing disorders (SRBDs) and sleep‐related metabolic abnormality. Methods The present study investigated baseline levels of objective sleep architecture together with obstructive sleep apnea (OSA) and central sleep apnea (CSA) using polysomnography in 88 HD study participants (M/F, 56/32; age 68.4 ± 9.3). Then, HD study participants were monitored for the occurrence of new‐onset CVD events with a median (range) follow‐up period of 33 (1–64) months. Results Among various measures of SQ, log (REM sleep latency [REM‐SL]) (interval between sleep‐onset and the first REM period) alone correlated in negative manners with triglycerides and non‐HDL‐C in all study participants and with fasting plasma glucose and HbA1c in study participants with type‐2 diabetes mellitus. In the Kaplan–Meier analysis, HD study participants with shorter REM‐SL had a significantly higher rate of new‐onset CVD events than those with longer REM‐SL. Stepwise logistic regression analysis and multivariate Cox proportional hazard regression analysis identified shorter REM‐SL as an independent risk factor for the development of a new‐onset CVD events, independent of mean oxygen saturation, log (AHI+1), log (central AHI+1), diabetes mellitus, CVD history, systolic blood pressure, statins use, and non‐HDL‐C. Conclusions The present study demonstrated that reduction of REM‐SL is independently associated with a higher rate of new‐onset of CVD events, independent of SRBDs (OSA and CSA) and diabetes mellitus, non‐HDL‐C in HD study participants, suggesting impaired SQ as a potential CVD risk factor, and thus a definite treatment target to protect against CVD specifically in HD study participants. REM‐SL might be a new risk factor of CVD events in HD patients with SRBDs.
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Affiliation(s)
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology, Molecular Medicine and Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koichiro Yoda
- Department of Metabolism, Endocrinology, Molecular Medicine and Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Mio Toyokawa
- Department of Metabolism, Endocrinology, Molecular Medicine and Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kyoko Norimine
- Department of Nephrology, Shirasagi Hospital, Osaka, Japan
| | | | - Senji Okuno
- Department of Nephrology, Shirasagi Hospital, Osaka, Japan
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de Melo CM, Dos Santos Quaresma MVL, Del Re MP, Ribeiro SML, Moreira Antunes HK, Togeiro SM, Tufik S, de Mello MT. One-month of a low-energy diet, with no additional effect of high-protein, reduces Obstructive Sleep Apnea severity and improve metabolic parameters in obese males. Clin Nutr ESPEN 2021; 42:82-89. [PMID: 33745625 DOI: 10.1016/j.clnesp.2020.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 11/23/2020] [Accepted: 12/04/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Obstructive Sleep Apnea (OSA) is closely associated with obesity. Weight loss ameliorates OSA and its associated metabolic disorders. A high protein intake may improve weight loss through increased energy expenditure, and fat-free mass maintenance during weight loss. OBJECTIVES To evaluate the effects of a low-energy, high-protein diet on OSA severity and metabolic parameters in obese men. METHODS Forty-five OSA obese (BMI ≥ 30 kg/m2) males were included in this randomized study and submitted to nocturnal polysomnography, body composition measured by plethysmography, biochemical analyses of blood glucose, insulin and lipids, and food intake evaluations before and after one month of a low-energy diet. Diets were designed to create a 30% deficit in total energy expenditure with 1.6 g of protein/kg/day (High Protein group - HP) or 0.8 g of protein/kg/day (Low Protein group - LP). RESULTS Only a time effect of the intervention was observed in body mass (-3.7 ± 2.0% for the LP group and -4.0 ± 1.5% for the HP group; p < 0.001), Body Mass Index (p < 0.001), fat mass in kg (p < 0.01) and fat-free mass in kg (p < 0.01). Significant improvements in Apnea Hypopnea Index were observed in both groups (54.0 ± 25.0 to 33.7 ± 31.7 in LP group; 39.7 ± 24.3 to 21.4 ± 25.9 in HP group; p = 0.06). Improvements of 38% and 46% in the Apnea-Hypopnea Index were observed in the LP and HP groups, respectively. Both interventions provided equivalent metabolic benefits as reductions in glucose (p < 0.001), insulin (p < 0.001), HOMA-IR (p = 0.005), triglycerides (p = 0.002), and in total cholesterol (p = 0.004). CONCLUSION One month of a low-energy diet resulted in significant improvements in OSA severity in obese men. Increased protein intake during a short period of low-energy diet had no further beneficial effects on OSA severity or biochemical parameters than a standard protein diet. Registered under ClinicalTrials.gov Identifier no. NCT01985035.
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Affiliation(s)
- Camila Maria de Melo
- Department of Psychobiology, Universidade Federal de São Paulo; Department of Nutrition, Universidade Federal de Lavras, Lavras, Brazil.
| | - Marcus Vinicius Lúcio Dos Santos Quaresma
- Department of Biocsciences, Universidade Federal de São Paulo; School of Public Health and School of Arts, Sciences and Humanities, Universidade de São Paulo, São Paulo, Brazil
| | | | - Sandra Maria Lima Ribeiro
- School of Public Health and School of Arts, Sciences and Humanities, Universidade de São Paulo, São Paulo, Brazil
| | | | - Sonia M Togeiro
- Department of Psychobiology, Universidade Federal de São Paulo
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo
| | - Marco Túlio de Mello
- Department of Psychobiology, Universidade Federal de São Paulo; Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Departamento de Esportes, Avenida Presidente Antônio Carlos 6627, Campus Pampulha, CEP 31270-901, Belo Horizonte, Minas Gerais, Brazil
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4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44:S40-S52. [PMID: 33298415 DOI: 10.2337/dc21-s004] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Sleep apnea and diabetes mellitus are independently associated with cardiovascular events and hospitalization for heart failure after coronary artery bypass grafting. Sci Rep 2020; 10:21664. [PMID: 33303900 PMCID: PMC7730381 DOI: 10.1038/s41598-020-78700-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/26/2020] [Indexed: 11/28/2022] Open
Abstract
The relative and combined effects of sleep apnea with diabetes mellitus (DM) on cardiovascular outcomes in patients undergoing coronary artery bypass grafting (CABG) remain unknown. In this secondary analysis of data from the SABOT study, 1007 patients were reclassified into four groups based on their sleep apnea and DM statuses, yielding 295, 218, 278, and 216 patients in the sleep apnea (+) DM (+), sleep apnea (+) DM (−), sleep apnea (−) DM (+), and sleep apnea (−) DM (−) groups, respectively. After a mean follow-up period of 2.1 years, the crude incidence of major adverse cardiac and cerebrovascular event was 18% in the sleep apnea (+) DM (+), 11% in the sleep apnea (+) DM (−), 13% in the sleep apnea (−) DM (+), and 5% in the sleep apnea (−) DM (−) groups. Using sleep apnea (−) DM (−) as the reference group, a Cox regression analysis indicated that sleep apnea (+) and DM (+) independently predicted MACCEs (adjusted hazard ratio, 3.2; 95% confidence interval, 1.7–6.2; p = 0.005) and hospitalization for heart failure (adjusted hazard ratio, 12.6; 95% confidence interval, 3.0–52.3; p < 0.001). Sleep apnea and DM have independent effects on the prognosis of patients undergoing CABG. Clinical trial registration: ClinicalTrials.gov identification no. NCT02701504.
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Dong L, Lin M, Wang W, Ma D, Chen Y, Su W, Chen Z, Wang S, Li X, Li Z, Liu C. Lipid accumulation product (LAP) was independently associatedwith obstructive sleep apnea in patients with type 2 diabetes mellitus. BMC Endocr Disord 2020; 20:179. [PMID: 33298050 PMCID: PMC7727244 DOI: 10.1186/s12902-020-00661-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Lipid accumulation product (LAP) is a new index based on a combination of waist circumference (WC) and serum triglycerides (TG) reflecting lipid accumulation. In this cross-sectional study, we aimed to explore whether LAP was independently associated with obstructive sleep apnea (OSA) in Type 2 diabetes mellitus (T2DM) patients. METHODS A cross-sectional study of 317 T2DM patients who underwent overnight polysomnography (PSG) tests was conducted. The clinical data between non-OSA group and OSA group were compared. Multivariable linear regression and multivariable logistic regression analyses were performed to determine associations of LAP, with apnea-hypopnea index (AHI) and OSA. RESULTS Among 317 patients, 219 (69.1%) were men, and the mean ages (±SD) were 51.4 (±13.5) years for men and 54.6 (±15.1) years for women (p = 0.067). The prevalence rates of OSA were 63.0% for men and 68.4% for women (p = 0.357). LAP (log-transformed) was significantly correlated with AHI (log-transformed), with the Pearson's correlation coefficient of 0.170 (p = 0.002). With adjustment for potential confounding factors, multivariate linear regression analyses showed the association of LAP with AHI was not statistically significant, with the adjusted linear regression coefficients (95% CI) of per SD increase of LAP for AHI (log-transformed) was 0.092 (- 0.011-0.194, p = 0.080). Multivariate logistic regression analyses showed LAP was significantly associated with increased risk of OSA, with the adjusted OR (95%CI) of per SD increase of LAP of 1.639 (1.032-2.604, p = 0.036). However, as constituents of LAP, neither TG nor WC was significantly associated with AHI and OSA. CONCLUSION LAP was independently associated with OSA and might be used as a potential OSA risk marker in T2DM patients, beyond the general index of obesity.
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Affiliation(s)
- Lianqin Dong
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Mingzhu Lin
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Wengui Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
| | - Danyan Ma
- School of Medicine, Xiamen University, Xiamen, China
| | - Yun Chen
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Weijuan Su
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Zheng Chen
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Shunhua Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Xuejun Li
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Zhibin Li
- Epidemiology Research Unit, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xiamen, 361003, China.
| | - Changqin Liu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China.
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China.
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China.
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Kothari V, Cardona Z, Chirakalwasan N, Anothaisintawee T, Reutrakul S. Sleep interventions and glucose metabolism: systematic review and meta-analysis. Sleep Med 2020; 78:24-35. [PMID: 33383394 DOI: 10.1016/j.sleep.2020.11.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Sleep disturbances (insufficient or poor sleep quality) have been linked to abnormal glucose metabolism. This systematic review and meta-analysis aimed to explore the effects of behavioral and pharmacological sleep interventions on glucose metabolism. METHODS Medline and Embase were used for systematic search. Studies reporting behavioral or pharmacological interventions in population with sleep disturbances, with measured outcomes of glucose metabolism and sleep parameters were selected. RESULTS Twenty two studies were eligible for review (eight were conducted in people with type 2 diabetes). Studies were grouped into three types of intervention: sleep extension (n = 6), sleep education or cognitive behavioral therapy for insomnia (CBT-I, n = 6) and pharmacological interventions (n = 10). CBT-I and sleep education resulted in significantly improved self-reported sleep quality (Pittsburgh Sleep Quality Index, mean difference, MD, -1.31, 95% confidence interval (CI) -1.83, -0.80), non-significant reduction in hemoglobin A1c level (MD -0.35%, 95% CI -0.84, 0.13), and non-significant reduction in fasting glucose levels (MD -4.76 mg/dL, 95% CI -14.19, 4.67). Other studies were not eligible for meta-analysis due to heterogeneity of interventions or outcomes. Sleep extension was able to increase sleep duration by varying degrees in short sleepers, and five of six studies demonstrated relationships between the intervention and measures of insulin resistance. A majority of pharmacological intervention studies showed improved sleep but the effects on glucose metabolism were mixed. CONCLUSIONS Available sleep interventions were effective in improving sleep but the effects on glucose metabolism were inconclusive. Larger randomized studies with consistent outcome measurements are needed to demonstrate this potential causal relationship.
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Affiliation(s)
- Vallari Kothari
- Division of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, IL, USA
| | - Zulma Cardona
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, IL, USA.
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Design and synthesis of new flavonols as dual ɑ-amylase and ɑ-glucosidase inhibitors: Structure-activity relationship, drug-likeness, in vitro and in silico studies. J Mol Struct 2020. [DOI: 10.1016/j.molstruc.2020.128458] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Mikołajczyk-Solińska M, Śliwińska A, Kosmalski M, Drzewoski J. The Phenotype of Elderly Patients with Type 2 Diabetes Mellitus and Poor Sleep Quality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5992. [PMID: 32824748 PMCID: PMC7459960 DOI: 10.3390/ijerph17165992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/12/2020] [Accepted: 08/16/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Sleep disturbances are a common problem among patients with Type 2 diabetes mellitus (T2DM). The aim of the study was to identify the phenotype of T2DM patients with poor sleep quality. METHODS An observational, cross-sectional study was conducted between May 2013 and August 2015. One hundred and sixty consecutive patients with T2DM: 74 women and 86 men, with a median age of 69.50 years (59.00; 79.50 years) were enrolled in the study. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. RESULTS Poor sleep quality was noted in 85 (53%) patients. Sleep disorders were associated with older age, as well as female gender, longer duration of diabetes, lower level of fasting plasma glucose, glycated hemoglobin A1c, estimated glomerular filtration rate, triglycerides, waist-to-hip ratio, and the presence of nephropathy. A multivariate logistic regression revealed that sleep disorders were associated with older age (Odd Ratio (OR) = 1.11, 95% Confidence Interval (CI) 1.07-1.15). Fifty-one patients (31.87%) were treated with sleeping pills. We found that older age, female gender, longer duration of diabetes, lower level of fasting plasma glucose, glycated hemoglobin A1c, estimated glomerular filtration rate, triglycerides, and the presence of nephropathy were linked with more frequent usage of hypnotics. A multivariate logistic regression demonstrated that older age (OR = 1.09, 95% CI 1.05-1.14) and nephropathy (OR = 2.79, 95% CI 1.24-6.28) were associated with a more frequent receiving the hypnotics, whereas male gender (OR = 0.30, 95% CI 0.13-0.71) has less frequent hypnotics usage. CONCLUSION Although, we assessed a wide range of patients' characteristics, age had the most negative impact on the quality of sleep in patients with T2DM. We detected more frequent use of hypnotics in older females, with coexisting nephropathy.
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Affiliation(s)
- Melania Mikołajczyk-Solińska
- Department of Internal Medicine, Diabetology and Clinical Pharmacology, Medical University of Lodz, 92-213 Lodz, Poland
| | - Agnieszka Śliwińska
- Department of Nucleic Acids Biochemistry, Medical University of Lodz, 92-213 Lodz, Poland;
| | - Marcin Kosmalski
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland;
| | - Józef Drzewoski
- Central Teaching Hospital of Medical University of Lodz, 92-213 Lodz, Poland;
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Bala C, Roman G, Ciobanu D, Rusu A. A systematic review of the effect of sleep apnea syndrome and its therapy on HbA1c in type 2 diabetes. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-019-00784-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Wang J, Hu L, Wang Z, Yang S, Wu S. Effect of obstructive sleep apnea syndrome on glycolipid metabolism and early atherosclerosis in diabetics. Diabetes Res Clin Pract 2020; 159:107999. [PMID: 31904443 DOI: 10.1016/j.diabres.2020.107999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/10/2019] [Accepted: 12/31/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the changes in glucose and lipid metabolism indexes and the condition of early atherosclerosis in patients with diabetes with and without obstructive sleep apnea syndrome (OSAS). METHODS Patients with type 2 diabetes mellitus (DM) aged 32-50 years who did not have significant complications were included. A total of 42 patients with DM with OSAS and 46 patients with DM without OSAS were chosen according to their sleep monitoring indexes. Height and weight were measured, and fasting blood glucose, postprandial blood glucose, endothelin (ET), nitric oxide (NO) and lipid profile were tested. Then, all the subjects were subjected to the pulse wave velocity (PWV) test. RESULTS The levels of glycated haemoglobin and triglycerides were significantly higher in patients with DM with OSAS than those in patients with DM without OSAS. ET, NO and PWV changed significantly. CONCLUSION Patients with diabetes with OSAS are more likely to have complications related to arteriosclerosis and aggravation of glycolipid metabolism disorder. Early intervention is recommended.
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Affiliation(s)
- Jue Wang
- Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
| | - Liye Hu
- Department of Endocrinology, Bethune International Peace Hospital, Shijiazhuang, Hebei 050082, China.
| | - Zhenxian Wang
- Hebei General Hospital, Shijiazhuang, Hebei 050000, China
| | - Shaoling Yang
- Department of Endocrinology, Bethune International Peace Hospital, Shijiazhuang, Hebei 050082, China
| | - Shan Wu
- Department of Endocrinology, Bethune International Peace Hospital, Shijiazhuang, Hebei 050082, China
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4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020; 43:S37-S47. [PMID: 31862747 DOI: 10.2337/dc20-s004] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Chen L, Ma W, Tang W, Zha P, Wang C, Chen D, Lei F, Li T, Tang X, Ran X. Prevalence of Obstructive Sleep Apnea in Patients With Diabetic Foot Ulcers. Front Endocrinol (Lausanne) 2020; 11:416. [PMID: 32760345 PMCID: PMC7371781 DOI: 10.3389/fendo.2020.00416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/26/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives: Diabetic foot ulcers (DFUs) are a considerable burden on patients and the healthcare service system. Patients with DFUs have many risk factors that might contribute to obstructive sleep apnea (OSA). The purposes of this study were to assess the prevalence of OSA and associated features in patients with DFUs. Methods: Between July 2017 and June 2019, we recruited 245 consecutive patients who sought for treatment at West China Hospital because of DFUs. Polysomnography data from 127 Patients were included in the final analysis. Results: Of the 127 patients, with a median age of 64 years (interquartile range, 55-73 years; range, 36-86 years) and a mean body mass index (BMI) 24.09 ± 0.37 kg/m2, 91 (72%) were men. The prevalence of OSA [apnea-hypopnea index (AHI) ≧5/h] was 92% in men and 97% in women (P = 0.304). Moderate to severe OSA (AHI ≧15/h) was noted in 44 men (48%) and 26 women (72%) (P = 0.015). The risk factors associated with the severity of OSA were sex, age, smoking, alcohol use, and duration of diabetes. After multivariable adjustment, duration of diabetes and age were independent predictive factors of the severity of OSA. No significant association was observed between BMI, waist circumference, Epworth score, and the severity of OSA. There were no significant associations between OSA and ischemic heart disease, cerebral infarction, hypertension, diabetic retinopathy, diabetic kidney disease, and peripheral artery disease. Conclusions: The prevalence of OSA was high in patients with DFUs, with moderate to severe OSA accounting for more than half of the patients. Age and duration of diabetes were independent predictive factors of the severity of OSA.
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Affiliation(s)
- Lihong Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wanxia Ma
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Weiwei Tang
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Panpan Zha
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chun Wang
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Dawei Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Lei
- State Key Laboratory of Biotherapy, Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Taomei Li
- State Key Laboratory of Biotherapy, Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Tang
- State Key Laboratory of Biotherapy, Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xingwu Ran
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Tang K, Spilman SK, Hahn KD, McCann DA, Purtle MW. Prevalence of risk for sleep apnea among hospitalized patients who survived a medical emergency team activation. J Clin Sleep Med 2019; 16:91-96. [PMID: 31957659 DOI: 10.5664/jcsm.8130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) is a common disorder that causes people to stop breathing in their sleep, and obstructive sleep apnea (OSA) is the most common form of SDB in the general population. Because OSA is often undiagnosed and undermanaged, it has been associated with adverse events and morbidity in hospitalized patients. The purpose of the study was to evaluate prevalence of OSA risk in a population of patients who survived a medical emergency team (MET) activation during hospitalization. METHODS This prospective study was conducted at a hospital in the Midwest in 2014. Patients who survived a MET activation and consented to participate were administered the STOP-Bang questionnaire and asked other health and lifestyle questions. Review of the medical record was conducted to ascertain patient characteristics, comorbidities, and medications. Differences were assessed using Kruskal-Wallis one-way analysis of variance and the chi-square test. RESULTS Of 148 study patients, median age was 68 years (interquartile range: 55-78) and 15% were morbidly obese (body mass index ≥ 40 kg/m²). Fifty percent of patients (n = 74) were found to be at high risk for OSA, yet only 38% (n = 28) of those patients received a previous diagnosis of OSA. Variables available in the medical record were highly correlated with the overall STOP-Bang score (r =. 75, P < .001). CONCLUSIONS Half of patients who survived a MET activation during hospitalization screened at high risk for OSA. Standardized screening for risk of sleep apnea, as well as a truncated risk score generated by variables in the medical record, could guide clinical decision making in this at-risk population.
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Affiliation(s)
- Kelly Tang
- College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa
| | | | | | - Dustin A McCann
- Pulmonology and Critical Care, The Iowa Clinic, Des Moines, Iowa
| | - Mark W Purtle
- Office of Medical Affairs, UnityPoint Health, Des Moines, Iowa
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Affiliation(s)
- Jacek Wolf
- From the Department of Hypertension and Diabetology, Faculty of Medicine and Center of Translational Medicine, Medical University of Gdańsk, Poland
| | - Krzysztof Narkiewicz
- From the Department of Hypertension and Diabetology, Faculty of Medicine and Center of Translational Medicine, Medical University of Gdańsk, Poland
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Xu PH, Hui CK, Lui MM, Lam DC, Fong DY, Ip MS. Incident Type 2 Diabetes in OSA and Effect of CPAP Treatment. Chest 2019; 156:743-753. [DOI: 10.1016/j.chest.2019.04.130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 12/31/2022] Open
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Assessment of risk for obstructive sleep apnea by using STOP-BANG questionnaire in type 2 diabetes mellitus. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00768-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Shinoda M, Yamakawa T, Takahashi K, Nagakura J, Suzuki J, Sakamoto R, Kadonosono K, Terauchi Y. PREVALENCE OF OBSTRUCTIVE SLEEP APNEA DETERMINED BY THE WATCHPAT IN NONOBESE JAPANESE PATIENTS WITH POOR GLUCOSE CONTROL AND TYPE 2 DIABETES. Endocr Pract 2019; 25:170-177. [PMID: 30817196 DOI: 10.4158/ep-2018-0200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Diagnosing obstructive sleep apnea (OSA) usually involves high cost, patient inconvenience, and the need for examination at a specialized center. This study employed a portable, wearable, diagnostic device (WatchPAT) to investigate the prevalence of OSA in nonobese Japanese patients with type 2 diabetes. METHODS Patients with type 2 diabetes were tested for OSA over one night using the WatchPAT. Logistic regression analysis was used to estimate the odds ratios (ORs) of risk factors for OSA in nonobese subjects. RESULTS A total of 200 eligible patients with type 2 diabetes were studied (64.5% men; aged 60.1 ± 13.6 years; body mass index [BMI], 26.3 ± 5.2 kg/m2). When OSA was defined as apnea-hypopnea index ≥5/hour, its prevalence was 80.5%. The prevalence of OSA in subjects with a BMI <20 kg/m2, ≥20 and <25 kg/m2, ≥25 and <30 kg/m2, and ≥30 kg/m2 was 38.9%, 73.5%, 86.5%, and 97.5%, respectively. The severity of OSA increased in proportion to BMI, especially when the BMI was >25 kg/m2. The prevalence of OSA was also high (66.3%) in normal-weight subjects (BMI <25 kg/m2). Furthermore, the serum triglyceride level (OR, 1.01; 95% confidence interval, 1.00 to 1.02; P = .042) was significantly related to OSA. CONCLUSION A high prevalence of OSA was observed in this nonobese population of Japanese patients with type 2 diabetes. The triglyceride level was associated with OSA among nonobese patients. ABBREVIATIONS AHI = apnea-hypopnea Index; BMI = body mass index; CI = confidence interval; ESS = Epworth Sleepiness Scale; HbA1c = glycated hemoglobin; OR = odds ratio; OSA = obstructive sleep apnea; PAT = peripheral arterial tone; T2D = type 2 diabetes; TG = triglyceride.
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Pataka A, Kalamaras G, Daskalopoulou E, Argyropoulou P. Sleep questionnaires for the screening of obstructive sleep apnea in patients with type 2 diabetes mellitus compared with non-diabetic patients. J Diabetes 2019; 11:214-222. [PMID: 30084533 DOI: 10.1111/1753-0407.12835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/17/2018] [Accepted: 07/27/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Several tools have been used to screen for obstructive sleep apnea (OSA). Evaluation of the predictive performance of different questionnaires is essential in patients with type 2 diabetes mellitus (T2DM) because the prevalence of OSA in this population is high. The aim of this study was to evaluate different sleep questionnaires to identify T2DM patients with OSA, and to compare the predictive values of these questionnaires with a matched sample of non-diabetic patients. METHODS The study was a retrospective study of two patients groups (n = 350 with T2DM, n = 350 without T2DM) visiting a sleep clinic and matched by age, gender, body mass index, and the apnea-hypopnea index (AHI). Symptoms of OSA and Epworth Sleepiness Scale (ESS), STOP-Bang, Berlin questionnaire, and Athens insomnia scale (AIS) scores were compared, and sleep studies were performed. RESULTS Diabetic patients with OSA complained more frequently of nocturia (P = 0.025), morning headaches (P = 0.04), restless sleep (P = 0.002), and leg movements (P = 0.01) than non-diabetic patients with OSA. Most predictive values of the sleep questionnaires did not differ significantly between the two groups; however, the AIS was higher only in T2DM women (P = 0.01). In both groups, the Berlin and STOP-Bang questionnaires had the highest sensitivity. The ESS had the highest specificity in T2DM patients and the STOP and S-B questionnaires had the highest specificity in non-diabetics. CONCLUSIONS The predictive performance of the questionnaires was similar in both groups, especially in the case of moderate and severe OSA.
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Affiliation(s)
- Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Kalamaras
- Respiratory Failure Unit, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efi Daskalopoulou
- Department of Sleep Medicine, Saint Paul Hospital, Thessaloniki, Greece
| | - Paraskevi Argyropoulou
- Respiratory Failure Unit, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Screening for High Risk of Sleep Apnea in an Ambulatory Care Setting in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030459. [PMID: 30764527 PMCID: PMC6388169 DOI: 10.3390/ijerph16030459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 12/03/2022]
Abstract
Sleep apnea is a potentially serious but under-diagnosed sleep disorder. Saudi Arabia has a high prevalence of hypertension, diabetes, obesity, and smoking, which are all major risk factors for sleep apnea. However, few studies report screening for sleep apnea in Saudi Arabia. A three-month prospective, questionnaire-based study, using the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS), screened 319 patients attending a family medicine clinic in Saudi Arabia for risk of sleep apnea. The results showed that when using the BQ and the ESS, 95 (29.8%) and 102 (32.0%) respondents were at high risk of sleep apnea. Taken together, the BQ and the ESS combined measure showed that 41 (12.9%) respondents were classified as high risk for sleep apnea. Logistic regression revealed that the high risk of sleep apnea was statistically significantly (p < 0.05) associated with respondent characteristics of obesity and hypertension. No associations were found between high risk for sleep apnea and: Smoking, diabetes mellitus, hypothyroidism or hyperlipidemia. Screening for sleep apnea using the BQ and ESS questionnaires, particularly among those who are obese or hypertensive, can be a fast, valid and acceptable way of alerting the physician to this disorder among patients.
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4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019; 42:S34-S45. [PMID: 30559230 DOI: 10.2337/dc19-s004] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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The potential role of vascular alterations and subsequent impaired liver blood flow and hepatic hypoxia in the pathophysiology of non-alcoholic steatohepatitis. Med Hypotheses 2018; 122:188-197. [PMID: 30593409 DOI: 10.1016/j.mehy.2018.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/21/2018] [Indexed: 12/12/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) covers a spectrum of disease ranging from steatosis to steatohepatitis (NASH) and fibrosis, but the underlying pathophysiological mechanisms remain largely unknown. As there is currently no approved pharmacological therapy and the prevalence of NAFLD keeps increasing, understanding of its pathophysiology is crucial. We hypothesise that vascular alterations in early NAFLD play a role in the progression of the disease by inducing an increased intrahepatic vascular resistance and consequently relative hypoxia in the liver. Evidence of the detrimental effects of hypoxia in NAFLD has already been observed in liver surgery, where the outcomes of steatotic livers after ischaemia-reperfusion are worse than in healthy livers, and in obstructive sleep apnoea, which is an independent risk factor of NAFLD. Moreover, early histological damage in NAFLD is situated in the pericentral zone, which is also the first zone to be affected by a decreased oxygen tension because of the unique hepatic vacsular anatomy that causes the pericentral oxygen tension to be the lowest. Angiogenesis is also a characteristic of NAFLD, driven by hypoxia-induced mechanisms, as demonstrated in both animal models and in humans with NAFLD. Relative hypoxia is most probably induced by impaired blood flow to the liver, caused by increased intrahepatic vascular resistance. An increased intrahepatic vascular resistance early in the development of disease has been convincingly demonstrated in several animal models of NAFLD, whereas an increased portal pressure, a consequence of increased intrahepatic vascular resistance, has been proven in patients with NAFLD. Animal studies demonstrated a decreased intrahepatic effect of vasodilators and an increased reactivity to vasoconstrictors that results in an increased intrahepatic vascular resistance, thus the presence of a functional component. Pharmacological products that target vasoregulation can hence improve the intrahepatic vascular resistance and this might prevent or reverse progression of NAFLD, representing an important therapeutic option to study. Some of the drugs currently under evaluation in clinical trials for NASH have interesting properties related to the hepatic vasculature. Some other interesting drugs have been tested in animal models but further study in patients with NAFLD is warranted. In summary, in this paper we summarise the evidence that leads to the hypothesis that an increased intrahepatic vascular resistance and subsequent parenchymal hypoxia in early NAFLD is an important pathophysiological driving mechanism for the progression of the disease.
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Fan B, Luk AOY, Chan JCN, Ma RCW. MicroRNA and Diabetic Complications: A Clinical Perspective. Antioxid Redox Signal 2018; 29:1041-1063. [PMID: 28950710 DOI: 10.1089/ars.2017.7318] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
SIGNIFICANCE The rising global prevalence of diabetes and its debilitating complications give rise to significant disability and premature mortality. Due to the silent nature of diabetes and its vascular complications, and limitations in current methods for detection, there is a need for novel biomarkers for early detection and prognosis. Recent Advances: Metabolic memory and epigenetic factors are important in the pathogenesis of diabetic complications and interact with genetic variants, metabolic factors, and clinical risk factors. Micro(mi)RNAs interact with epigenetic mechanisms and pleiotropically mediate the effects of hyperglycemia on the vasculature. Utilizing mature profiling techniques and platforms, an increasing number of miRNA signatures and interaction networks have been identified for diabetes and its related cardiorenal complications. As a result, these short, single-stranded molecules are emerging as potential diagnostic and predictive tools in human studies, and may function as disease biomarkers, as well as treatment targets. CRITICAL ISSUES However, there is complex interaction between the genome and epigenome. The regulation of miRNAs may differ across species and tissues. Most profiling studies to date lack validation, often requiring large, well-characterized cohorts and reliable normalization strategies. Furthermore, the incremental benefits of miRNAs as biomarkers, beyond prediction provided by traditional risk factors, are critical issues to consider, yet often neglected in published studies. FUTURE DIRECTIONS All in all, the future for miRNA-based diagnostics and therapeutics for diabetic complications appears promising. Improved understanding of the complex mechanisms underlying miRNA dysregulation, and more well-designed studies utilizing prospective samples would facilitate the translation to clinical use.
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Affiliation(s)
- Baoqi Fan
- 1 Department of Medicine and Therapeutics, The Chinese University of Hong Kong , Shatin, China
| | - Andrea On Yan Luk
- 1 Department of Medicine and Therapeutics, The Chinese University of Hong Kong , Shatin, China .,2 Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong , Shatin, China
| | - Juliana Chung Ngor Chan
- 1 Department of Medicine and Therapeutics, The Chinese University of Hong Kong , Shatin, China .,2 Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong , Shatin, China .,3 Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong , Prince of Wales Hospital, Shatin, China .,4 The Chinese University of Hong Kong-Shanghai Jiao Tong University Joint Research Centre in Diabetes Genomics and Precision Medicine , Shatin, China
| | - Ronald Ching Wan Ma
- 1 Department of Medicine and Therapeutics, The Chinese University of Hong Kong , Shatin, China .,2 Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong , Shatin, China .,3 Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong , Prince of Wales Hospital, Shatin, China .,4 The Chinese University of Hong Kong-Shanghai Jiao Tong University Joint Research Centre in Diabetes Genomics and Precision Medicine , Shatin, China
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West SD, Prudon B, Hughes J, Gupta R, Mohammed SB, Gerry S, Stradling JR. Continuous positive airway pressure effect on visual acuity in patients with type 2 diabetes and obstructive sleep apnoea: a multicentre randomised controlled trial. Eur Respir J 2018; 52:1801177. [PMID: 30166323 PMCID: PMC6203406 DOI: 10.1183/13993003.01177-2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023]
Abstract
We sought to establish whether continuous positive airway pressure (CPAP) for obstructive sleep apnoea (OSA) in people with type 2 diabetes and diabetic macular oedema (DMO) improved visual acuity.We randomly assigned 131 eligible patients aged 30-85 years from 23 UK centres with significant DMO causing visual impairment (LogMAR letters identified ≥39 and ≤78, score 0.92-0.14) plus severe OSA on screening to either usual ophthalmology care (n=67) or usual ophthalmology care plus CPAP (n=64) for 12 months.Mean age of participants was 64 years, 73% male, mean body mass index 35.0 kg·m- 2 Mean 4% oxygen desaturation index was 36 events·h-1 There was no significant difference in the visual acuity at 12 months between the CPAP group and the control group (mean LogMAR 0.33 (95% CI 0.29-0.37) versus 0.31 (95% CI 0.27-0.35); p=0.39), and no significant correlation between change in LogMAR and average CPAP use. The median±sd (range) daily CPAP use was 3.33±2.25 (0-7.93) h at 3 months, 3.19±2.54 (0-8.07) h at 6 months and 3.21±2.70 (0-7.98) h at 12 months.CPAP therapy for OSA did not improve visual acuity in people with type 2 diabetes and DMO compared with usual care alone over 12 months.
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Affiliation(s)
- Sophie D West
- Newcastle Regional Sleep Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Benjamin Prudon
- Dept of Respiratory Medicine, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Joan Hughes
- Newcastle Regional Sleep Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rajen Gupta
- Newcastle Eye Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Seid B Mohammed
- Centre for Statistics in Medicine, Nuffield Dept of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Dept of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - John R Stradling
- Oxford Respiratory Trials Unit, Churchill Hospital and NIHR Oxford Biomedical Research Centre, Oxford, UK
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