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Bai M, Chen D, Liu Y, Ran X, Wang C, Chen L, Yan D, He S, Wu M, Luo B, Wang W, Lei Z, Gao Y. Cardiac electrophysiology, structure and diastolic function in patients with diabetic foot versus those without diabetic foot. J Diabetes Investig 2024; 15:1276-1286. [PMID: 38860568 PMCID: PMC11363107 DOI: 10.1111/jdi.14250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 05/10/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
AIMS/INTRODUCTION To evaluate the differences in cardiac autonomic function, cardiac structure and diastolic function between individuals with diabetic foot (DF) and those with diabetes but without DF. MATERIALS AND METHODS A total of 413 individuals with DF and 437 without DF who underwent a 24-h electrocardiogram Holter and a Doppler echocardiogram were included. The heart rate variability parameters to evaluate cardiac autonomic function, and the indices for the assessment of cardiac structure and left ventricular (LV) diastolic function, including left atrium, LV posterior wall thickness, interventricular septum and E/e' ratio, were measured or calculated. Propensity score matching was used for the sensitivity analysis to minimize potential imbalance. RESULTS In both the crude and propensity score matching analyses, significant differences were observed in heart rate variability between individuals with and without DF, as evidenced by lower standard deviation of the normal sinus interval, lower low-frequency power/high-frequency power ratio, lower standard deviation of the 5-min average RR intervals, lower low-frequency power, lower percentage of normal adjacent RR interval difference >50 ms, lower root mean square of successive RR interval differences and lower high-frequency power (all P < 0.05). In multivariate analysis, DF showed an independent negative correlation with the aforementioned indices of heart rate variability (all P < 0.05). Individuals with DF showed higher left atrium, LV posterior wall thickness, interventricular septum and a higher E/e' ratio than those without DF in the crude analysis (all P < 0.05), whereas these indices were no longer associated with DF in the multivariate analysis and the propensity score matching analyses. CONCLUSIONS Cardiac autonomic modulation was more severely impaired in individuals with DF than in their counterparts without DF. There has been insufficient evidence to demonstrate the independent association of DF and LV diastolic dysfunction.
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Affiliation(s)
- Mingxin Bai
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Dawei Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Yan Liu
- Department of EndocrinologyChengdu Eighth People's HospitalChengduSichuanChina
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Chun Wang
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Lihong Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Donge Yan
- Department of Cardiology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Sen He
- Department of Cardiology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Murong Wu
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Bo Luo
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Wen Wang
- Chinese Evidence‐Based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Zhiyi Lei
- West China Medical SchoolSichuan UniversityChengduSichuanChina
| | - Yun Gao
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China HospitalSichuan UniversityChengduSichuanChina
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Driendl S, Stadler S, Arzt M, Zeman F, Heid IM, Baumert M. Nocturnal hypoxemic burden and micro- and macrovascular disease in patients with type 2 diabetes. Cardiovasc Diabetol 2024; 23:195. [PMID: 38844945 PMCID: PMC11157751 DOI: 10.1186/s12933-024-02289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Micro- and macrovascular diseases are common in patients with type 2 diabetes mellitus (T2D) and may be partly caused by nocturnal hypoxemia. The study aimed to characterize the composition of nocturnal hypoxemic burden and to assess its association with micro- and macrovascular disease in patients with T2D. METHODS This cross-sectional analysis includes overnight oximetry from 1247 patients with T2D enrolled in the DIACORE (DIAbetes COhoRtE) study. Night-time spent below a peripheral oxygen saturation of 90% (T90) as well as T90 associated with non-specific drifts in oxygen saturation (T90non - specific), T90 associated with acute oxygen desaturation (T90desaturation) and desaturation depths were assessed. Binary logistic regression analyses adjusted for known risk factors (age, sex, smoking status, waist-hip ratio, duration of T2D, HbA1c, pulse pressure, low-density lipoprotein, use of statins, and use of renin-angiotensin-aldosterone system inhibitors) were used to assess the associations of such parameters of hypoxemic burden with chronic kidney disease (CKD) as a manifestation of microvascular disease and a composite of cardiovascular diseases (CVD) reflecting macrovascular disease. RESULTS Patients with long T90 were significantly more often affected by CKD and CVD than patients with a lower hypoxemic burden (CKD 38% vs. 28%, p < 0.001; CVD 30% vs. 21%, p < 0.001). Continuous T90desaturation and desaturation depth were associated with CKD (adjusted OR 1.01 per unit, 95% CI [1.00; 1.01], p = 0.008 and OR 1.30, 95% CI [1.06; 1.61], p = 0.013, respectively) independently of other known risk factors for CKD. For CVD there was a thresholdeffect, and only severly and very severly increased T90non-specific was associated with CVD ([Q3;Q4] versus [Q1;Q2], adjusted OR 1.51, 95% CI [1.12; 2.05], p = 0.008) independently of other known risk factors for CVD. CONCLUSION While hypoxemic burden due to oxygen desaturations and the magnitude of desaturation depth were significantly associated with CKD, only severe hypoxemic burden due to non-specific drifts was associated with CVD. Specific types of hypoxemic burden may be related to micro- and macrovascular disease.
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Affiliation(s)
- Sarah Driendl
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Stefan Stadler
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Florian Zeman
- Centre of Clinical Studies, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Iris M Heid
- Department of Genetic Epidemiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Mathias Baumert
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
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Simonson M, Li Y, Zhu B, McAnany JJ, Chirakalwasan N, Sutabutr Vajaranant T, Hanlon EC, Pannain S, Anothaisintawee T, Reutrakul S. Multidimensional sleep health and diabetic retinopathy: Systematic review and meta-analysis. Sleep Med Rev 2024; 74:101891. [PMID: 38118339 PMCID: PMC10963161 DOI: 10.1016/j.smrv.2023.101891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023]
Abstract
Diabetic retinopathy (DR) is one of the most prevalent microvascular diabetic complications. Poor sleep health and obstructive sleep apnea (OSA) are risk factors for diabetes and poor glycemic control. Recent studies have suggested associations between poor sleep health/OSA and DR. Furthermore, there have been suggestions of melatonin dysregulation in the context of DR. We conducted a systematic review and meta-analysis exploring the associations between multidimensional sleep health (duration, satisfaction, efficiency, timing/regularity and alertness), OSA and melatonin with DR. Forty-two studies were included. Long, but not short sleep, was significantly associated with DR, OR 1.41 (95%CI 1.21, 1.64). Poor sleep satisfaction was also significantly associated with DR, OR 2.04 (1.41, 2.94). Sleep efficiency and alertness were not associated with DR, while the evidence on timing/regularity was scant. Having OSA was significantly associated with having DR, OR 1.34 (1.07, 1.69). Further, those with DR had significantly lower melatonin/melatonin metabolite levels than those without DR, standardized mean difference -0.94 (-1.44, -0.44). We explored whether treating OSA with continuous positive airway pressure (CPAP) led to improvement in DR (five studies). The results were mixed among studies, but potential benefits were observed in some. This review highlights the association between poor multidimensional sleep health and DR.
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Affiliation(s)
- Matthew Simonson
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Yanliang Li
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Naricha Chirakalwasan
- Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Thailand; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Erin C Hanlon
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, IL, USA
| | - Silvana Pannain
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, IL, USA
| | - Thunyarat Anothaisintawee
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sirimon Reutrakul
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA; Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois, Chicago, USA.
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Zhao BH, Ruze A, Zhao L, Li QL, Tang J, Xiefukaiti N, Gai MT, Deng AX, Shan XF, Gao XM. The role and mechanisms of microvascular damage in the ischemic myocardium. Cell Mol Life Sci 2023; 80:341. [PMID: 37898977 PMCID: PMC11073328 DOI: 10.1007/s00018-023-04998-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023]
Abstract
Following myocardial ischemic injury, the most effective clinical intervention is timely restoration of blood perfusion to ischemic but viable myocardium to reduce irreversible myocardial necrosis, limit infarct size, and prevent cardiac insufficiency. However, reperfusion itself may exacerbate cell death and myocardial injury, a process commonly referred to as ischemia/reperfusion (I/R) injury, which primarily involves cardiomyocytes and cardiac microvascular endothelial cells (CMECs) and is characterized by myocardial stunning, microvascular damage (MVD), reperfusion arrhythmia, and lethal reperfusion injury. MVD caused by I/R has been a neglected problem compared to myocardial injury. Clinically, the incidence of microvascular angina and/or no-reflow due to ineffective coronary perfusion accounts for 5-50% in patients after acute revascularization. MVD limiting drug diffusion into injured myocardium, is strongly associated with the development of heart failure. CMECs account for > 60% of the cardiac cellular components, and their role in myocardial I/R injury cannot be ignored. There are many studies on microvascular obstruction, but few studies on microvascular leakage, which may be mainly due to the lack of corresponding detection methods. In this review, we summarize the clinical manifestations, related mechanisms of MVD during myocardial I/R, laboratory and clinical examination means, as well as the research progress on potential therapies for MVD in recent years. Better understanding the characteristics and risk factors of MVD in patients after hemodynamic reconstruction is of great significance for managing MVD, preventing heart failure and improving patient prognosis.
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Affiliation(s)
- Bang-Hao Zhao
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Amanguli Ruze
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Ling Zhao
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Qiu-Lin Li
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Jing Tang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Nilupaer Xiefukaiti
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Min-Tao Gai
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - An-Xia Deng
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Xue-Feng Shan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China
| | - Xiao-Ming Gao
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asian, Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Clinical Medical Research Institute of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, 830054, China.
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, China.
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Adam CA, Marcu DTM, Mitu O, Roca M, Aursulesei Onofrei V, Zabara ML, Tribuș LC, Cumpăt C, Crișan Dabija R, Mitu F. Old and Novel Predictors for Cardiovascular Risk in Diabetic Foot Syndrome—A Narrative Review. APPLIED SCIENCES 2023; 13:5990. [DOI: 10.3390/app13105990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Diabetic foot syndrome (DFS) is a complication associated with diabetes that has a strong negative impact, both medically and socio-economically. Recent epidemiological data show that one in six patients with diabetes will develop an ulcer in their lifetime. Vascular complications associated with diabetic foot have multiple prognostic implications in addition to limiting functional status and leading to decreased quality of life for these patients. We searched the electronic databases of PubMed, MEDLINE and EMBASE for studies that evaluated the role of DFS as a cardiovascular risk factor through the pathophysiological mechanisms involved, in particular the inflammatory ones and the associated metabolic changes. In the era of evidence-based medicine, the management of these cases in multidisciplinary teams of “cardio-diabetologists” prevents the occurrence of long-term disabling complications and has prognostic value for cardiovascular morbidity and mortality among diabetic patients. Identifying artificial-intelligence-based cardiovascular risk prediction models or conducting extensive clinical trials on gene therapy or potential therapeutic targets promoted by in vitro studies represent future research directions with a modulating role on the risk of morbidity and mortality in patients with DFS.
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Affiliation(s)
- Cristina Andreea Adam
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, 700661 Iasi, Romania
| | - Dragos Traian Marius Marcu
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, 700115 Iasi, Romania
| | - Ovidiu Mitu
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Mihai Roca
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, 700661 Iasi, Romania
| | - Viviana Aursulesei Onofrei
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Mihai Lucian Zabara
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Carina Tribuș
- Department of Internal Medicine, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine, Ilfov County Emergency Hospital, 022104 Bucharest, Romania
| | - Carmen Cumpăt
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Management, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania
| | - Radu Crișan Dabija
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, 700115 Iasi, Romania
- Academy of Medical Sciences, 030167 Bucharest, Romania
- Academy of Romanian Scientists, 700050 Iasi, Romania
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Akset M, Poppe KG, Kleynen P, Bold I, Bruyneel M. Endocrine disorders in obstructive sleep apnoea syndrome: A bidirectional relationship. Clin Endocrinol (Oxf) 2023; 98:3-13. [PMID: 35182448 DOI: 10.1111/cen.14685] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/21/2021] [Accepted: 01/30/2022] [Indexed: 12/16/2022]
Abstract
Obstructive sleep apnoea (OSA) is a common disorder characterized by recurrent episodes of apnoea or hypopnea due to total or partial pharyngeal collapse and temporary upper airway obstruction during sleep. The prevalence of OSA is increasing and currently affects about 30% of men and 13% of women in Europe. Intermittent hypoxia, oxidative stress, systemic inflammation, and sleep fragmentation resulting from OSA can provoke subsequent cardiometabolic disorders. The relationships between endocrine disorders and OSA are complex and bidirectional. Indeed, several endocrine disorders are risk factors for OSA. Compared with the general population, the prevalence of OSA is increased in patients with obesity, hypothyroidism, acromegaly, Cushing syndrome, and type 1 and 2 diabetes. In some cases, treatment of the underlying endocrine disorder can improve, and occasionally cure, OSA. On the other hand, OSA can also induce endocrine disorders, particularly glucose metabolism abnormalities. Whether continuous positive airway pressure (CPAP) treatment for OSA can improve these endocrine disturbances remains unclear due to the presence of several confounding factors. In this review, we discuss the current state-of-the-art based on the review of the current medical literature for key articles focusing on the bidirectional relationship between endocrine disorders and OSA and the effects of treatment. Screening of OSA in endocrine patients is also discussed, as it remains a subject of debate.
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Affiliation(s)
- Maud Akset
- Department of Pulmonary Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kris Gustave Poppe
- Department of Endocrinology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre Kleynen
- Department of Endocrinology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ionela Bold
- Department of Pulmonary Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marie Bruyneel
- Department of Pulmonary Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Microvascular complications identify a specific coronary atherosclerotic phenotype in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2022; 21:211. [PMID: 36243750 PMCID: PMC9571474 DOI: 10.1186/s12933-022-01637-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Patients with type 2 diabetes mellitus (T2DM) are considered as a homogeneous cohort of patients. However, the specific role of diabetic microvascular complications (DMC), in determining the features of coronary plaques is poorly known. We investigated whether the presence of DMC may identify a different phenotype of patients associated to specific clinical, angiographic, optical coherence tomography (OCT) features and different prognosis. Methods We prospectively enrolled consecutive T2DM patients with obstructive coronary artery disease (CAD) at their first coronary event. Patients were stratified according to the presence or absence of DMC, including diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy. OCT assessment of the culprit vessel was performed in a subgroup of patients. The incidence of major adverse cardiac events (MACEs) was assessed at follow-up. Results We enrolled 320 T2DM patients (mean age 70.3 ± 8.8 years; 234 [73.1%] men, 40% acute coronary syndrome, 60% chronic coronary syndrome). Patients with DMC (172 [53.75%]) presented a different clinical and biochemical profile and, of importance, a higher prevalence of multivessel CAD (109 [63.4%] vs. 68 [45.9%], p = 0.002). At OCT analysis, DMC was associated to a higher prevalence of large calcifications and healed plaques and to a lower prevalence of lipid plaques. Finally, MACEs rate was significantly higher (25 [14.5%] vs. 12 [8.1%], p = 0.007) in DMC patients, mainly driven by a higher rate of planned revascularizations, and DMC predicted the occurrence of MACEs (mean follow-up 33.4 ± 15.6 months). Conclusions The presence of DMC identifies a distinct diabetic population with more severe CAD but with a more stable pattern of coronary atherosclerosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01637-y.
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Construction of a Prediction Model for the Mortality of Elderly Patients with Diabetic Nephropathy. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5724050. [PMID: 36133909 PMCID: PMC9484980 DOI: 10.1155/2022/5724050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/09/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022]
Abstract
To construct a prediction model for all-cause mortality in elderly diabetic nephropathy (DN) patients, in this cohort study, the data of 511 DN patients aged ≥65 years were collected and the participants were divided into the training set (n = 358) and the testing set (n = 153). The median survival time of all participants was 2 years. The data in the training set were grouped into the survival group (n = 203) or the death group (n = 155). Variables with P ≤ 0.1 between the two groups were selected as preliminary predictors and involved into the multivariable logistic regression model and the covariables were gradually adjusted. The receiver operator characteristic (ROC), Kolmogorov-Smirnov (KS), and calibration curves were plotted for evaluating the predictive performance of the model. Internal validation of the performance of the model was verified in the testing set. The predictive values of the model were also conducted in terms of people with different genders and ages or accompanied with chronic kidney disease (CKD) or cardiovascular diseases (CVD), respectively. In total, 216 (42.27%) elderly DN patients were dead within 2 years. The prediction model for the 2-year mortality of elderly patients with DN was established based on length of stay (LOS), temperature, heart rate, peripheral oxygen saturation (SpO2), serum creatinine (Scr), red cell distribution width (RDW), the simplified acute physiology score-II (SAPS-II), hyperlipidemia, and the Chronic Kidney Disease Epidemiology Collaboration equation for estimated glomerular filtration rate (eGFR-CKD-EPI). The AUC of the model was 0.78 (95% CI: 0.73–0.83) in the training set and 0.72 (95% CI: 0.63–0.80) in the testing set. The AUC of the model was 0.78 (95% CI: 0.65–0.91) in females and 0.78 (95%CI: 0.68–0.88) in patients ≤75 years. The AUC of the model was 0.74 (95% CI: 0.64–0.84) in patients accompanied with CKD. The model had good predictive value for the mortality of elderly patients with DN within 2 years. In addition, the model showed good predictive values for female DN patients, DN patients ≤75 years, and DN patients accompanied with CKD.
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Wang J, Wang W, Zhang W, Wang J, Huang Y, Hu Z, Chen Y, Guo X, Deng F, Zhang L. Co-exposure to multiple air pollutants and sleep disordered breathing in patients with or without obstructive sleep apnea: A cross-sectional study. ENVIRONMENTAL RESEARCH 2022; 212:113155. [PMID: 35351455 DOI: 10.1016/j.envres.2022.113155] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/31/2022] [Accepted: 03/18/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Air pollution may be a contributing risk factor for obstructive sleep apnea (OSA). However, the health effects of co-exposure to multiple air pollutants on OSA patients remain unclear. OBJECTIVES To assess the joint effect of multi-pollutant on sleep disordered breathing (SDB) parameters in patients with or without OSA and identify the dominant pollutants. METHODS A total of 2524 outpatients from April 2020 to May 2021 were recruited in this cross-sectional study. Ambient air pollutant data were obtained from the nearest central monitoring stations to participants' residential address. SDB parameters were measured by the ApneaLink devices, including apnea-hypopnea index (AHI), hypopnea index (HI), oxygen desaturation index (ODI), average oxygen saturation (SpO2), percentage sleep time with <90% saturation (T90), and desaturation. Bayesian kernel machine regression (BKMR) was applied to evaluate the effects of multiple pollutants. RESULTS Significant associations were observed between air pollutants and SDB parameters (including increases in AHI, HI, ODI, and desaturation) among patients with OSA. Co-exposure to air pollutants was positively correlated with AHI, HI, and ODI. PM10 and O3 dominated the effects of pollutant mixtures on OSA, with the highest posterior inclusion probability (PIP) values of 0.592 and 0.640, respectively. Stratified analysis showed that, compared to male patients with OSA, stronger effects on the SDB parameters were observed in female patients. Stronger associations were also found in the warm season than those in the cold season. CONCLUSION Co-exposure to air pollutants was associated with SDB parameters among patients with OSA, PM10 and O3 might play the dominant roles.
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Affiliation(s)
- Junyi Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Wanzhou Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Wenlou Zhang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Jianli Wang
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Yongwei Huang
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Zixuan Hu
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Yahong Chen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Xinbiao Guo
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Furong Deng
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China.
| | - Liqiang Zhang
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, 100191, China.
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10
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Qin Z, Li X, Ren H, Song W, Su L, Gao X. The Correlation between Obstructive Sleep Apnea and Retinal Vein Obstruction: A Meta-Analysis and Systematic Review. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8065629. [PMID: 35935317 PMCID: PMC9296346 DOI: 10.1155/2022/8065629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
Abstract
Despite of inadequate evidence, previous studies have demonstrated a potential correlation between obstructive sleep apnea (OSA) and retinal vein occlusion (RVO). In this study, a meta-analysis is conducted to investigate the correlation between OSA and RVO. Databases are searched for relevant literatures up to July 14, 2021, including PubMed, Embase, Cochrane, Web of Science, CNKI, WanFang, VIP, and Chinese Biomedical Literature Database (CBM). The odds ratio (OR) and 95% confidence interval (CI) are estimated to evaluate the correlation between OSA and RVO. Six articles were finally enrolled, including 36,086 subjects from 5 case-controlled studies and 1 cohort study. It is clearly evident that the RVO risk is higher among OSA patients than non-OSA patients (OR = 3.24, 95% CI = 3.24). The results of sensitivity analysis indicate that the present meta-analysis is robust and reliable. Furthermore, Egger's test for publication bias is performed with P = 0.195, and the results reveal no significant publication bias. The findings demonstrate that OSA is significantly correlated with RVO, and OSA is a risk factor for RVO.
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Affiliation(s)
- Ziwen Qin
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Xiang Li
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Hanyu Ren
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Wei Song
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Longlong Su
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Xiaoling Gao
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
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11
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Vila-Nova TEL, de Luna Gomes JM, do Egito Vasconcelos BC, Pellizzer EP, Moraes SLD. The influence of nocturnal use of complete dentures on cardiorespiratory parameters of patients with obstructive sleep apnea: a systematic review and meta-analysis. Clin Oral Investig 2022; 26:4675-4686. [PMID: 35616727 DOI: 10.1007/s00784-022-04517-7] [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] [Received: 11/11/2021] [Accepted: 04/23/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether wearing complete dentures during sleep influences the cardiorespiratory parameters of patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS A systematic review was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to determine whether wearing complete dentures during sleep influences the cardiorespiratory parameters of patients with OSA. An electronic search was performed in four databases, PubMed/MEDLINE, Cochrane Library, Web of Science, and SCOPUS, and in the gray literature (TRIALS) until November 2021. This review included clinical trials, randomized clinical trials, and studies in which patients using conventional complete dentures were diagnosed with OSA using polysomnography and the cardiorespiratory parameters were measured using oximetry or polysomnography during sleep. RESULTS In total, 788 references were found in the database, and 12 articles were selected for full reading. Six articles were selected for qualitative and quantitative analyses after applying the inclusion and exclusion criteria and reading the full article. The meta-analysis showed that mean oxygen saturation (SpO2) increased with the use of complete dentures (p = 0.001), but the other parameters showed no significant differences between those wearing and not wearing dentures during sleep. CONCLUSIONS The mean SpO2 reduced in patients wearing complete dentures, but the other cardiorespiratory parameters evaluated were not affected. CLINICAL RELEVANCE This study indicates a possible influence of the use of complete dentures on the mean SpO2 during sleep. The use of complete denture could aid other treatments in improving respiratory and sleep quality.
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Affiliation(s)
| | - Jéssica Marcela de Luna Gomes
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, São Paulo State University (UNESP), José Bonifacio street 1193, Araçatuba, São Paulo, 1605000, Brazil
| | | | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, São Paulo State University (UNESP), José Bonifacio street 1193, Araçatuba, São Paulo, 1605000, Brazil.
| | - Sandra Lúcia Dantas Moraes
- Department of Prosthodontics, School of Dentistry, Pernambuco University (UPE), Recife, Pernambuco, Brazil
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12
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Mahmoud MI, Alotaibi RK, Almusally R, Shafiek H, Elamin Y, Alhaj Z, AlBaker W, Elfaki A, Qutub H, Albahrani SJ, Alabdrabalnabi FM, Al Saeed ZA, Al Argan R, Al.Rubaish F, Alqurashi YD, Jatoi NA, Alharmaly AH, Almubarak ZZ, Al Said AH, Albahrani N. Effect of nocturnal hypoxemia on glycemic control among diabetic Saudi patients presenting with obstructive sleep apnea. Front Endocrinol (Lausanne) 2022; 13:1020617. [PMID: 36743921 PMCID: PMC9889975 DOI: 10.3389/fendo.2022.1020617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a prevalent disease that is associated with an increased incidence of type II diabetes mellitus (DM) if left untreated. We aimed to determine the association between glycosylated hemoglobin (HbA1c) levels and both nocturnal hypoxemia and apnea-hypopnea index (AHI) among a Saudi patients with OSA. METHODS A cross-sectional study that enrolled 103 adult patients diagnosed with DM and confirmed to have OSA by full night attended polysomnography between 2018 and 2021. Those who presented with acute illness, chronic obstructive pulmonary disease (COPD)/restrictive lung diseases causing sleep-related hypoxemia, or no available HbA1c level within 6 months before polysomnography were excluded from the study. Univariate and multivariate linear regression analyses between HbA1c levels and parameters of interest were tested. RESULTS Sixty-seven (65%) of the studied population had uncontrolled DM (HbA1c ≥7%). In univariate regression analysis, there was a significant positive association between HbA1c, and sleep time spent with an oxygen saturation below 90% (T90), female gender, and body mass index (BMI) (p<0.05) but not AHI, or associated comorbidities (p>0.05). In the multivariate analysis, HbA1c was positively associated with increasing T90 (p<0.05), and ODI (p<0.05), but not with AHI (p>0.05). CONCLUSION Nocturnal hypoxemia could be an important factor affecting glycemic control in patients with OSA suffering from DM irrespective of the severity of both diseases.
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Affiliation(s)
- Mahmoud I. Mahmoud
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Raed K. Alotaibi
- Family and Community Medicine Department, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rayyan Almusally
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Saudi Arabia
- *Correspondence: Rayyan Almusally,
| | - Hanaa Shafiek
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasir Elamin
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Ziad Alhaj
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
- United Lincolnshire Hospitals, NHS Trust, Lincoln, United Kingdom
| | - Waleed AlBaker
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Alaeldin Elfaki
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
- United Lincolnshire Hospitals, NHS Trust, Lincoln, United Kingdom
| | - Hatem Qutub
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Suha J. Albahrani
- Family Medicine Department, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Fatima M. Alabdrabalnabi
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Saudi Arabia
- Internal Medicine Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Zahra A. Al Saeed
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Saudi Arabia
- Internal Medicine Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Reem Al Argan
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Fatima Al.Rubaish
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Yousef D. Alqurashi
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noor-Ahmed Jatoi
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Abdullah H. Alharmaly
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Saudi Arabia
- Pulmonary Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Zainab Z. Almubarak
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Abir H. Al Said
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Nada Albahrani
- Otolaryngology-Head and Neck Surgery Department, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
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13
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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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