1
|
Ebrahimi H, Mahmoudi P, Zamani F, Moradi S. Neck circumference and metabolic syndrome: A cross-sectional population-based study. Prim Care Diabetes 2021; 15:582-587. [PMID: 33602607 DOI: 10.1016/j.pcd.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to investigate the possible association of neck circumference with cardiometabolic risk factors, and to find out the possible cutoff points of neck circumference for the diagnosis of metabolic syndrome among the Iranian population. METHOD This is a cross-sectional study in 1619 participants who were selected through clustered random sampling, as a part of a health cohort in Amol, Iran. Diagnosis of metabolic syndrome (MetS) was based on the modified criteria of the National Cholesterol Educational Program Adult Treatment Panel (NCEP ATP III). Associations of neck circumference with Mets and its components were studied using logistic regression. The optimal cutoff point of neck circumference for MetS diagnosis was calculated based on the Youden index. RESULTS Metabolic syndrome was diagnosed in 433 (26.7%) of patients. Neck circumference was shown to be significantly associated with central obesity, hypertension, hypertriglyceridemia, impaired fasting glucose, and low serum high-density lipoprotein (HDL) level, as well as MetS. The optimal cutoff points of neck circumference in the diagnosis of MetS are 36 cm and 42 cm for women and men, respectively. Sensitivity of the optimal cut-off point of NC for diagnosing patients with MetS was higher in women compared to men (70.6% compared to 55.9%). CONCLUSION A significant association was observed between neck circumference and the presence of MetS among the Iranian population and neck circumference can be offered as a new index in screening and diagnosis for MetS and assessing cardiometabolic risk factors.
Collapse
Affiliation(s)
- Hooman Ebrahimi
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Mahmoudi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sedighe Moradi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
2
|
Liu X, Miao Y, Wu F, Du T, Zhang Q. Effect of CPAP therapy on liver disease in patients with OSA: a review. Sleep Breath 2018; 22:963-972. [PMID: 29327118 DOI: 10.1007/s11325-018-1622-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/15/2017] [Accepted: 01/05/2018] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) may play an important role in the progression of nonalcoholic fatty liver disease (NAFLD).The effect of continuous positive airway pressure (CPAP) treatment, the first-line therapy for OSA, on liver disease in OSA patients is still debated. We provide this review of previous studies to summarize the effects of CPAP treatment on liver disease in OSA patients in aspects of liver function, liver steatosis, fibrosis, and incidence of liver disease. CPAP treatment may be beneficial to liver disease in subjects with OSA independent of metabolic risk factors, but a sufficiently long therapeutic duration (perhaps greater than 3 months) may be needed to achieve these positive effects. Though the mechanism of impact of CPAP treatment on liver in OSA patients is unclear, the influence of CPAP treatment on the factors of the "Two-hit" hypothesis (insulin resistance, fatty acids dysregulation, oxidative stress, and inflammation) may be a reasonable explanation.
Collapse
Affiliation(s)
- Xin Liu
- Institute of Gerontology of Tianjin, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, China
| | | | - Fan Wu
- Institute of Gerontology of Tianjin, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, China
| | - Tingting Du
- Institute of Gerontology of Tianjin, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, China
| | - Qiang Zhang
- Institute of Gerontology of Tianjin, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, China.
| |
Collapse
|
3
|
Bakker JP, Weng J, Wang R, Redline S, Punjabi NM, Patel SR. Associations between Obstructive Sleep Apnea, Sleep Duration, and Abnormal Fasting Glucose. The Multi-Ethnic Study of Atherosclerosis. Am J Respir Crit Care Med 2015; 192:745-53. [PMID: 26084035 DOI: 10.1164/rccm.201502-0366oc] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE No data exist as to the role of ethnicity in the associations between obstructive sleep apnea (OSA), sleep duration, and metabolic dysfunction. OBJECTIVES To examine links between OSA, objectively measured habitual sleep duration, and fasting glucose in U.S. ethnic groups. METHODS The Multi-Ethnic Study of Atherosclerosis is a multisite community-based study that conducted polysomnography and wrist actigraphy. In 2,151 subjects (1,839 in fully adjusted models), the apnea-hypopnea index was used to classify OSA as none (0-4.9/h), mild (5-14.9/h), or moderate to severe (≥15/h). Actigraphic sleep duration was classified as short (≤5 h/night), intermediate (>5 and <8 h/night), or long (≥8 h/night). Subjects were classified as having normal fasting glucose (<100 mg/dl and no hypoglycemic medication use) or abnormal fasting glucose (≥100 mg/dl and/or hypoglycemic medication use). MEASUREMENTS AND MAIN RESULTS The sample was 45.8% male, age 68.5 ± 9.2 (mean ± SD) years, and 27.3% African American, 37.2% white, 11.8% Chinese, and 23.8% Hispanic. The prevalence of abnormal fasting glucose was 40.2%. Relative to subjects without apnea, moderate-to-severe OSA was significantly associated with abnormal fasting glucose in African Americans (odds ratio, 2.14; 95% confidence interval, 1.12-4.08) and white participants (odds ratio, 2.85; 95% confidence interval, 1.20-6.75), but not among Chinese or Hispanic subjects, after adjusting for site, age, sex, waist circumference, and sleep duration (P = 0.06 for ethnicity-by-OSA severity interaction). In contrast, sleep duration was not significantly associated with abnormal fasting glucose after considering the influence of OSA. CONCLUSIONS This large multiethnic study confirmed previous reports of an independent association between OSA and metabolic dysfunction, and suggested that this association may vary by ethnicity.
Collapse
Affiliation(s)
- Jessie P Bakker
- 1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Jia Weng
- 1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Rui Wang
- 1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Susan Redline
- 1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Naresh M Punjabi
- 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanjay R Patel
- 1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and
| |
Collapse
|
4
|
Arjmand G, Shidfar F, Molavi Nojoomi M, Amirfarhangi A. Anthropometric Indices and Their Relationship With Coronary Artery Diseases. HEALTH SCOPE 2015. [DOI: 10.17795/jhealthscope-25120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
5
|
Iftikhar IH, Hoyos CM, Phillips CL, Magalang UJ. Meta-analyses of the Association of Sleep Apnea with Insulin Resistance, and the Effects of CPAP on HOMA-IR, Adiponectin, and Visceral Adipose Fat. J Clin Sleep Med 2015; 11:475-85. [PMID: 25700870 PMCID: PMC4365462 DOI: 10.5664/jcsm.4610] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 12/04/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We sought to conduct an updated meta-analysis of randomized controlled trials (RCTs) on the effect of continuous positive airway pressure (CPAP) on insulin resistance, as measured by homeostasis model assessment of insulin resistance (HOMA-IR), visceral abdominal fat (VAF), and adiponectin. Additionally, we performed a separate meta-analysis and meta-regression of studies on the association of insulin resistance and obstructive sleep apnea (OSA). METHODS All included studies were searched from PubMed (from conception to March 15, 2014). Data were pooled across all included RCTs as the mean difference in HOMA-IR and VAF, and as the standardized mean difference in the case of adiponectin analysis. From the included case-control studies, data on the difference of HOMA-IR between cases and controls were pooled across all studies, as the standardized mean difference (SMD). RESULTS There was a significant difference in HOMA-IR (-0.43 [95% CIs: -0.75 to -0.11], p = 0.008) between CPAP treated and non CPAP treated participants. However, there was no significant difference in VAF or adiponectin; (-47.93 [95% CI: -112.58 to 16.72], p = 0.14) and (-0.06 [95% CI: -0.28 to 0.15], p = 0.56), respectively. Meta-analysis of 16 case-control studies showed a pooled SMD in HOMA-IR of 0.51 (95% CI: 0.28 to 0.75), p ≤ 0.001, between cases and controls. CONCLUSIONS The results of our meta-analyses show that CPAP has a favorable effect on insulin resistance. This effect is not associated with any significant changes in total adiponectin levels or amount of VAF. Our findings also confirm a significant association between OSA and insulin resistance.
Collapse
Affiliation(s)
- Imran H. Iftikhar
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of South Carolina School of Medicine, Columbia, SC
| | - Camilla M. Hoyos
- Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, Australia
| | - Craig L. Phillips
- Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Ulysses J. Magalang
- Divison of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
6
|
|
7
|
Martínez Cerón E, Casitas Mateos R, García-Río F. Sleep apnea-hypopnea syndrome and type 2 diabetes. A reciprocal relationship? Arch Bronconeumol 2014; 51:128-39. [PMID: 25145320 DOI: 10.1016/j.arbres.2014.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/15/2014] [Accepted: 06/16/2014] [Indexed: 01/03/2023]
Abstract
Epidemiological data suggest that sleep apnea-hypopnea syndrome (SAHS) is independently associated with the development of insulin resistance and glucose intolerance. Moreover, despite significant methodological limitations, some studies report a high prevalence of SAHS in patients with type 2 diabetes mellitus (DM2). A recent meta-analysis shows that moderate-severe SAHS is associated with an increased risk of DM2 (relative risk=1.63 [1.09 to 2.45]), compared to the absence of apneas and hypopneas. Common alterations in various pathogenic pathways add biological plausibility to this relationship. Intermittent hypoxia and sleep fragmentation, caused by successive apnea-hypopnea episodes, induce several intermediate disorders, such as activation of the sympathetic nervous system, oxidative stress, systemic inflammation, alterations in appetite-regulating hormones and activation of the hypothalamic-pituitary-adrenal axis which, in turn, favor the development of insulin resistance, its progression to glucose intolerance and, ultimately, to DM2. Concomitant SAHS seems to increase DM2 severity, since it worsens glycemic control and enhances the effects of atherosclerosis on the development of macrovascular complications. Furthermore, SAHS may be associated with the development of microvascular complications: retinopathy, nephropathy or diabetic neuropathy in particular. Data are still scant, but it seems that DM2 may also worsen SAHS progression, by increasing the collapsibility of the upper airway and the development of central apneas and hypopneas.
Collapse
Affiliation(s)
| | | | - Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Universidad Autónoma de Madrid, Madrid, España; CIBER de enfermedades respiratorias (CIBERES), Madrid, España.
| |
Collapse
|
8
|
Aurora RN, Punjabi NM. Obstructive sleep apnoea and type 2 diabetes mellitus: a bidirectional association. THE LANCET RESPIRATORY MEDICINE 2013; 1:329-38. [PMID: 24429158 DOI: 10.1016/s2213-2600(13)70039-0] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnoea and type 2 diabetes are common medical disorders that have important clinical, epidemiological, and public health implications. Research done in the past two decades indicates that obstructive sleep apnoea, through the effects of intermittent hypoxaemia and sleep fragmentation, could contribute independently to the development of insulin resistance, glucose intolerance, and type 2 diabetes. Conversely, type 2 diabetes might increase predisposition to, or accelerate progression of, obstructive and central sleep apnoea, possibly through the development of peripheral neuropathy and abnormalities of ventilatory and upper airway neural control. Although more research is needed to clarify the mechanisms underlying the bidirectional association between the two disorders, their frequent coexistence should prompt all health-care professionals to embrace clinical practices that include screening of a patient presenting with one disorder for the other. Early identification of obstructive sleep apnoea in patients with metabolic dysfunction, including type 2 diabetes, and assessment for metabolic abnormalities in those with obstructive sleep apnoea could reduce cardiovascular disease risk and improve the quality of life of patients with these chronic diseases.
Collapse
Affiliation(s)
- R Nisha Aurora
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
| |
Collapse
|
9
|
Heinrichsen ET, Haddad GG. Role of high-fat diet in stress response of Drosophila. PLoS One 2012; 7:e42587. [PMID: 22870336 PMCID: PMC3411628 DOI: 10.1371/journal.pone.0042587] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 07/09/2012] [Indexed: 01/08/2023] Open
Abstract
Obesity is associated with many diseases, one of the most common being obstructive sleep apnea (OSA), which in turn leads to blood gas disturbances, including intermittent hypoxia (IH). Obesity, OSA and IH are associated with metabolic changes, and while much mammalian work has been done, mechanisms underlying the response to IH, the role of obesity and the interaction of obesity and hypoxia remain unknown. As a model organism, Drosophila offers tremendous power to study a specific phenotype and, at a subsequent stage, to uncover and study fundamental mechanisms, given the conservation of molecular pathways. Herein, we characterize the phenotype of Drosophila on a high-fat diet in normoxia, IH and constant hypoxia (CH) using triglyceride and glucose levels, response to stress and lifespan. We found that female flies on a high-fat diet show increased triglyceride levels (p<0.001) and a shortened lifespan in normoxia, IH and CH. Furthermore, flies on a high-fat diet in normoxia and CH show diminished tolerance to stress, with decreased survival after exposure to extreme cold or anoxia (p<0.001). Of interest, IH seems to rescue this decreased cold tolerance, as flies on a high-fat diet almost completely recovered from cold stress following IH. We conclude that the cross talk between hypoxia and a high-fat diet can be either deleterious or compensatory, depending on the nature of the hypoxic treatment.
Collapse
Affiliation(s)
- Erilynn T. Heinrichsen
- Department of Pediatrics (Division of Respiratory Medicine) and Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, California, United States of America
| | - Gabriel G. Haddad
- Department of Pediatrics (Division of Respiratory Medicine) and Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, California, United States of America
- Department of Neurosciences, University of California San Diego, La Jolla, California, United States of America
- Rady Children's Hospital, San Diego, California, United States of America
- * E-mail:
| |
Collapse
|
10
|
Harper RM, Kumar R, Macey PM, Ogren JA, Richardson HL. Functional neuroanatomy and sleep-disordered breathing: implications for autonomic regulation. Anat Rec (Hoboken) 2012; 295:1385-95. [PMID: 22851218 DOI: 10.1002/ar.22514] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 04/18/2012] [Indexed: 11/05/2022]
Abstract
A major concern with sleep-disordered breathing conditions, which include obstructive sleep apnea (OSA), central apnea, and congenital central hypoventilation syndrome (CCHS), is the high incidence of accompanying autonomic dysfunction and metabolic disorders. Patients with OSA show exaggerated sympathetic tone, leading to hypertension, cardiac arrhythmia, profuse sweating, impaired cerebral perfusion, and stroke. In addition, OSA appears in 86% of obese Type II diabetic patients, suggesting common deleterious processes. Autonomic deficiencies also appear in CCHS patients, who are often hypoglycemic. The impaired autonomic control may stem from injury to central sympathetic and parasympathetic regulatory areas resulting from apnea-related inflammation, hypoxia, or perfusion-related consequences in OSA, and genetic mutation repercussions in CCHS. Disturbed sleep organization from apnea arousals may also disrupt hormonal release. Brain areas affected in both OSA and CCHS include cortical and limbic regions that influence hypothalamic-regulated sympathetic control and hormone release, essential for glycemic regulation, as well as parasympathetic nuclei influencing the pancreas and other viscera, and raphé serotonergic sites, important for thermal and vascular regulation. Brain injury and altered functional responses appear in OSA and CCHS, assessed with magnetic resonance imaging techniques, in areas which show regional gray matter loss, alterations of free water within tissue, loss of axonal integrity, and disruption of functional responses to autonomic and ventilatory challenges. Evaluation of neural injury and distortion in functional signals to autonomic challenges in localized brain areas can provide insights into common pathological mechanisms for dysregulation of hormonal release and autonomic processes in sleep-disordered breathing and metabolic disorders.
Collapse
Affiliation(s)
- Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California, USA.
| | | | | | | | | |
Collapse
|
11
|
Wysocka E, Cofta S, Dziegielewska S, Gozdzik J, Torlinski L, Batura-Gabryel H. Adipocytokines in sleep apnea syndrome. Eur J Med Res 2010; 14 Suppl 4:255-8. [PMID: 20156767 PMCID: PMC3521364 DOI: 10.1186/2047-783x-14-s4-255] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Biomarkers of adipose tissue may affect glucose and lipid metabolism and present pro-inflammatory properties, thus could be involved in the pathobiochemistry of cardiovascular disease (CVD). The coexistence of sleep apnea syndrome (OSA) and metabolic risk factors of CVD is worth explaining. The aim of the study was to compare the serum adipocytokines in subjects with and without OSA, who had all elevated body mass index (BMI). METHODS Overweight (BMI: 25.0-29.9 kg/m2) and obese (BMI: 30.0-39.9 kg/m2) OSA-suspected Caucasian males, aged 30-63, with no acute disease or chronic disorder underwent polysomnographic evaluation to select OSA-positive (AHI > or = 5) and OSA-negative (AHI <5) subjects. Four subgroups were created of 18 persons each: Over(weight)-OSA-Neg, Over-OSA-Pos, Obese-OSA-Neg, Obese-OSA-Pos. In all subjects, plasma carbohydrate and lipid metabolism parameters, and serum uric acid, resistin and leptin concentrations were determined. RESULTS A decreased resistin level was observed in Over-OSA-Pos vs. Over-OSA-Neg subjects (P=0.037) as well as in Obese-OSA-Pos vs. Obese-OSA-Neg (P=0.045). No differences in leptin concentrations were observed. A positive correlation between leptin and BMI was in both overweight subgroups and a negative one between resistin and fasting glucose was in both obese subgroups. CONCLUSIONS OSA may decrease the serum resistin level in subjects with excess body mass and also may contribute to glucose metabolism, but has no influence on the leptin level.
Collapse
Affiliation(s)
- E Wysocka
- Department of Clinical Biochemistry and Laboratory Medicine, Poznan University of Medical Sciences, Poznan, Poland.
| | | | | | | | | | | |
Collapse
|
12
|
Preis SR, Massaro JM, Hoffmann U, D'Agostino RB, Levy D, Robins SJ, Meigs JB, Vasan RS, O'Donnell CJ, Fox CS. Neck circumference as a novel measure of cardiometabolic risk: the Framingham Heart study. J Clin Endocrinol Metab 2010; 95:3701-10. [PMID: 20484490 PMCID: PMC2913042 DOI: 10.1210/jc.2009-1779] [Citation(s) in RCA: 281] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Neck circumference, a proxy for upper-body sc fat, may be a unique fat depot that confers additional cardiovascular risk above and beyond central body fat. METHODS AND RESULTS Participants with neck circumference measures who underwent multidetector computed tomography to assess visceral adipose tissue (VAT) were included [n=3307, 48% women; mean age=51 yr; mean body mass index (BMI)=27.8 kg/m2; mean neck circumference=40.5 cm (men) and 34.2 cm (women)]. Sex-specific linear regression models were used to assess the association between sd increase in neck circumference and cardiovascular disease (CVD) risk factors (systolic and diastolic blood pressure; total, low-density lipoprotein, and high-density lipoprotein cholesterol and triglycerides; and fasting plasma glucose, insulin, proinsulin, and homeostasis model assessment of insulin resistance). Neck circumference was correlated with VAT [r=0.63 (men); r=0.74 (women); P<0.001] and BMI [r=0.79 (men); r=0.80 (women); P<0.001]. After further adjustment for VAT, neck circumference was positively associated with systolic blood pressure, diastolic blood pressure in men only, triglycerides, fasting plasma glucose in women only, insulin, proinsulin, and homeostasis model assessment of insulin resistance and was inversely associated with high-density lipoprotein (all P values<0.01). Similar results were observed in models that adjusted for both VAT and BMI. In a secondary analysis of incident CVD as an outcome, there was no statistically significant association observed for neck circumference in multivariable-adjusted models. CONCLUSIONS Neck circumference is associated with CVD risk factors even after adjustment for VAT and BMI. These findings suggest that upper-body sc fat may be a unique, pathogenic fat depot.
Collapse
Affiliation(s)
- Sarah Rosner Preis
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, Massachusetts 01702, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Louis JM, Auckley D, Sokol RJ, Mercer BM. Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy. Am J Obstet Gynecol 2010; 202:261.e1-5. [PMID: 20005507 DOI: 10.1016/j.ajog.2009.10.867] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 07/27/2009] [Accepted: 10/19/2009] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of the study was to estimate the maternal and neonatal morbidities associated with obstructive sleep apnea (OSA) in pregnancy. STUDY DESIGN Women delivering between 2000-2008 with confirmed OSA in an academic center were included. Normal-weight and obese controls were randomly selected at a 2:1 ratio. Maternal and neonatal morbidities were compared between the groups. Multivariate analyses were performed to evaluate maternal morbidity and preterm birth (PTB). RESULTS The analysis included 57 pregnancies complicated by OSA. Compared with normal-weight (n = 114) controls, OSA patients had more preeclampsia (PET) (19.3% vs 7.0%; P = .02) and PTB (29.8% vs 12.3%; P = .007). Controlling for comorbid conditions, OSA was associated with an increased risk of PTB (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.02-6.6), mostly secondary to PET (63%). Cesarean delivery (OR, 8.1; 95% CI, 2.9-22.1) and OSA were associated with maternal morbidity (OR, 4.6; 95% CI, 1.5-13.7). CONCLUSION Pregnancies complicated by OSA are at increased risk for preeclampsia, medical complications, and indicated PTB.
Collapse
Affiliation(s)
- Judette M Louis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA
| | | | | | | |
Collapse
|
14
|
Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Bixler EO. Insomnia with objective short sleep duration is associated with type 2 diabetes: A population-based study. Diabetes Care 2009; 32:1980-5. [PMID: 19641160 PMCID: PMC2768214 DOI: 10.2337/dc09-0284] [Citation(s) in RCA: 350] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined the joint effects of insomnia and objective short sleep duration, the combination of which is associated with higher morbidity, on diabetes risk. RESEARCH DESIGN AND METHODS A total of 1,741 men and women randomly selected from Central Pennsylvania were studied in the sleep laboratory. Insomnia was defined by a complaint of insomnia with duration of >or=1 year, whereas poor sleep was defined as a complaint of difficulty falling asleep, staying asleep, or early final awakening. Polysomnographic sleep duration was classified into three categories: >or=6 h of sleep (top 50% of the sample); 5-6 h (approximately third quartile of the sample); and <or=5 h (approximately the bottom quartile of the sample). Diabetes was defined either based on a fasting blood glucose >126 mg/dl or use of medication. In the logistic regression model, we simultaneously adjusted for age, race, sex, BMI, smoking, alcohol use, depression, sleep-disordered breathing, and periodic limb movement. RESULTS Chronic insomnia but not poor sleep was associated with a higher risk for diabetes. Compared with the normal sleeping and >or=6 h sleep duration group, the highest risk of diabetes was in individuals with insomnia and <or=5 h sleep duration group (odds ratio [95% CI] 2.95 [1.2-7.0]) and in insomniacs who slept 5-6 h (2.07 [0.68-6.4]). CONCLUSIONS Insomnia with short sleep duration is associated with increased odds of diabetes. Objective sleep duration may predict cardiometabolic morbidity of chronic insomnia, the medical impact of which has been underestimated.
Collapse
Affiliation(s)
- Alexandros N Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Vgontzas AN. Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance? Arch Physiol Biochem 2008; 114:211-23. [PMID: 18946782 DOI: 10.1080/13813450802364627] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Despite the early recognition of the strong association between obstructive sleep apnoea (OSA) and obesity, and OSA and cardiovascular problems, sleep apnoea has been treated as a "local abnormality" of the respiratory track rather than as a "systemic illness". In 1997, we first reported that the pro-inflammatory cytokines interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNFalpha) were elevated in patients with disorders of excessive daytime sleepiness (EDS) and proposed that these cytokines were mediators of daytime sleepiness. In subsequent studies, it was shown that IL-6, TNFalpha, and insulin levels were elevated in sleep apnoea independently of obesity and that visceral fat was the primary parameter linked with sleep apnoea. Further studies showed that women with the polycystic ovary syndrome (PCOS) were much more likely than controls to have sleep-disordered breathing (SDB) and daytime sleepiness, suggesting a pathogenetic role of insulin resistance in OSA. Additional accumulated evidence that supports the role of obesity and the associated metabolic aberrations in the pathogenesis of sleep apnoea and related symptoms include: obesity without sleep apnoea is associated with daytime sleepiness; the protective role of gonadal hormones as suggested by the increased prevalence of sleep apnoea in post-menopausal women and the significantly reduced risk for OSA in women on hormonal therapy; partial effects of continuous positive airway pressure (CPAP) in obese patients with apnoea on hypercytokinemia, insulin resistance indices, and visceral fat; and that the prevalence of the metabolic syndrome in the U.S. population from the Third National Health and Nutrition Examination Survey (1988-1994) parallels the prevalence of symptomatic sleep apnoea in general random samples. Furthermore, the beneficial effect of a cytokine antagonist on EDS and apnoea in obese, male apnoeics and that of exercise and weight loss on SDB and EDS in general random or clinical samples, supports the hypothesis that cytokines and insulin resistance are mediators of EDS and sleep apnoea in humans. Finally, our recent finding that in obese, hypothalamic CRH neuron is hypoactive, provides additional evidence on the potential central neural mechanisms for depressed ventilation and consequent development of sleep apnoea in obese individuals. In conclusion, accumulating evidence provides support to our thesis that obesity via inflammation, insulin resistance, visceral adiposity, and central neural mechanisms, e.g. hypofunctioning hypothalamic CRH, play a major role in the pathogenesis of sleep apnoea, sleepiness, and the associated cardiovascular co-morbidities.
Collapse
Affiliation(s)
- Alexandros N Vgontzas
- Department of Psychiatry, Sleep Research and Treatment Center, Hershey, PA 17033, USA.
| |
Collapse
|
16
|
Sadikot S. An overview: Obstructive Sleep Apnea and the Metabolic Syndrome: Should “X” be changed to “Zzz…Zzzz….Zzzzzzzzz….Zzz”? Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2007. [DOI: 10.1016/j.dsx.2007.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|