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Schiza S, Bouloukaki I, Kaditis A, Lombardi C, Bonsignore MR. Vitamin D deficiency: A forgotten aspect in sleep disorders? A critical update. Sleep Med 2024; 121:77-84. [PMID: 38941960 DOI: 10.1016/j.sleep.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/28/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
Over the past few years, there has been a surge in interest regarding the connection between sleep duration and quality, sleep disorders, mainly Obstructive sleep apnoea (OSA) and Vitamin D. There is growing evidence to support a new role of Vitamin D in the maintenance and regulation of optimal sleep. Furthermore, a notable link has been identified between OSA and a decrease in serum Vitamin D levels, which appears to intensify as the severity of sleep apnea worsens. Vitamin D status could also potentially serve as a mediator or provide an explanation for the association between OSA and cardiometabolic morbidity, but the current state of research in this area is inadequate. Studies have indicated that the supplementation of Vitamin D can optimize sleep quality, presenting more proof of the connection between insufficient vitamin D levels and sleep disorders. However, it is unclear whether low serum Vitamin D levels are a contributing factor to OSA development or if OSA predisposes individuals to Vitamin D deficiency. As a result, various studies have endeavored to examine the complex relationship between OSA and Vitamin D deficiency. In children and adolescents, while data is limited, there seems also to be a link between sleep disorders and Vitamin D levels. Therefore, the objective of this review is to provide a comprehensive overview of the current evidence on the association between Vitamin D and sleep disorders in both adults and children.
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Affiliation(s)
- Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece.
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Athanasios Kaditis
- Division of Pediatric Pulmonology and Cystic Fibrosis Center, Department of Child Health, University of Missouri School of Medicine, MUHC Children's Hospital, Columbia, MO, USA; Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, St. Luke Hospital, Milan, Italy
| | - Maria R Bonsignore
- Division of Respiratory Medicine, PROMISE Dept, University of Palermo, Palermo, Italy; IBIM CNR, Palermo, Italy
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Loh HH, Sukor N. Obstructive sleep apnea and vitamin D level: Has the dust settled? THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13593. [PMID: 36746181 DOI: 10.1111/crj.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/08/2023] [Accepted: 01/25/2023] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea and vitamin D deficiency are associated with multiple complications with increased morbidity and mortality. However, the relationship between these two entities remains unclear, with clinical studies demonstrating contradictory results. This narrative review aims to present the current evidence and understanding of this relationship and discuss the possible mechanisms linking these two disease entities. Finally, we summarize and propose areas of opportunity for future research.
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Affiliation(s)
- Huai Heng Loh
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
| | - Norlela Sukor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
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Yao N, Ma C, Dou R, Shen C, Yuan Y, Li W, Qu J. Exploring the link between vitamin D deficiency and obstructive sleep apnea: A comprehensive review. J Sleep Res 2024:e14166. [PMID: 38414320 DOI: 10.1111/jsr.14166] [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: 11/19/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/29/2024]
Abstract
Despite the high prevalence and significant health burden of obstructive sleep apnea (OSA), its underlying pathophysiology remains incompletely understood. This comprehensive review explores the emerging connection between vitamin D deficiency and OSA, discusses potential mechanisms underlying this association, and explores the therapeutic implications of these findings. Recent research has consistently highlighted the high incidence of vitamin D deficiency among patients with OSA, which often occurs independently of geographical location. This suggests that factors beyond lack of sunlight exposure may be involved. This review also discusses how reduced vitamin D may be associated with more severe manifestations of OSA. In addition, it explores the potentiality of using vitamin D supplements as a therapeutic strategy for OSA, noting that some studies have found improvements in sleep quality and a reduction in OSA severity. Potential mechanisms are proposed, including the role of vitamin D deficiency in promoting inflammation, oxidative stress, hypoxia, impairing immune function, muscle function, and gene polymorphism of vitamin D receptors, all of which could contribute to the pathogenesis of obstructive sleep apnea. The paper underscores the need for future research to validate these observations, to determine optimal vitamin D supplementation dosage and duration, to explore potential side effects and risks, and to investigate potential interactions with other treatments.
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Affiliation(s)
- Nan Yao
- Department of General Surgery, Aerospace Center Hospital, Beijing, China
| | - Chenyuan Ma
- Department of Emergency, Gansu Provincial People's Hospital, Gansu, China
| | - Ruixue Dou
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Chao Shen
- Department of Gastrointestinal, Peking University International Hospital, Beijing, China
| | - Ye Yuan
- Department of Neurosurgery, People's Hospital of Chiping District, Liaocheng, China
| | - Wei Li
- Department of Gastrointestinal, Peking University International Hospital, Beijing, China
| | - Jun Qu
- Department of General Surgery, Aerospace Center Hospital, Beijing, China
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Loh HH, Lim QH, Kang WH, Yee A, Yong MC, Sukor N. Obstructive sleep apnea and vitamin D: an updated systematic review and meta-analysis. Hormones (Athens) 2023; 22:563-580. [PMID: 37704922 DOI: 10.1007/s42000-023-00481-3] [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: 04/25/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE : Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder which leads to increased cardiovascular risks. Vitamin D deficiency is associated with various cardiometabolic complications, including increased cardiovascular morbidity and mortality. We aimed to analyze the difference in serum 25-hydroxyvitamin D (25-OHD) level, prevalence of vitamin D insufficiency and deficiency, and the effect of CPAP treatment on serum 25-OHD levels among adult patients with OSA. METHODS We pooled data from 18 observational studies involving 5592 individuals. Baseline parameters that might have contributed to the significant differences observed were also analyzed. RESULTS Patients with OSA had significantly lower serum 25-OHD levels (pooled d + - 0.74 [95% CI: - 1.19 to - 0.28], p < 0.01) and higher prevalence of vitamin D deficiency (pooled log (odds ratio) 0.98 [95% CI: 0.30 to 1.67], p < 0.01) compared to those without OSA. Subgroup analysis demonstrated that these differences were significant only in moderate OSA and severe OSA. Neither age nor BMI nor geographical latitude contributed significantly to the differences observed in serum 25-OHD levels. The use of CPAP did not lead to significant changes in serum 25-OHD levels. CONCLUSION Patients with OSA have lower serum 25-OHD levels with a higher prevalence of vitamin D deficiency, regardless of age or BMI, pointing to an independent association between vitamin D and OSA.
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Affiliation(s)
- Huai Heng Loh
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS), Jalan Datuk Mohammad Musa, 94300, Kota Samarahan, Sarawak, Malaysia.
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Quan Hziung Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Waye Hann Kang
- Department of Medicine, M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mei Ching Yong
- Department of Medicine, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Norlela Sukor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
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Archontogeorgis K, Voulgaris A, Nena E, Zissimopoulos A, Bouloukaki I, Schiza SE, Steiropoulos P. Vitamin D Levels in Patients with Overlap Syndrome, Is It Associated with Disease Severity? J Pers Med 2022; 12:jpm12101693. [PMID: 36294836 PMCID: PMC9605178 DOI: 10.3390/jpm12101693] [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: 09/16/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) has been defined as overlap syndrome (OVS). Recently, a link between OSA, COPD and Vitamin D (Vit D) serum concentration was reported, however, evidence regarding Vit D status in patients with OVS is scarce. The aim of the present study was to evaluate Vit D serum levels and to explore the association of those levels with anthropometric, pulmonary function and sleep parameters in patients with OVS. Methods: Vit D serum levels were measured in patients diagnosed with OVS, as confirmed by overnight polysomnography and pulmonary function testing. Results: A total of 90 patients (79 males and 11 females) were included in the analysis. The patients were divided into three groups matched for age, gender, and BMI: the control group that included 30 patients (27 males and 3 females), the OSA group that included 30 patients (26 males and 4 females), and the OVS group that included 30 patients (26 males and 4 females). Patients with OVS exhibited decreased serum 25(OH)D levels compared with OSA patients and controls (14.5 vs. 18.6 vs. 21.6 ng/mL, p < 0.001). In the OVS group, multiple linear regression analysis identified AHI and FEV1, as predictors of serum 25(OH)D levels (p = 0.041 and p = 0.038, respectively). Conclusions: Lower Vit D levels have been observed in patients with OVS compared with OSA patients and non-apneic controls, indicating an increased risk of hypovitaminosis D in this population which might be associated with disease severity.
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Affiliation(s)
- Kostas Archontogeorgis
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Athanasios Voulgaris
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Social Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Athanasios Zissimopoulos
- Laboratory of Nuclear Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, 71110 Heraklion, Greece
| | - Sophia E. Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, 71110 Heraklion, Greece
| | - Paschalis Steiropoulos
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- Correspondence: ; Tel.: +30-551352096
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de Oliveira DL, Dokkedal-Silva V, Fernandes GL, Kim LJ, Tufik S, Andersen ML. Sleep duration as an independent factor associated with vitamin D levels in the EPISONO cohort. J Clin Sleep Med 2021; 17:2439-2449. [PMID: 34170232 DOI: 10.5664/jcsm.9452] [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] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea and short sleep duration have been separately associated with inadequate serum 25-hydroxyvitamin D [25(OH)D] levels. However, whether these 2 factors may concurrently influence 25(OH)D in the general population is unknown. We hypothesized that both obstructive sleep apnea and short sleep duration would be independently associated with lower concentrations of 25(OH)D in a sex-dependent manner. METHODS In this cross-sectional study, 712 individuals, part of the prospective EPISONO cohort (Brazil), underwent polysomnography, answered sleep questionnaires, and had their blood collected for serum 25(OH)D quantification. RESULTS Individuals with a sleep duration of < 6 hours had 2-fold increased odds of 25(OH)D < 20 ng/mL compared with those who reported 6 or more hours of sleep, even after adjusting for confounding factors. Subset sex analysis revealed that men with a sleep duration of < 6 hours had 4-fold increased odds of 25(OH)D < 20 ng/mL. In women, short sleep duration was not associated with lower 25(OH)D levels. The presence of obstructive sleep apnea (as classified according to the individual's apnea-hypopnea index) was not independently related to 25(OH)D concentrations in men or women. Sleep parameters, including sleep latency and sleep efficiency, had no association with 25(OH)D < 20 ng/mL. CONCLUSIONS Short sleep, but not apnea-hypopnea index, was an independent factor associated with low 25(OH)D serum levels in men, but not in women. Apnea-hypopnea index scores were not associated with 25(OH)D levels in either sex. These results raise the possibility of investigating sex-specific characteristics, such as gonadal hormone regulation, and re-evaluating obstructive events by classifying them in mild, moderate, and severe obstructive sleep apnea. CITATION de Oliveira DL, Dokkedal-Silva V, Fernandes GL, Kim LJ, Tufik S, Andersen ML. Sleep duration as an independent factor associated with vitamin D levels in the EPISONO cohort. J Clin Sleep Med. 2021;17(12):2439-2449.
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Affiliation(s)
- Daniela Leite de Oliveira
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil *Contributed equally
| | - Vinícius Dokkedal-Silva
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil *Contributed equally
| | - Guilherme Luiz Fernandes
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil *Contributed equally
| | - Lenise Jihe Kim
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil *Contributed equally
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil *Contributed equally
| | - Monica Levy Andersen
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil *Contributed equally
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Huang T, Tworoger SS, Redline S, Curhan GC, Paik JM. Obstructive Sleep Apnea and Risk for Incident Vertebral and Hip Fracture in Women. J Bone Miner Res 2020; 35:2143-2150. [PMID: 32909307 PMCID: PMC7719618 DOI: 10.1002/jbmr.4127] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/09/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022]
Abstract
Recent studies suggest a positive association between obstructive sleep apnea (OSA), a disorder associated with intermittent hypoxia and sleep fragmentation, and derangements in bone metabolism. However, no prospective study to date has investigated the association between OSA and fracture risk in women. We conducted a prospective study examining the relation between OSA and risk of incident vertebral fracture (VF) and hip fracture (HF) in the Nurses' Health Study. History of physician-diagnosed OSA was assessed by self-reported questionnaires. A previous validation study demonstrated high concordance between self-reports and medical record identification of OSA. OSA severity was further categorized according to the presence or absence of self-reported sleepiness. Self-reports of VF were confirmed by medical record review. Self-reported HF was assessed by biennial questionnaires. Cox proportional-hazards models estimated the hazard ratio for fracture according to OSA status, adjusted for potential confounders, including BMI, physical activity, calcium intake, history of osteoporosis, and falls, and use of sleep medications. Among 55,264 women without prior history of fracture, physician-diagnosed OSA was self-reported in 1.3% in 2002 and increased to 3.3% by 2012. Between 2002 and 2014, 461 incident VF cases and 921 incident HF cases were documented. The multivariable-adjusted hazard ratio (HR) for confirmed VF for women with history of OSA was 2.00 (95% CI, 1.29-3.12) compared with no OSA history, with the strongest association observed for OSA with daytime sleepiness (HR 2.86; 95% CI, 1.31-6.21). No association was observed between OSA history and self-reported HF risk (HR 0.83; 95% CI, 0.49-1.43). History of OSA is independently associated with higher risk of confirmed VF but did not have a statistically significant association with self-reported HF in women. Further research is warranted in understanding the role of OSA and intermittent hypoxia in bone metabolism and health that may differ by fracture site. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Tianyi Huang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Gary C Curhan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Julie M Paik
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
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Archontogeorgis K, Nena E, Papanas N, Steiropoulos P. The role of vitamin D in obstructive sleep apnoea syndrome. Breathe (Sheff) 2018; 14:206-215. [PMID: 30186518 PMCID: PMC6118887 DOI: 10.1183/20734735.000618] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is a common disorder of multifactorial pathogenesis and is associated with obesity, diabetes and cardiovascular disease. Vitamin D is a fat-soluble vitamin with an important function in calcium absorption and homeostasis, which is also implicated in several nonskeletal conditions. The prevalence of vitamin D deficiency is increasing worldwide and is associated with similar metabolic disturbances to OSAS. Moreover, recent data suggest that in OSAS patients serum levels of vitamin D are lower compared with non-apnoeic subjects. However, the mechanisms linking vitamin D deficiency and OSAS are not completely understood and several hypotheses have been advanced. To date, a limited number of studies have assessed the association between lower serum concentrations of vitamin D and OSAS, and have reported inconsistent results. Similarly, contradictory results have been produced by studies which evaluated the effect of continuous positive airway pressure treatment on serum vitamin D levels. The aim of this review is to summarise current knowledge on the association between OSAS and vitamin D levels. Due to multiple confounding factors, vitamin D deficiency is common among sleep apnoea patients; thus, screening should be performed when clinically indicatedhttp://ow.ly/L3ow30krmol
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Affiliation(s)
- Kostas Archontogeorgis
- M.Sc. Program "Sleep Medicine", Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Second Dept of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paschalis Steiropoulos
- M.Sc. Program "Sleep Medicine", Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Riemann D. Focus on sleep-disordered breathing and central nervous hypersomnolence. J Sleep Res 2018; 27:e12740. [DOI: 10.1111/jsr.12740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shen H, Zhao J, Liu Y, Sun G. Interactions between and Shared Molecular Mechanisms of Diabetic Peripheral Neuropathy and Obstructive Sleep Apnea in Type 2 Diabetes Patients. J Diabetes Res 2018; 2018:3458615. [PMID: 30116739 PMCID: PMC6079583 DOI: 10.1155/2018/3458615] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/26/2018] [Indexed: 02/07/2023] Open
Abstract
Type 2 diabetes (T2D) accounts for about 90% of all diabetes patients and incurs a heavy global public health burden. Up to 50% of T2D patients will eventually develop neuropathy as T2D progresses. Diabetic peripheral neuropathy (DPN) is a common diabetic complication and one of the main causes of increased morbidity and mortality of T2D patients. Obstructive sleep apnea (OSA) affects over 15% of the general population and is associated with a higher prevalence of T2D. Growing evidence also indicates that OSA is highly prevalent in T2D patients probably due to diabetic peripheral neuropathy. However, the interrelations among diabetic peripheral neuropathy, OSA, and T2D hitherto have not been clearly elucidated. Numerous molecular mechanisms have been documented that underlie diabetic peripheral neuropathy and OSA, including oxidative stress, inflammation, endothelin-1, vascular endothelial growth factor (VEGF), accumulation of advanced glycation end products, protein kinase C (PKC) signaling, poly ADP ribose polymerase (PARP), nitrosative stress, plasminogen activator inhibitor-1, and vitamin D deficiency. In this review, we seek to illuminate the relationships among T2D, diabetic peripheral neuropathy, and OSA and how they interact with one another. In addition, we summarize and explain the shared molecular mechanisms involved in diabetic peripheral neuropathy and OSA for further mechanistic investigations and novel therapeutic strategies for attenuating and preventing the development and progression of diabetic peripheral neuropathy and OSA in T2D.
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Affiliation(s)
- Hong Shen
- Department of Endocrinology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Junrong Zhao
- Department of Nephrology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Ying Liu
- Department of Nephrology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Guangdong Sun
- Department of Nephrology, The Second Hospital of Jilin University, Changchun 130041, China
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