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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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Bonsignore MR, Mazzuca E, Baiamonte P, Bouckaert B, Verbeke W, Pevernagie DA. REM sleep obstructive sleep apnoea. Eur Respir Rev 2024; 33:230166. [PMID: 38355150 PMCID: PMC10865098 DOI: 10.1183/16000617.0166-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/18/2023] [Indexed: 02/16/2024] Open
Abstract
Obstructive sleep apnoea (OSA) can occur in both rapid eye movement (REM) and non-REM sleep or be limited to REM sleep, when the upper airway is most prone to collapse due to REM sleep atonia. Respiratory events are usually longer and more desaturating in REM than in NREM sleep. The prevalence of REM OSA is higher in women than in men and REM OSA usually occurs in the context of mild-moderate OSA based on the apnoea-hypopnoea index calculated for the entire sleep study. Studies have highlighted some detrimental consequences of REM OSA; for example, its frequent association with systemic hypertension and a degree of excessive daytime sleepiness similar to that found in nonsleep-stage-dependent OSA. Moreover, REM OSA could increase cardiometabolic risk. Continuous positive airway pressure (CPAP) treatment aimed at preventing REM OSA should be longer than the 4 h usually considered as good compliance, since REM sleep occurs mostly during the second half of the night. Unfortunately, patients with REM OSA show poor adherence to CPAP. Alternative non-CPAP treatments might be a good choice for REM OSA, but data are lacking. This review summarises the available data on REM OSA and critically examines the weaknesses and strengths of existing literature.
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Affiliation(s)
- Maria R Bonsignore
- PROMISE Department, University of Palermo, Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
| | - Emilia Mazzuca
- Department of Respiratory Diseases, Cervello Hospital, AO Villa Sofia-Cervello, Palermo, Italy
| | - Pierpaolo Baiamonte
- Department of Respiratory Diseases, Cervello Hospital, AO Villa Sofia-Cervello, Palermo, Italy
| | - Bernard Bouckaert
- Department of Respiratory Diseases and Sleep Disorders Centre, AZ Delta, Rumbeke, Belgium
| | - Wim Verbeke
- Department of Respiratory Diseases and Sleep Disorders Centre, AZ Delta, Rumbeke, Belgium
| | - Dirk A Pevernagie
- Department of Respiratory Diseases and Sleep Disorders Centre, AZ Delta, Rumbeke, Belgium
- Department Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
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Singh M, Deokar K, Sinha BP, Keena M, Desai G. Ocular manifestations of common pulmonary diseases: a narrative review. Monaldi Arch Chest Dis 2023; 94. [PMID: 36867059 DOI: 10.4081/monaldi.2023.2535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
Several pulmonary disorders can cause ocular involvement. Understanding these manifestations is critical for early diagnosis and treatment. Hence, we set out to examine the most common ocular manifestations of asthma, chronic obstructive pulmonary disease (COPD), sarcoidosis, obstructive sleep apnea (OSA), and lung cancer. Allergic keratoconjunctivitis and dry eye are two ocular manifestations of bronchial asthma. The inhaled corticosteroids used to treat asthma can cause cataract formation. COPD is associated with ocular microvascular changes as a result of chronic hypoxia and systemic inflammation spillover into the eyes. Its clinical significance, however, is unknown. Ocular involvement is common in sarcoidosis, occurring in 20% of cases of pulmonary sarcoidosis. It can affect nearly any anatomical structure of the eye. Obstructive sleep apnea has been linked to floppy eye syndrome, glaucoma, non-arteritic anterior ischemic optic neuropathy, keratoconus, retinal vein occlusion, and central serous retinopathy, according to research. However, while an association has been established, causality has yet to be established. The effect of positive airway pressure (PAP) therapy used to treat OSA on the aforementioned ocular conditions is unknown. PAP therapy can cause eye irritation and dryness. Lung cancer can affect the eyes through direct nerve invasion, ocular metastasis, or as part of a paraneoplastic syndrome. The goal of this narrative review is to raise awareness about the link between ocular and pulmonary disorders in order to aid in the early detection and treatment of these conditions.
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Affiliation(s)
- Mamta Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Rajkot.
| | - Kunal Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot.
| | - Bibhuti Prassan Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna.
| | - Monika Keena
- Department of Pulmonary Medicine, Railway hospital, Jodhpur.
| | - Govind Desai
- Department of Pulmonary Medicine, S.Nijalingappa Medical College and H.S.K Hospital, Bagalkot.
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Obstructive sleep apnea is not associated with diabetic retinopathy in diabetes: a prospective case-control study. Sleep Breath 2023; 27:121-128. [PMID: 35141812 DOI: 10.1007/s11325-022-02578-2] [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: 08/30/2021] [Revised: 01/16/2022] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Diabetic retinopathy (DR) is the most common ocular complication of type 2 diabetes mellitus (T2D) and is associated with diabetes duration, glycemic control, and hypertension (HTN). Obstructive sleep apnea (OSA) is frequent in T2D and is associated with poor glycemic control. However, it is unclear if there is an association between OSA and DR. This study aimed to assess whether or not the presence of OSA in patients with T2D was associated with DR. METHODS In this prospective case-control study, consecutive patients with DM attending the ophthalmology clinics were recruited to include patients with DR (cases) and without DR (controls). OSA was diagnosed by attended polysomnography (PSG). Blood pressure and a fasting morning blood sample, including glycosylated hemoglobin (HbA1c), were recorded. Patients were matched for age, body mass index (BMI), gender, and T2D duration. RESULTS Thirty diabetic patients with DR were matched with 30 controls. In all patients, the prevalence of moderate-to-severe OSA was 57%. In the logistic regression analysis, DR was associated with increased HbA1c (OR 2.63, 95% CI 1.35-5.16, p = 0.004) but not with any PSG parameter. In the DR group, PSG parameters were not associated with the severity of ocular disease (non-proliferative, proliferative, presence/absence of macular edema). The proliferative aspect of DR was correlated with age (p = 0.017). DR occurred more frequently in uncontrolled diabetes compared to well-controlled diabetes (80% vs 38%, p = 0.029). CONCLUSIONS In patients with T2D, the presence of DR is not associated with OSA, but with poorly controlled T2D.
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Nakayama LF, Tempaku PF, Bergamo VC, Polizelli MU, Santos da Cruz NF, Bittencourt LRA, Regatieri CVS. Obstructive sleep apnea and the retina: a review. J Clin Sleep Med 2021; 17:1947-1952. [PMID: 34165073 DOI: 10.5664/jcsm.9312] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CITATION This review's objective was to synthesize the literature on the repercussions of obstructive sleep apnea (OSA) in the retinal vascular system. Two independent investigators conducted a search using the MEDLINE/PubMed database using the following terms: sleep apnea syndrome, obstructive sleep apnea, retina, vascular tortuosity, central serous chorioretinopathy, diabetes mellitus, and subfoveal choroidal thickness. Patients with OSA present increased vascular tortuosity compared with patients without OSA, decreased parafoveal and peripapillary vessel density, and increased retinal vein occlusion incidence. In central serous chorioretinopathy patients and patients who are poor responders to intravitreal anti-VEGF (-vascular endothelial growth factor) treatment for macular edema, OSA is more frequent. Macular choroidal thickness alterations are controversial, and OSA may worsen diabetic maculopathy, thus being a risk factor for diabetic retinopathy, proliferative diabetic retinopathy, and macular edema. OSA is a prevalent syndrome with many systemic vascular changes. The retina and choroid are the most affected ocular structures, with primarily vascular changes. New noninvasive technologies such as optical coherence tomography and optical coherence tomography angiography could help to better understand retinal structures and help clarify the ophthalmological repercussions of OSA. CITATION Nakayama LF, Tempaku PF, Bergamo VC, et al. Obstructive sleep apnea and the retina: a review. J Clin Sleep Med. 2021;17(9):1947-1952.
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Affiliation(s)
- Luis Filipe Nakayama
- Department of Ophthalmology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | - Priscila Farias Tempaku
- Departamento de Psicobiologia, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | - Vinicius Campos Bergamo
- Department of Ophthalmology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | - Murilo Ubukata Polizelli
- Department of Ophthalmology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
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Al Saeed AA, AlShabib NS, Al Taisan AA, Kreary YA. Association of Retinal Vascular Manifestation and Obstructive Sleep Apnea (OSA): A Narrative Review. Clin Ophthalmol 2021; 15:3315-3320. [PMID: 34393479 PMCID: PMC8360361 DOI: 10.2147/opth.s305968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/20/2021] [Indexed: 12/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by frequent episodes of partial or complete obstruction of the airway during sleep causing repeated episodes of apnea. OSA is more prevalent in middle-aged and older adults. OSA is associated with numerous ocular manifestations, including retinal manifestations. Literature highlighted the clear association between OSA and numerous ocular conditions including glaucoma and papilledema. This comprehensive and narrative review aims to summarize up-to-date clinical research concerning the association of OSA and vascular conditions that affect the retina. OSA is associated with the central serous chorioretinopathy (CSC), retinal vein occlusion (RVO), hypertensive retinopathy (HTRP) and development of diabetic retinopathy (DR). Sympathetic activation, hypoxia, and hormonal dysregulation all lead to serious retinal vascular conditions that will worsen OSA patients’ quality of life. It is important to refer patients with newly diagnosed OSA to an ophthalmology clinic for the appropriate test.
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Affiliation(s)
- Ali A Al Saeed
- College of Medicine, King Faisal University, Al-Ahasa, Saudi Arabia
| | | | - Abdulaziz A Al Taisan
- Department of Ophthalmology, College of Medicine, King Faisal University, Al-Ahasa, Saudi Arabia
| | - Yahya A Kreary
- Department of Vitreoretinal Surgery, Dhahran Eye Specialist Hospital, Dhahran, Eastern Province, Saudi Arabia
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Liu PK, Chiu TY, Wang NK, Levi SR, Tsai MJ. Ocular Complications of Obstructive Sleep Apnea. J Clin Med 2021; 10:jcm10153422. [PMID: 34362205 PMCID: PMC8348497 DOI: 10.3390/jcm10153422] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is characterized by repetitive episodes of paused breathing during sleep, which in turn induces transient nocturnal hypoxia and hypercapnia. The high prevalence of OSA and its associated health consequences place a heavy burden on the healthcare system. In particular, the consequent episodic oxygenic desaturation/reoxygenation series and arousals from sleep in patients with OSA have the potential to trigger oxidative stress, elevated systemic inflammatory responses, and autonomic dysfunction with sympathetic activation. Given these adverse side-effects, OSA is highly correlated to many eye diseases that are common in everyday ophthalmic practices. Some of these ocular consequences are reversible, but they may permanently threaten a patient’s vision if not treated appropriately. Here, this article seeks to review the ocular consequences and potential pathophysiologic associations in patients with OSA. Understanding these OSA-related eye diseases may help clinicians provide comprehensive care to their patients.
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Affiliation(s)
- Pei-Kang Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-K.L.); (T.-Y.C.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Tzu-Yu Chiu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-K.L.); (T.-Y.C.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Sarah R. Levi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 5601)
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Nishimura A, Kasai T, Matsumura K, Kikuno S, Nagasawa K, Okubo M, Narui K, Mori Y. Obstructive sleep apnea during rapid eye movement sleep in patients with diabetic kidney disease. J Clin Sleep Med 2021; 17:453-460. [PMID: 33108268 DOI: 10.5664/jcsm.8924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVES Although recent studies suggest that obstructive sleep apnea during rapid eye movement (REM) is associated with different cardiometabolic and neurocognitive risks compared with non-REM (NREM) sleep, there is no information on whether obstructive sleep apnea during REM and/or NREM sleep is independently associated with diabetic kidney disease (DKD). METHODS In this cross-sectional study, 303 patients with type 2 diabetes who were followed up at our diabetes outpatient clinic underwent all-night polysomnography. Logistic regression analysis was performed to determine the separate effects of obstructive sleep apnea during REM and/or NREM sleep (REM and/or NREM-apnea-hypopnea index [AHI]) and several other polysomnography parameters on DKD after adjustment for several known risk factors for DKD. RESULTS The median (interquartile range) AHI, REM-AHI, and NREM-AHI of the patients (age 57.8 ± 11.8 years, male sex 86.8%, hypertension 64.3%, and DKD 35.2%) were 29.8 (18.0-45.4), 35.4 (21.1-53.3), and 29.1 (16.3-45.4) events/h, respectively. REM-AHI quartiles, but not NREM-AHI quartiles, correlated independently and significantly with DKD (P = .03 for linear trend, odds ratio (OR), and 95% confidence interval for Q2: 3.14 (1.10-8.98), Q3: 3.83 (1.26-11.60), Q4: 4.97 (1.60-15.46), compared with Q1). In addition, categorical AHI (P = .01, OR, and 95% confidence interval for ≥ 15 to < 30: 1.54 (0.64-3.71), ≥ 30: 3.08 (1.36-6.94) compared with < 15), quartiles of AHI (P = .01), quartiles of lowest arterial oxyhemoglobin saturation (P < .01), quartiles of percentage of time spent with arterial oxyhemoglobin saturation < 90 (P < .01), and quartiles of mean arterial oxyhemoglobin saturation were independently associated with DKD. CONCLUSIONS Obstructive sleep apnea, especially during REM sleep, is a potential risk factor for DKD.
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Affiliation(s)
- Akihiro Nishimura
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Takatoshi Kasai
- Sleep Center, Toranomon Hospital, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kimio Matsumura
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Shota Kikuno
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Kaoru Nagasawa
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Minoru Okubo
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Yasumichi Mori
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW The aim of this article is to summarize up-to-date research on the effects of obstructive sleep apnea (OSA) on retinal vascular conditions. RECENT FINDINGS OSA is associated with the development of diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy. The severity of OSA and biomarkers such as the apnea-hypopnea index (AHI) correlate with the severity of retinal disease. Dysregulation of circadian locomotor output cycles kaput (CLOCK) genes that govern circadian rhythm is associated with development of proliferative retinal disease. SUMMARY OSA and retinal vascular disease have a high cost burden on the healthcare system. OSA creates systemic changes and hypoxic conditions that may incite or exacerbate retinal vascular diseases. Retinal changes may be the first clinical manifestation of otherwise undiagnosed OSA, so it is important to refer patients with new-onset retinal vascular disease for appropriate sleep testing.
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Affiliation(s)
| | - Kapil G Kapoor
- Eastern Virginia Medical School, Norfolk
- Wagner and Kapoor Research Institute, Virginia Beach, Virginia, USA
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Shen H, Wang W. Effect of glutathione liposomes on diabetic nephropathy based on oxidative stress and polyol pathway mechanism. J Liposome Res 2020; 31:317-325. [PMID: 32567425 DOI: 10.1080/08982104.2020.1780607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A novel antioxidant glutathione liposomes (GSH-LIP) were prepared and applied for diabetic nephropathy therapy. GSH-LIP not only improve the bioavailability and antioxidant capacity of glutathione to scavenge redundant ROS inducing by oxidative stress, but also effectively inhibit the activity of AR and sorbitol accumulation in polyol pathway. The imaging in vivo showed that GSH-LIP could target kidney and significantly improve renal pathology. GSH-LIP may become a new AR inhibitor and antioxidant, which provides a new theoretical basis for the study of drugs for therapy diabetic nephropathy.
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Affiliation(s)
- Huajuan Shen
- Department of Nephrology, ZheJiang Provincial People's Hospital (People's Hospital Of HangZhou Medical College), Hangzhou, Zhejiang, China
| | - Wei Wang
- Clinical Laboratory, Zhejiang Province Tongde Hospital, Hangzhou, Zhejiang, China
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Du C, He C, Dong L, Zheng S, Wang W, Zheng C, Wang S, Lin M, Yang S, Li X, Li Z, Liu C. Associations of apnea hypopnea index and educational attainments with microvascular complications in patients with T2DM. Endocrine 2020; 67:363-373. [PMID: 31927752 DOI: 10.1007/s12020-020-02192-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/05/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The relationship between obstructive sleep apnea (OSA) and diabetic microvascular complications (DMC) are controversial. Whether low education is associated with increased risk of DMC independently of poor lifestyles are currently unknown. The aim of this study is to explore the independent associations of different PSG index and educational attainment with risks of DR, DKD, and DPN. METHODS A cross-sectional study of 330 patients with T2DM who underwent overnight polysomnography (PSG) tests. Multivariable logistic regression analysis was performed to determine the associations of PSG index and educational attainments with DR, DKD, and DPN. RESULTS The prevalence rates of DMC were 30.6% for DR, 24.9% for DKD, and 64.6% for DPN. All PSG index (AHI, REM-AHI, NREM-AHI, the severity of OSAS, ODI, MAI, and lowest SaO2) were not significantly associated with risks of DR, DKD, or DPN with adjustment for potential confounding factors. Subjects with increasing educational attainments showed significantly decreased prevalence rates of DR (42.6, 27.3, and 21.3%, p = 0.005), DKD (31.7, 25.3, and 14.7%, p = 0.035) and DPN (74.3, 63.6, and 53.3%, p = 0.015), respectively. Logistic regression analyses showed that educational attainment of primary or below showed significantly increased risks of DR (OR (95% CIs): 3.596 (1.453-8.899, p = 0.006)) and DKD (OR (95% CIs): 3.201 (1.244-8.242, p = 0.016)) as compared with that of college or above. There were significant trends of lower educational attainment with increased risks of DR and DKD (p values < 0.05). CONCLUSION PSG index were not significantly associated with DMC. But lower education was significantly associated with increased risks of DR and DKD, and strategies to prevent DMC for those with low education should be strengthened.
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Affiliation(s)
- Chunmin Du
- School of Medicine, Xiamen University, Xiamen, China
| | - Chunmei He
- Xiamen Diabetes Institute, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Lianqin Dong
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Silan Zheng
- School of Medicine, Xiamen University, Xiamen, China
| | - Wengui Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Caiyu Zheng
- School of Medicine, Xiamen University, Xiamen, China
| | - Shunhua Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - MingZhu Lin
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Shuyu Yang
- Xiamen Diabetes Institute, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Xuejun Li
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Zhibin Li
- Epidemiology Research Unit, The First Affiliated Hospital, Xiamen University, Xiamen, China.
| | - Changqin Liu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China.
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