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Ogbu I, Menon T, Chahil V, Kahlon A, Devanand D, Kalra DK. Sleep Disordered Breathing and Neurocognitive Disorders. J Clin Med 2024; 13:5001. [PMID: 39274214 PMCID: PMC11396397 DOI: 10.3390/jcm13175001] [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: 07/31/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 09/16/2024] Open
Abstract
Sleep-disordered breathing (SDB), which includes conditions such as obstructive sleep apnea (OSA) and central sleep apnea (CSA), is an independent risk factor for cerebral small vessel disease (CSVD), stroke, heart failure, arrhythmias, and other cardiovascular disorders. The influence of OSA on brain structure and cognitive function has become an essential focus in the heart-brain axis, given its potential role in developing neurocognitive abnormalities. In this review, we found that OSA plays a significant role in the cardio-neural pathway that leads to the development of cerebral small vessel disease and neurocognitive decline. Although data is still limited on this topic, understanding the critical role of OSA in the heart-brain axis could lead to the utilization of imaging modalities to simultaneously identify early signs of pathology in both organ systems based on the known OSA-driven pathological pathways that result in a disease state in both the cardiovascular and cerebrovascular systems. This narrative review aims to summarize the current link between OSA and neurocognitive disorders, cardio-neural pathophysiology, and the treatment options available for patients with OSA-related neurocognitive disorders.
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Affiliation(s)
- Ikechukwu Ogbu
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | - Tushar Menon
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | - Vipanpreet Chahil
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | - Amrit Kahlon
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | | | - Dinesh K Kalra
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
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Zhou P, Li L, Lin Z, Ming X, Feng Y, Hu Y, Chen X. Exploring the Shared Genetic Architecture Between Obstructive Sleep Apnea and Body Mass Index. Nat Sci Sleep 2024; 16:711-723. [PMID: 38863482 PMCID: PMC11166156 DOI: 10.2147/nss.s459136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/25/2024] [Indexed: 06/13/2024] Open
Abstract
Purpose The reciprocal comorbidity of obstructive sleep apnea (OSA) and body mass index (BMI) has been observed, yet the shared genetic architecture between them remains unclear. This study aimed to explore the genetic overlaps between them. Methods Summary statistics were acquired from the genome-wide association studies (GWASs) on OSA (Ncase = 41,704; Ncontrol = 335,573) and BMI (Noverall = 461,460). A comprehensive genome-wide cross-trait analysis was performed to quantify global and local genetic correlation, infer the bidirectional causal relationships, detect independent pleiotropic loci, and investigate potential comorbid genes. Results A positive significant global genetic correlation between OSA and BMI was observed (r g = 0.52, P = 2.85e-122), which was supported by three local signal. The Mendelian randomization analysis confirmed bidirectional causal associations. In the meta-analysis of cross-traits GWAS, a total of 151 single-nucleotide polymorphisms were found to be pleiotropic between OSA and BMI. Additionally, we discovered that the genetic association between OSA and BMI is concentrated in 12 brain regions. Finally, a total 134 expression-tissue pairs were observed to have a significant impact on both OSA and BMI within the specified brain regions. Conclusion Our comprehensive genome-wide cross-trait analysis indicates a shared genetic architecture between OSA and BMI, offering new perspectives on the possible mechanisms involved.
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Affiliation(s)
- Peng Zhou
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Ling Li
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Zehua Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Xiaoping Ming
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Yiwei Feng
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Yifan Hu
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Xiong Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
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Makhdom EA, Maher A, Ottridge R, Nicholls M, Ali A, Cooper BG, Ajjan RA, Bellary S, Hanif W, Hanna F, Hughes D, Jayagopal V, Mahto R, Patel M, Young J, Nayak AU, Chen MZ, Kyaw-Tun J, Gonzalez S, Gouni R, Subramanian A, Adderley N, Patel S, Tahrani AA. The impact of obstructive sleep apnea treatment on microvascular complications in patients with type 2 diabetes: a feasibility randomized controlled trial. J Clin Sleep Med 2024; 20:947-957. [PMID: 38318821 PMCID: PMC11145053 DOI: 10.5664/jcsm.11020] [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: 07/06/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is associated with an increased risk of diabetes-related complications. Hence, it is plausible that continuous positive airway pressure (CPAP) could have a favorable impact on these complications. We assessed the feasibility of conducting a randomized control trial in patients with type 2 diabetes and OSA over 2 years. METHODS We conducted an open-label multicenter feasibility randomized control trial of CPAP vs no CPAP in patients with type 2 diabetes and OSA. Patients with resting oxygen saturation < 90%, central apnea index > 15 events/h, or Epworth Sleepiness Scale ≥ 11 were excluded. OSA was diagnosed using a multichannel portable device (ApneaLink Air, ResMed). The primary outcome measures were related to feasibility and the secondary outcomes were changes in various clinical and biochemical parameters related to diabetes outcomes. RESULTS Eighty-three (40 CPAP vs 43 no CPAP) patients were randomly assigned, with a median (interquartile range) follow-up of 645 (545, 861) days. CPAP compliance was inadequate, with a median usage of approximately 3.5 hours/night. Early CPAP use predicted longer-term compliance. The adjusted analysis showed a possible favorable association between being randomly assigned to CPAP and several diabetes-related end points (chronic kidney disease, neuropathy, and quality of life). CONCLUSIONS It was feasible to recruit, randomly assign, and achieve a high follow-up rate over 2 years in patients with OSA and type 2 diabetes. CPAP compliance might improve by a run-in period before randomization. A full randomized control trial is necessary to assess the observed favorable association between CPAP and chronic kidney disease , neuropathy, and quality of life in patients with type 2 diabetes. CLINICAL TRIAL REGISTRATION Registry: ISRCTN; Name: The impact of sleep disorders in patients with type 2 diabetes; URL: https://www.isrctn.com/ISRCTN12361838; Identifier: ISRCTN12361838. CITATION Makhdom EA, Maher A, Ottridge R, et al. The impact of obstructive sleep apnea treatment on microvascular complications in patients with type 2 diabetes: a feasibility randomized controlled trial. J Clin Sleep Med. 2024;20(6):947-957.
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Affiliation(s)
- Esraa A. Makhdom
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Department of Respiratory Care, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Alisha Maher
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Ryan Ottridge
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Mathew Nicholls
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Asad Ali
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Brendan G. Cooper
- University Hospitals of Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ramzi A. Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Srikanth Bellary
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- University Hospitals of Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Aston University, Birmingham, United Kingdom
| | - Wasim Hanif
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Fahmy Hanna
- University Hospitals of North Midlands NHS Trust, Stoke on Trent, United Kingdom
| | - David Hughes
- University Hospitals of Derby & Burton NHS Trust, Derby, United Kingdom
| | | | - Rajni Mahto
- South Warwickshire NHS Foundation Trust, South Warwickshire, United Kingdom
| | - Mayank Patel
- University Hospital Southampton NHS FT, Southampton, United Kingdom
| | - James Young
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Ananth U. Nayak
- University Hospitals of North Midlands NHS Trust, Stoke on Trent, United Kingdom
| | - Mimi Z. Chen
- St. George’s University Hospitals NHS FT, London, United Kingdom
| | - Julie Kyaw-Tun
- Calderdale and Huddersfield NHS FT, Huddersfield, United Kingdom
| | - Susana Gonzalez
- Bradford Teaching Hospitals NHS FT, Bradford, United Kingdom
| | - Ravikanth Gouni
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Nicola Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Abd A. Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- University Hospitals of Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Zunica ERM, Heintz EC, Dantas WS, Hebert RC, Tanksley M, Beyl RA, Mader EC, Kirwan JP, Axelrod CL, Singh P. Effects of metformin on glucose metabolism and mitochondrial function in patients with obstructive sleep apnea: A pilot randomized trial. Physiol Rep 2024; 12:e15948. [PMID: 38346816 PMCID: PMC10861357 DOI: 10.14814/phy2.15948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
Obstructive sleep apnea (OSA) is associated with increased risk for diabetes, and standard treatment with positive airway pressure (PAP) device shows inconsistent effects on glucose metabolism. Metformin is known to treat and prevent diabetes, but its effects on skeletal muscle mitochondrial function are not completely understood. Here, we evaluate the effects of metformin on glucose metabolism and skeletal muscle mitochondrial function in patients with OSA. Sixteen adults with obesity (50.9 ± 6.7 years, BMI: 36.5 ± 2.9 kg/m2 ) and moderate-to-severe OSA were provided with PAP treatment and randomized to 3 months of placebo (n = 8) or metformin (n = 8) treatment in a double-blind parallel-group design. Whole body glucose metabolism was determined by oral glucose tolerance test. A skeletal muscle biopsy was obtained to evaluate mitochondrial respiratory capacity and expression of proteins related to mitochondrial dynamics and energy metabolism. Whole body insulin-sensitivity (Matsuda index) did not change in metformin or placebo treated groups. However, metformin treatment prevented increases in insulin release relative to placebo during follow-up. Insulin area under the curve (AUC) and insulin to glucose AUC ratio increased in placebo but remained unchanged with metformin. Furthermore, metformin treatment improved skeletal muscle mitochondrial respiratory capacity and dynamics relative to placebo. Metformin treatment prevented the decline in whole body glucose homeostasis and skeletal muscle mitochondrial function in patients with moderate to severe OSA. Patients with OSA may benefit from the addition of metformin to prevent diabetes.
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Affiliation(s)
- Elizabeth R. M. Zunica
- Integrated Physiology and Molecular Medicine LaboratoryPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Elizabeth C. Heintz
- Integrated Physiology and Molecular Medicine LaboratoryPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Wagner S. Dantas
- Integrated Physiology and Molecular Medicine LaboratoryPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - R. Caitlin Hebert
- Translational Physiology LaboratoryPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - MaKayla Tanksley
- Sleep and Cardiometabolic Health LaboratoryPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Robbie A. Beyl
- Integrated Physiology and Molecular Medicine LaboratoryPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Edward C. Mader
- Louisiana State University Health Science CenterNew OrleansLouisianaUSA
| | - John P. Kirwan
- Integrated Physiology and Molecular Medicine LaboratoryPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Christopher L. Axelrod
- Integrated Physiology and Molecular Medicine LaboratoryPennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Prachi Singh
- Sleep and Cardiometabolic Health LaboratoryPennington Biomedical Research CenterBaton RougeLouisianaUSA
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Wester M, Arzt M, Sinha F, Maier LS, Lebek S. Insights into the Interaction of Heart Failure with Preserved Ejection Fraction and Sleep-Disordered Breathing. Biomedicines 2023; 11:3038. [PMID: 38002038 PMCID: PMC10669157 DOI: 10.3390/biomedicines11113038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is emerging as a widespread disease with global socioeconomic impact. Patients with HFpEF show a dramatically increased morbidity and mortality, and, unfortunately, specific treatment options are limited. This is due to the various etiologies that promote HFpEF development. Indeed, cluster analyses with common HFpEF comorbidities revealed the existence of several HFpEF phenotypes. One especially frequent, yet underappreciated, comorbidity is sleep-disordered breathing (SDB), which is closely intertwined with the development and progression of the "obese HFpEF phenotype". The following review article aims to provide an overview of the common HFpEF etiologies and phenotypes, especially in the context of SDB. As general HFpEF therapies are often not successful, patient- and phenotype-individualized therapeutic strategies are warranted. Therefore, for the "obese HFpEF phenotype", a better understanding of the mechanistic parallels between both HFpEF and SDB is required, which may help to identify potential phenotype-individualized therapeutic strategies. Novel technologies like single-cell transcriptomics or CRISPR-Cas9 gene editing further broaden the groundwork for deeper insights into pathomechanisms and precision medicine.
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Affiliation(s)
- Michael Wester
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany; (M.A.); (L.S.M.)
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany; (M.A.); (L.S.M.)
| | - Frederick Sinha
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany; (M.A.); (L.S.M.)
| | - Lars Siegfried Maier
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany; (M.A.); (L.S.M.)
| | - Simon Lebek
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany; (M.A.); (L.S.M.)
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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He S, Cistulli PA, de Chazal P. A Review of Novel Oximetry Parameters for the Prediction of Cardiovascular Disease in Obstructive Sleep Apnoea. Diagnostics (Basel) 2023; 13:3323. [PMID: 37958218 PMCID: PMC10649141 DOI: 10.3390/diagnostics13213323] [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: 08/30/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is a sleep disorder with repetitive collapse of the upper airway during sleep, which leads to intermittent hypoxic events overnight, adverse neurocognitive, metabolic complications, and ultimately an increased risk of cardiovascular disease (CVD). The standard diagnostic parameter for OSA, apnoea-hypopnoea index (AHI), is inadequate to predict CVD morbidity and mortality, because it focuses only on the frequency of apnoea and hypopnoea events, and fails to reveal other physiological information for the prediction of CVD events. Novel parameters have been introduced to compensate for the deficiencies of AHI. However, the calculation methods and criteria for these parameters are unclear, hindering their use in cross-study analysis and studies. This review aims to discuss novel parameters for predicting CVD events from oximetry signals and to summarise the corresponding computational methods.
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Affiliation(s)
- Siying He
- Charles Perkins Centre, Faculty of Engineering, Sydney University, Camperdown, NSW 2050, Australia;
| | - Peter A. Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, Sydney University, Camperdown, NSW 2050, Australia;
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Philip de Chazal
- Charles Perkins Centre, Faculty of Engineering, Sydney University, Camperdown, NSW 2050, Australia;
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Yu Q, Hu X, Zheng T, Liu L, Kuang G, Liu H, Wang X, Li J, Huang J, Wang T, Lin Z, Xiong N. Obstructive sleep apnea in Parkinson's disease: A prevalent, clinically relevant and treatable feature. Parkinsonism Relat Disord 2023; 115:105790. [PMID: 37541789 DOI: 10.1016/j.parkreldis.2023.105790] [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: 04/27/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Abstract
Parkinson's disease (PD) is a chronic neurodegenerative disease characterized by motor and non-motor symptoms, including obstructive sleep apnea (OSA), a common comorbid sleep disorder. The prevalence of OSA in PD is high, and its impact on quality of life, accident risk, and limited treatment options underscores the need for vigilant monitoring and effective interventions. OSA is observed in 20-70% of PD patients, whereas the general population exhibits a lower prevalence ranging from 2 to 14%. These discrepancies in prevalence may be attributed to differences in demographic characteristics, sample sizes with selection bias, and variations in scoring systems for apnea and hypopnea events used across different studies. This review highlights the potential pathogenesis of comorbid OSA in PD and provides an overview of ongoing clinical trials investigating interventions for this condition. Several mechanisms have been implicated in the development of OSA in PD, including intermittent hypoxemia, sleep fragmentation, alterations in the glymphatic system homeostasis, upper airway obstruction, and inflammation. Given the adverse effects of PD comorbid OSA, early intervention measures are crucial. It is imperative to conduct longitudinal studies and clinical trials to elucidate the pathogenesis and develop novel and effective interventions for OSA in PD patients. These efforts aim to delay the progression of PD, enhance patients' quality of life, and alleviate the burden on society and families.
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Affiliation(s)
- Qinwei Yu
- Department of Cardiology, Wuhan Red Cross Hospital, 392 Hongkong Road, Wuhan, Hubei China; Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xinyu Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Tao Zheng
- Department of Neurology, Wuhan Red Cross Hospital, 392 Hongkong Road, Wuhan, Hubei China
| | - Li Liu
- Department of Clinical Laboratory, People's Hospital of Maojian District, Shiyan City, Hubei China
| | - Guiying Kuang
- Department of Neurology, Wuhan Red Cross Hospital, 392 Hongkong Road, Wuhan, Hubei China
| | - Hanshu Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xinyi Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jingwen Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jinsha Huang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Tao Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhicheng Lin
- Laboratory of Psychiatric Neurogenomics, McLean Hospital; Harvard Medical School, Belmont, MA, 02478, USA
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Chen A, Ju C, Mackenzie IS, MacDonald TM, Struthers AD, Wei L, Man KK. Impact of beta-blockers on mortality and cardiovascular disease outcomes in patients with obstructive sleep apnoea: a population-based cohort study in target trial emulation framework. THE LANCET REGIONAL HEALTH. EUROPE 2023; 33:100715. [PMID: 37601338 PMCID: PMC10432194 DOI: 10.1016/j.lanepe.2023.100715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023]
Abstract
Background There is no real-world evidence regarding the association between beta-blocker use and mortality or cardiovascular outcomes in patients with obstructive sleep apnoea (OSA). We aimed to investigate the impact of beta-blocker use on all-cause mortality and cardiovascular diseases (CVDs) in patients with OSA. Methods We conducted a target trial emulation study of 37,581 patients with newly diagnosed OSA from 1st January 2000 to 30th November 2021 using the IMRD-UK database (formerly known as the THIN database). We compared the treatment strategies of initiating beta-blocker treatment within one year versus non-beta-blocker treatment through the method of clone-censor-weight. Covariates, including patients' demographics, lifestyle, comorbidities, and recent medications, were measured and controlled. Patients were followed up for all-cause mortality or composite CVD outcomes (angina, myocardial infarction, stroke/transient ischaemic attack, heart failure, or atrial fibrillation). We estimated the five-year absolute risks, risk differences and risk ratio with 95% confidence intervals (CIs) with standardised, weighted pooled logistic regression, which is a discrete-time hazard model for survival analysis. Several sensitivity analyses were performed, including multiple imputation addressing the missing data. Findings The median follow-up time was 4.1 (interquartile range, 1.9-7.8) years. The five-year absolute risk of all-cause mortality and CVD outcomes were 4.9% (95% CI, 3.8-6.0) and 13.0% (95% CI, 11.4-15.0) among beta-blocker users, and 4.0% (95% CI, 3.8-4.2) and 9.4% (95% CI, 9.1-9.7) among non-beta-blocker users, respectively. The five-year absolute risk difference and risk ratio between the two groups for all-cause mortality and CVD outcomes were 0.9% (95% CI, -0.2 to 2.1) and 1.22 (95% CI, 0.96-1.54), and 3.5% (95% CI, 2.1-5.5) and 1.37 (95% CI, 1.22-1.62), respectively. Findings were consistent across the sensitivity analyses. Interpretation Beta-blocker treatment was associated with an increased risk of CVD and a trend for an increased risk of mortality among patients with OSA. Further studies are needed to confirm our findings. Funding Innovation and Technology Commission of the Hong Kong Special Administration Region Government.
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Affiliation(s)
- Anthony Chen
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, England
- Faculty of Medicine & Health Sciences, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, England
| | - Chengsheng Ju
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, England
| | - Isla S. Mackenzie
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland
| | - Thomas M. MacDonald
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland
| | - Allan D. Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, England
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, China
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, England
| | - Kenneth K.C. Man
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, WC1H 9JP, England
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, China
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, England
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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9
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Herth J, Sievi NA, Schmidt F, Kohler M. Effects of continuous positive airway pressure therapy on glucose metabolism in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis. Eur Respir Rev 2023; 32:230083. [PMID: 37673425 PMCID: PMC10481331 DOI: 10.1183/16000617.0083-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/27/2023] [Indexed: 09/08/2023] Open
Abstract
Obstructive sleep apnoea is a highly prevalent chronic disorder and has been shown to be associated with disturbed glucose metabolism and type 2 diabetes. However, the evidence from individual clinical trials on the effect of continuous positive airway pressure (CPAP) treatment on glycaemic control in patients with co-existing obstructive sleep apnoea and type 2 diabetes remains controversial. A systematic review of randomised controlled trials assessing the effect of CPAP on glycaemic control in patients with obstructive sleep apnoea and type 2 diabetes was conducted using the databases MEDLINE, Embase, Cochrane and Scopus up to December 2022. Meta-analysis using a random-effect model was performed for outcomes that were reported in at least two randomised controlled trials. From 3031 records screened, 11 RCTs with a total of 964 patients were included for analysis. CPAP treatment led to a significant reduction in haemoglobin A1c (HbA1c) (mean difference -0.24%, 95% CI -0.43- -0.06%, p=0.001) compared to inactive control groups. Meta-regression showed a significant association between reduction in HbA1c and hours of nightly CPAP usage. CPAP therapy seems to significantly improve HbA1c and thus long-term glycaemic control in patients with type 2 diabetes and obstructive sleep apnoea. The amount of improvement is dependent on the hours of usage of CPAP and thus optimal adherence to CPAP should be a primary goal in these patients.
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Affiliation(s)
- Jonas Herth
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Felix Schmidt
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Hermanns N, Ehrmann D, Shapira A, Kulzer B, Schmitt A, Laffel L. Coordination of glucose monitoring, self-care behaviour and mental health: achieving precision monitoring in diabetes. Diabetologia 2022; 65:1883-1894. [PMID: 35380233 PMCID: PMC9522821 DOI: 10.1007/s00125-022-05685-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
Monitoring of glucose plays an essential role in the management of diabetes. However, to fully understand and meaningfully interpret glucose levels, additional information on context is necessary. Important contextual factors include data on behaviours such as eating, exercise, medication-taking and sleep, as well as data on mental health aspects such as stress, affect, diabetes distress and depressive symptoms. This narrative review provides an overview of the current state and future directions of precision monitoring in diabetes. Precision monitoring of glucose has made great progress over the last 5 years with the emergence of continuous glucose monitoring (CGM), automated analysis of new glucose variables and visualisation of CGM data via the ambulatory glucose profile. Interestingly, there has been little progress in the identification of subgroups of people with diabetes based on their glycaemic profile. The integration of behavioural and mental health data could enrich such identification of subgroups to stimulate precision medicine. There are a handful of studies that have used innovative methodology such as ecological momentary assessment to monitor behaviour and mental health in people's everyday life. These studies indicate the importance of the interplay between behaviour, mental health and glucose. However, automated integration and intelligent interpretation of these data sources are currently not available. Automated integration of behaviour, mental health and glucose could lead to the identification of certain subgroups that, for example, show a strong association between mental health and glucose in contrast to subgroups that show independence of mental health and glucose. This could inform precision diagnostics and precision therapeutics. We identified just-in-time adaptive interventions as a potential means by which precision monitoring could lead to precision therapeutics. Just-in-time adaptive interventions consist of micro-interventions that are triggered in people's everyday lives when a certain problem is identified using monitored behaviour, mental health and glucose variables. Thus, these micro-interventions are responsive to real-life circumstances and are adaptive to the specific needs of an individual with diabetes. We conclude that, with current developments in big data analysis, there is a huge potential for precision monitoring in diabetes.
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Affiliation(s)
- Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany.
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Amit Shapira
- Harvard Medical School, Joslin Diabetes Center, Boston, MA, USA
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Lori Laffel
- Harvard Medical School, Joslin Diabetes Center, Boston, MA, USA
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
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Tan JWC, Leow LC, Wong S, Khoo SM, Kasai T, Kojodjojo P, Sy DQ, Lee CP, Chirakalwasan N, Li HY, Koh N, Tan A, Ong TH, Aung AT, Toh ST, Lee CH. Asian Pacific Society of Cardiology Consensus Statements on the Diagnosis and Management of Obstructive Sleep Apnoea in Patients with Cardiovascular Disease. Eur Cardiol 2022; 17:e16. [PMID: 35795612 PMCID: PMC9247989 DOI: 10.15420/ecr.2021.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is strongly associated with cardiovascular disease (CVD). However, evidence supporting this association in the Asian population is scarce. Given the differences in the epidemiology of CVD and cardiovascular risk factors, as well as differences in the availability of healthcare resources between Asian and Western countries, an Asian Pacific Society of Cardiology (APSC) working group developed consensus recommendations on the management of OSA in patients with CVD in the Asia-Pacific region. The APSC expert panel reviewed and appraised the available evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed and put to an online vote. Consensus was reached when 80% of votes for a given recommendation were in support of ‘agree’ or ‘neutral.’ The resulting statements provide guidance on the assessment and treatment of OSA in patients with CVD in the Asia-Pacific region. The APSC hopes for these recommendations to pave the way for screening, early diagnosis and treatment of OSA in the Asia-Pacific region.
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Affiliation(s)
- Jack Wei Chieh Tan
- Department of Cardiology National Heart Centre Singapore, Singapore; Department of Cardiology, Sengkang General Hospital, Singapore
| | - Leong Chai Leow
- Department of Respiratory and Critical Care Medicine; Singapore General Hospital, Singapore
| | - Serene Wong
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Fast and Chronic Programmes, Alexandra Hospital, Singapore
| | - See Meng Khoo
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Fast and Chronic Programmes, Alexandra Hospital, Singapore
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Duong-Quy Sy
- Clinical Research Center, Lam Dong Medical College, Dalat, Vietnam; Pham Ngoc Thach Medical University, Ho Chi Minh City, Vietnam
| | - Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Hsueh-Yu Li
- Department of Otolaryngology – Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Natalie Koh
- Department of Cardiology National Heart Centre Singapore, Singapore
| | - Adeline Tan
- Division of Respiratory Medicine, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Thun How Ong
- Department of Respiratory and Critical Care Medicine; Singapore General Hospital, Singapore
| | - Aye Thandar Aung
- Department of Cardiovascular Medicine, Mandalay General Hospital, Mandalay, Myanmar
| | - Song Tar Toh
- Department of Otorhinolaryngology – Head and Neck Surgery, Singapore General Hospital, Singapore; Singhealth Duke-NUS Sleep Centre, Singapore
| | - Chi-Hang Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
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Xie T, Guo D, Luo J, Guo Z, Zhang S, Wang A, Wang X, Wang X, Cao W, Su L, Guo J, Huang R, Xiao Y. The Relationship Between HIF1α and Clock Gene Expression in Patients with Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:381-392. [PMID: 35299629 PMCID: PMC8922359 DOI: 10.2147/nss.s348580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/27/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose In this study, we aimed to investigate the precise relationship between hypoxia-inducible factor 1α (HIF1α), circadian clock genes, and OSA. Methods We recruited 21 patients with OSA and 22 age-matched controls who underwent polysomnography and had their peripheral blood collected on the evening before and the morning after sleep. OSA was defined as an apnea hypopnea index (AHI) ≥15 events/h. Patients in which T90 > 0 were defined as having nocturnal hypoxemia (NH) and were referred to as the NH group. The mRNA levels of HIF1α, HIF1β and several clock genes (Timeless, Clock, Bmal1, Per1, Per2, Per3, Cry1, Cry2, Ck1δ, Rorα, NR1D1, and NPAS2) were determined by RT-qPCR. The percentage difference in gene expression levels when compared between the morning and evening was then determined as referred to as morning-evening variation (MEV). Results The MEV for HIF1α mRNA expression in OSA patients increased significantly by 23% (P = 0.008) when compared to patients without OSA. The gene expression levels of Timeless (P = 0.038) and Cry2 (P = 0.012) decreased with AHI. The MEV of Bmal1, Rorα, and HIF1α mRNA levels were upregulated by 16% (P = 0.006), 14% (P = 0.027), and 25% (P = 0.005), respectively, in participants with NH when compared to those without NH. Furthermore, the MEV for HIF1α mRNA levels was positively correlated with the MEV of Bmal1, Cry1, and CK1δ mRNA levels (R = 0.638, P < 0.001; R = 0.327, P = 0.002; R = 0.332, P = 0.001, respectively) and negatively correlated with LSpO2 (R = -0.464, P =0.009) and Mean SpO2 (R = -0.500, P = 0.003). Conclusion Our data suggest that patients with OSA or NH tend to develop circadian rhythm disorders that may be induced by the hypoxia-mediated augmentation of HIF1α gene expression in OSA.
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Affiliation(s)
- Ting Xie
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Dan Guo
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jinmei Luo
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zijian Guo
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Sumei Zhang
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Anqi Wang
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiaoxi Wang
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiaona Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Wenhao Cao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Linfan Su
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Junwei Guo
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Rong Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yi Xiao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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Bertrand M, Bastien C, Boutin I, Vallières A. A psychological view on the effectiveness of psychosocial interventions on positive airway pressure treatment adherence and sleep quality in patients with obstructive sleep apnea. Sleep Med 2022; 91:62-74. [DOI: 10.1016/j.sleep.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
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Agrawal R, Spiegelman AM, Bandi VD, Hirshkowitz M, Sharafkhaneh A. Obstructive sleep apnea in diabetic patients is associated with higher healthcare utilization. Sleep Breath 2022; 26:1817-1820. [DOI: 10.1007/s11325-021-02552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
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Fonseca MAD, Moreira AKS, Lima RBDS, Oliveira MDA, Santos-de-Araújo AD, Rêgo AS, Penha LRLN, Ferreira PR, Gonçalves MC, Bassi-Dibai D. Relationship between obstructive sleep apnea syndrome and functional capacity in patients with diabetes mellitus type 2: an observational transversal study. ACTA ACUST UNITED AC 2021; 67:878-881. [PMID: 34709334 DOI: 10.1590/1806-9282.20210232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/02/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to verify the association among obstructive sleep apnea, functional capacity, and metabolic control. METHODS This was a cross-sectional study involving individuals of both sexes with clinical diagnosis of diabetes mellitus type 2 who were above 18 years of age. The assessment consisted of a volunteer identification form, a 2-minute step test, and the Stop-Bang questionnaire. In order to assess metabolic control, HbA1c and fasting glucose data were collected from medical records. RESULTS A total of 100 individuals with diabetes mellitus type 2, of whom 61% were women, were included in this study. According to the Stop-Bang instrument, 26, 57, and 17% of patients had low, intermediate, and high risk of developing OSA, respectively. There was no association between the 2-minute step test and metabolic variables and diabetes mellitus type 2 chronicity with Stop-Bang. CONCLUSIONS We concluded that there is no association among obstructive sleep apnea measured by means of Stop-Bang instrument, functional capacity measured by means of 2-minute step test, and metabolic variables in individuals with diabetes mellitus type 2.
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Affiliation(s)
| | | | | | | | - Aldair Darlan Santos-de-Araújo
- Universidade de São Carlos, Postgraduate Program in Physical Therapy, Department of Physical Therapy - São Carlos (SP), Brazil
| | - Adriana Sousa Rêgo
- Universidade CEUMA, Department of Physical Therapy - São Luís (MA), Brazil
| | | | | | | | - Daniela Bassi-Dibai
- Universidade CEUMA, Postgraduate Program in Management and Health Services - São Luís (MA), Brazil
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Allahwala UK, Cistulli P, Ciofani JL, Dissanayake HU, Ward M, Weaver JC, Bhindi R. Influence of Obstructive Sleep Apnoea on Outcomes in Patients With ST Elevation Myocardial Infarction (STEMI): the Role of the Coronary Collateral Circulation. Heart Lung Circ 2021; 30:1883-1890. [PMID: 34366217 DOI: 10.1016/j.hlc.2021.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/07/2021] [Accepted: 07/06/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) occurs frequently in patients with coronary artery disease, with associated intermittent hypoxia a possible stimulus for coronary collateral recruitment through ischaemic preconditioning. We sought to determine whether OSA affects recruitment of coronary collaterals and prognosis of patients presenting with ST elevation myocardial infarction (STEMI). METHODS Patients with a STEMI undergoing percutaneous coronary intervention (PCI) from July 2010 to December 2019 were reviewed. Electronic medical records were accessed to determine documented patient history of OSA. Patients with robust collaterals were defined as Rentrop grade 2 or 3. RESULTS 1,863 patients were included, of which 143 (7.7%) patients had documented evidence of OSA in their health record. Patients with OSA had a higher body mass index (BMI) (30.2 kg/m2 vs 27 kg/m2, p<0.0001), greater rate of hypertension (61.1% vs 45.1%, p<0.0001), hypercholesterolaemia (47.4% vs 38.4%, p<0.05) and diabetes mellitus (22.6% vs 15.9%, p<0.05). Patients with OSA were more likely to have robust coronary collaterals (OR: 2.2 [95% CI: 1.5-3.2]) and a lower rate of left ventricular (LV) impairment (50.7% vs 63.1%, p<0.01), a higher LV ejection fraction (50.3% vs 46.7%, p<0.0001) and a lower peak troponin-I level (26,452 ng/L vs 39,469 ng/L, p<0.01). There were no differences in rates of in-hospital or longer term mortality, in patients with OSA compared to those without. CONCLUSIONS Patients with documented OSA presenting with STEMI appear to have more robust coronary collaterals observed on angiography which likely mediates lower myocardial necrosis. Broader implications of this finding on treatment require further investigation.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| | - Peter Cistulli
- Centre for Sleep Health and Research, Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia; Sleep Research Group, Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Jonathan L Ciofani
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia. https://twitter.com/JonathanCiofani
| | - Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Michael Ward
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - James C Weaver
- The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia. https://twitter.com/Ravinay
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RSSDI clinical practice recommendations for screening, diagnosis, and treatment in type 2 diabetes mellitus with obstructive sleep apnea. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-020-00909-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Elfil M, Bahbah EI, Attia MM, Eldokmak M, Koo BB. Impact of Obstructive Sleep Apnea on Cognitive and Motor Functions in Parkinson's Disease. Mov Disord 2020; 36:570-580. [PMID: 33296545 DOI: 10.1002/mds.28412] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/29/2020] [Accepted: 11/16/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is a chronic neurodegenerative disorder that presents with motor and non-motor manifestations. Amongst the non-motor features, various forms of sleep disturbances can occur, and obstructive sleep apnea (OSA) is considered to be a common comorbidity. We conducted this systematic review and meta-analysis to assess the impact of OSA on cognitive and motor functions in PD. METHODS The information sources of for this systematic review and meta-analysis were PubMed, SCOPUS, Web of Science, and ScienceDirect. Studies meeting the following criteria were included: (1) studies including idiopathic PD patients, (2) studies using polysomnography to categorize PD patients into PD with OSA and PD without OSA, and (3) studies with observational designs (case-control, cohort, or cross-sectional). Data analysis was performed using RevMan. RESULTS Our meta-analysis showed that OSA was associated with significantly lower scores of Montreal Cognitive Assessments (MoCA) (mean difference (MD) = -0.70, 95% confidence interval (CI) [-1.28, -0.13], P = 0.01) and Mini-Mental State Examination (MMSE) (MD = -0.69, 95% CI [-1.17, -0.21], P = 0.005). Moreover, the score of the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS III) was significantly higher in PD patients with OSA as compared with those without OSA (MD = 1.63, 95% CI [0.03, 3.23], P = 0.049). CONCLUSIONS OSA is associated with increased severity of PD-associated cognitive dysfunction and motor symptoms. However, further studies are needed to corroborate these findings, assess the underlying mechanisms by which OSA influences the motor and cognitive functions in PD, and investigate whether OSA can accelerate the neurodegenerative process of PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Eshak I Bahbah
- Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | | | - Mohamed Eldokmak
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Brian B Koo
- Department of Neurology, Yale University, New Haven, Connecticut, USA.,Center for Neuroepidemiology and Clinical Neurologic Research, New Haven, Connecticut, USA.,Department of Neurology, Connecticut Veterans Affairs Healthcare System, West Haven, Connecticut, USA
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Alam MS, Dyck R, Janzen B, Karunanayake C, Dosman J, Pahwa P. Risk factors, incidence, and prevalence of diabetes among rural farm and non-farm residents of Saskatchewan, Canada; a population-based longitudinal cohort study. J Diabetes Metab Disord 2020; 19:1563-1582. [PMID: 33520853 PMCID: PMC7843656 DOI: 10.1007/s40200-020-00693-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Saskatchewan has a high prevalence of diabetes. It is the largest, rurally populated, predominantly agricultural province in Canada. This research aims to determine the risk factors associated with the incidence and longitudinal changes in the prevalence of diabetes among Saskatchewan's adult rural farm and non-farm residents. METHODS The Saskatchewan Rural Health Study (SRHS) is a prospective cohort study conducted in two phases: a baseline survey (2010, 8261 participants) and a follow-up survey (2014, 4867 participants). Generalized estimation equations and survival analysis techniques were used to determine diabetes prevalence and incidence risk factors, respectively. RESULTS Incidence of diabetes among rural residents was 2.75%. Positive family history, high BMI, sleep apnea and an abnormal Epworth Sleepiness Score (ESS) were significant predictors for diabetes incidence. A substantial increase (1.98%) of diabetes prevalence was observed after four years of follow-up. Risk factors of diabetes prevalence were increasing age, male, low income, positive family history, high BMI, hypertension and heart attack. CONCLUSION A mix of individual and contextual factors interacting in complex pathways were responsible for the high incidence and prevalence of diabetes among rural residents. The most original finding of that study was a positive association of sleep apnea, and ESS with incident diabetes warrants further research to identify a causal linkage. Increased diabetes risk among rural male insecticide users indicates an adverse consequence of unprotected chemical exposures in the agricultural field. Urgent population-based preventive measures should initiate to slow the increasing trend of diabetes prevalence among rural residents.
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Affiliation(s)
- Md Saiful Alam
- Department of Community Health and Epidemiology, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Roland Dyck
- Department of Medicine, College of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan S7N0W0 Canada
| | - Bonnie Janzen
- Department of Community Health and Epidemiology, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Chandima Karunanayake
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK S7N 2Z4 Canada
| | - James Dosman
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK S7N 2Z4 Canada
| | - Punam Pahwa
- Department of Community Health and Epidemiology, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK S7N 2Z4 Canada
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Soontornrungsun B, Khamsai S, Sawunyavisuth B, Limpawattana P, Chindaprasirt J, Senthong V, Chotmongkol V, Sawanyawisuth K. Obstructive sleep apnea in patients with diabetes less than 40 years of age. Diabetes Metab Syndr 2020; 14:1859-1863. [PMID: 32992217 DOI: 10.1016/j.dsx.2020.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/02/2020] [Accepted: 09/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Obstructive sleep apnea (OSA) is known to be associated with diabetes mellitus (DM). Age is factor associated with different clinical features of OSA. There is limited data on clinical differences of young DM patients with OSA versus older DM patients with OSA. This study aimed to find clinical differences of DM coexisting with OSA between young age group and older. METHODS This is a retrospective, analytical study conducted at Srinagarind Hospital, Thailand. The inclusion criteria were adult patients diagnosed as DM with OSA. The study period was between January 2008 and December 2019. The diagnosis of OSA was made by presence of apnea hypopnea index (AHI) of ≥5 times/hour by polysomnography. Clinical predictors of OSA in young DM patients with age under 40 years were executed. RESULTS There were 56 patients in the young diabetes mellitus group, while there were 137 patients in the older diabetes mellitus group. The mean (SD) age of diagnosis for diabetes mellitus of both groups were 31.61 (6.53) and 54.68 (7.62) years, respectively. There were three independent predictors for DM in the young: atrial fibrillation (AF), body mass index (BMI) and glomerular filtration rate (GFR). Presence of AF perfectly predicted DM with OSA in age over 40 years. The adjusted odds ratio for BMI and GFR were 1.29 (95% CI 1.05, 1.58) and 1.06 (1.01, 1.13). The BMI over 32 kg/m2 and GFR over 77 ml/min/m2 gave sensitivity of 80.00%. CONCLUSIONS Young DM patients with OSA had more severe OSA, were more obese, had better renal function, and had fewer AF than the older ones.
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Affiliation(s)
- Benjawan Soontornrungsun
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Sittichai Khamsai
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Bundit Sawunyavisuth
- Department of Marketing, Faculty of Business Administration and Accountancy, Khon Kaen University, Khon Kaen, Thailand
| | - Panita Limpawattana
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Jarin Chindaprasirt
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Vichai Senthong
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Verajit Chotmongkol
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand.
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Kuvat N, Tanriverdi H, Armutcu F. The relationship between obstructive sleep apnea syndrome and obesity: A new perspective on the pathogenesis in terms of organ crosstalk. CLINICAL RESPIRATORY JOURNAL 2020; 14:595-604. [PMID: 32112481 DOI: 10.1111/crj.13175] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 02/13/2020] [Accepted: 02/23/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a common disorder that has a major impact on public health. The connection between OSAS and obesity is very complex and likely represents an interaction between biological and lifestyle factors. Oxidative stress, inflammation and metabolic dysregulation are both actors involved in the pathogenesis of OSAS and obesity. Also, the current evidence suggests that gut microbiota plays a significant role in the emergence and progression of some metabolic disorders. When the relationship between OSAS and obesity is evaluated extensively, it is understood that they show mutual causality with each other, and that metabolic challenges such as impaired microbiota affect this bidirectional organ interaction, and by ensuing organ injury. OBJECTIVES The aim of this study is to investigate the association between OSAS and obesity, and the effect of "organ crosstalk" on the pathogenesis of the relationship and to contribute to the diagnosis and treatment options in the light of current data. DATA SOURCE We performed an electronic database search including PubMed, EMBASE and Web of Science. We used the following search terms: OSAS, obesity, inflammation, metabolic dysregulation and gut microbiota. CONCLUSION Obesity and OSAS adversely affect many organs and systems. Besides the factors affecting the diagnosis of the OSAS-obesity relationship, mutual organ interactions among the respiratory system, adipose tissue and intestines should not be ignored for prevention and treatment of OSAS and obesity. Comprehensive clinical trials addressing the efficacy and efficiency of current or potential treatments on therapeutic applications in the OSAS-obesity relationship are needed.
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Affiliation(s)
- Nuray Kuvat
- Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Hakan Tanriverdi
- Department of Chest Diseases, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Ferah Armutcu
- Department of Biochemistry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Mostafa SS, Mendonça F, G. Ravelo-García A, Morgado-Dias F. A Systematic Review of Detecting Sleep Apnea Using Deep Learning. SENSORS (BASEL, SWITZERLAND) 2019; 19:E4934. [PMID: 31726771 PMCID: PMC6891618 DOI: 10.3390/s19224934] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 02/02/2023]
Abstract
Sleep apnea is a sleep related disorder that significantly affects the population. Polysomnography, the gold standard, is expensive, inaccessible, uncomfortable and an expert technician is needed to score. Numerous researchers have proposed and implemented automatic scoring processes to address these issues, based on fewer sensors and automatic classification algorithms. Deep learning is gaining higher interest due to database availability, newly developed techniques, the possibility of producing machine created features and higher computing power that allows the algorithms to achieve better performance than the shallow classifiers. Therefore, the sleep apnea research has currently gained significant interest in deep learning. The goal of this work is to analyze the published research in the last decade, providing an answer to the research questions such as how to implement the different deep networks, what kind of pre-processing or feature extraction is needed, and the advantages and disadvantages of different kinds of networks. The employed signals, sensors, databases and implementation challenges were also considered. A systematic search was conducted on five indexing services from 2008-2018. A total of 255 papers were found and 21 were selected by considering the inclusion and exclusion criteria, using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach.
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Affiliation(s)
- Sheikh Shanawaz Mostafa
- Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal;
- Madeira Interactive Technologies Institute, 9020-105 Funchal, Portugal
| | - Fábio Mendonça
- Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal;
- Madeira Interactive Technologies Institute, 9020-105 Funchal, Portugal
| | - Antonio G. Ravelo-García
- Institute for Technological Development and Innovation in Communications, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas, Spain;
| | - Fernando Morgado-Dias
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, 9000-082 Funchal, Portugal
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Schroeder K, Gurenlian JR. Recognizing Poor Sleep Quality Factors During Oral Health Evaluations. Clin Med Res 2019; 17:20-28. [PMID: 31160475 PMCID: PMC6546276 DOI: 10.3121/cmr.2019.1465] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 11/18/2022]
Abstract
Oral health practitioners routinely perform oral health assessments for the dental patient to determine if oral disease is present. Systemic health is often a contributor to oral health concerns. One area in particular that has a direct effect on oral structures and oral health is poor sleep quality and open mouth breathing. Sleep is a fundamental process of the human body, which regulates core biological functions. Sleep quality reflects a person's ability to fall asleep, stay asleep, and enter into the various rejuvenating sleep cycles for the full duration. A person who does not obtain quality sleep can exhibit a wide range of oral, systemic, and cognitive health problems. Obstructive sleep apnea, which historically has been considered an adult male disease, is being recognized more often in women children. Research suggests various oral malformations found in newborns and young children can manifest as obstructive sleep apnea in adults. Oral health professionals are in a position to recognize the relationship between sleep and health, identify sleep quality concerns in relation to oral health assessments, administer sleep quality assessments, and determine appropriate referrals for further sleep quality evaluation.
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Affiliation(s)
- Kelly Schroeder
- Dental Hygienist-Researcher, Marshfield Clinic Research Institute, Center for Oral and Systemic Health, Marshfield, Wisconsin, USA
| | - JoAnn R Gurenlian
- Professor and Graduate Program Director, Department of Dental Hygiene, Idaho State University, Pocatello, Idaho, USA
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Chattu VK, Chattu SK, Burman D, Spence DW, Pandi-Perumal SR. The Interlinked Rising Epidemic of Insufficient Sleep and Diabetes Mellitus. Healthcare (Basel) 2019; 7:E37. [PMID: 30841553 PMCID: PMC6473416 DOI: 10.3390/healthcare7010037] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 12/15/2022] Open
Abstract
For healthy existence, humans need to spend one-third of their time sleeping. Any qualitative or quantitative disturbances in sleep would result in an increased prevalence of obesity, metabolic disorders, diabetes, cardiovascular diseases, and hypertension. The paper aims to highlight the growing global problem of insufficient sleep and its significant impact on the rising incidence of diabetes mellitus. An extensive literature search was done in all major databases for "insufficient sleep" and "Diabetes Mellitus" for this review. Shorter (<6 h) and longer (>9 h) durations of sleep have been adversely related to insulin resistance. Though the relation between insufficient sleep and diabetes mellitus is more or less understood, little is known about how oversleeping or hypersomnia (10⁻12 h) increases the risk of diabetes. The relationship between sleep disturbances and diabetes is dual-sided, as chronic sleep disturbances would elevate the risk of developing insulin resistance, while diabetes would worsen the quality of sleep. Both the qualitative and quantitative disturbances in sleep significantly increase the risk of developing diabetes, which is supported by numerous community-based and hospital-based epidemiological studies discussed in this review. Obstructive sleep apnea is one of the most common sleep disorders and is characterized by chronic intermittent hypoxia and increased sympathetic activity, thus leading to a higher prevalence of diabetes. Sleep therapy may serve as a low-cost method for fighting against the rising epidemic of diabetes.
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Affiliation(s)
- Vijay Kumar Chattu
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
- Global Institute of Public Health, Thiruvananthapuram, Kerala 695024, India.
| | - Soosanna Kumary Chattu
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Deepa Burman
- School of Medicine, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA.
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Clinical Evaluation for Oral Appliance Therapy. Sleep Med Clin 2018; 13:489-501. [DOI: 10.1016/j.jsmc.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hannon TS, Watson SE, Jalou HE, Chakravorty S, Mather KJ, Arslanian SA. Characteristics of Obstructive Sleep Apnea Across the Spectrum of Glucose Tolerance in Obese Adolescents. Front Endocrinol (Lausanne) 2018; 9:281. [PMID: 29910773 PMCID: PMC5992282 DOI: 10.3389/fendo.2018.00281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/14/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND It is not known if dysglycemia and sleep-disordered breathing are linked in adolescents, as in adults. OBJECTIVE To perform a pilot study evaluating measures of sleep-disordered breathing across the spectrum of glucose tolerance in obese adolescents. We hypothesized that dysglycemia would be associated with sleep-disordered breathing. PARTICIPANTS/METHODS This was a prospective, cross-sectional clinical pilot study that included 57 adolescents [body mass index (BMI) 38.9 ± 8.4 kg/m2] aged 12-18 years (14.5 ± 1.6) with normal glucose tolerance (NGT), or dysglycemia [impaired glucose tolerance (IGT) or type 2 diabetes (T2D)]. MEASURES Anthropometrics, overnight polysomnogram, and oral glucose tolerance tests were performed. Participant characteristics and outcome measures were compared by glucose tolerance status. Correlational analyses were conducted to assess the associations between variables of interest. RESULTS Participants with dysglycemia (n = 21) were not different from those with NGT (n = 36) for BMI, waist circumference, body fat, or sleep characteristics. Nocturnal oxygen desaturation was associated with higher BMI (r = -0.334, p = 0.012). The apnea-hypopnea index (AHI) was not associated with physical and metabolic parameters. Although participants with dysglycemia tended to have higher AHIs (median 3.2, 2.2, and 1.6 events/h for T2D, IGT, and NGT, respectively), there was not a linear relationship between measures of glycemia and AHI. CONCLUSION Further study with a larger proportion of youth with prediabetes and T2D is necessary to determine whether evaluation for sleep-disordered breathing is uniformly warranted.
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Affiliation(s)
- Tamara S. Hannon
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
- *Correspondence: Tamara S. Hannon,
| | - Sara E. Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - Hasnaa E. Jalou
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sangeeta Chakravorty
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Kieren J. Mather
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Silva A. Arslanian
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Obesity, obstructive sleep apnea and type 2 diabetes mellitus: Epidemiology and pathophysiologic insights. SLEEP MEDICINE AND DISORDERS : INTERNATIONAL JOURNAL 2018; 2:52-58. [PMID: 30167574 PMCID: PMC6112821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Obesity is a major global health issue, and its prevalence is increasing. Obesity is associated with much comorbidity such as obstructive sleep apnea (OSA), type 2 diabetes mellitus (T2DM), and cardiovascular diseases (CVD). Obesity is also one of the major causative factors of OSA, and OSA itself can promote the onset of after T2DM because hypoxic episodes decrease insulin sensitivity, and activation of the sympathetic pathway leads to the release of inflammatory markers associated with insulin resistance. Continuous Positive Airway Pressure (CPAP) can be used to ameliorate both conditions, as CPAP decreased hypoxia episodes and increases insulin sensitivity and improves glucose metabolism. Weight-loss strategies play an important role in improving OSA, T2DM, and other associated comorbidities. Lifestyle modification of diet and exercise, medications or bariatric surgery should be considered weight loss. The purpose of this review is to describe the relationship between obesity, OSA, and T2DM.
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Uncoupling of Vascular Nitric Oxide Synthase Caused by Intermittent Hypoxia. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:2354870. [PMID: 27840666 PMCID: PMC5093285 DOI: 10.1155/2016/2354870] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/03/2016] [Indexed: 12/15/2022]
Abstract
Objective. Obstructive sleep apnea (OSA), characterized by chronic intermittent hypoxia (CIH), is often present in diabetic (DB) patients. Both conditions are associated with endothelial dysfunction and cardiovascular disease. We hypothesized that diabetic endothelial dysfunction is further compromised by CIH. Methods. Adult male diabetic (BKS.Cg-Dock7m +/+ Leprdb/J) (db/db) mice (10 weeks old) and their heterozygote littermates were subjected to CIH or intermittent air (IA) for 8 weeks. Mice were separated into 4 groups: IA (intermittent air nondiabetic), IH (intermittent hypoxia nondiabetic), IADB (intermittent air diabetic), and IHDB (intermittent hypoxia diabetic) groups. Endothelium-dependent and endothelium-independent relaxation and modulation by basal nitric oxide (NO) were analyzed using wire myograph. Plasma 8-isoprostane, interleukin-6 (IL-6), and asymmetric dimethylarginine (ADMA) were measured using ELISA. Uncoupling of eNOS was measured using dihydroethidium (DHE) staining. Results. Endothelium-dependent vasodilation and basal NO production were significantly impaired in the IH and IADB group compared to IA group but was more pronounced in IHDB group. Levels of 8-isoprostane, IL-6, ADMA, and eNOS uncoupling were ≈2-fold higher in IH and IADB groups and were further increased in the IHDB group. Conclusion. Endothelial dysfunction is more pronounced in diabetic mice subjected to CIH compared to diabetic or CIH mice alone. Oxidative stress, ADMA, and eNOS uncoupling were exacerbated by CIH in diabetic mice.
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