These findings suggest that SDB is pathophysiologically related to impaired glucose homeostasis, and that CPAP can be an important therapeutic approach for diabetic patients with SDB.

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Obstructive sleep apnea (OSA) is independently associated with glucose intolerance and insulin resistance, and recent studies have shown that continuous positive airway pressure (CPAP) improves insulin sensitivity. The objective of this study was to describe the change in glycosylated hemoglobin (HbA1c) after treatment with CPAP in patients with type 2 diabetes mellitus and OSA. To test this hypothesis, we performed a retrospective analysis of 38 patients seen in the sleep clinic of an urban public teaching hospital. All patients had OSA and type 2 diabetes mellitus, and their diabetic medication regimen had remained unchanged during the period of CPAP therapy. Sixty-one percent were men, body mass index was 42+/-9.5 kg/m(2), and the Apnea-Hypopnea Index was 53+/-36 per hour. HbA1c before therapy with CPAP was 7.8+/-1.4% and decreased to 7.3+/-1.3% after 134+/-119 days of therapy (p<0.001). Treatment with CPAP leads to a clinically significant drop in HbA1c in patients with type 2 diabetes mellitus and severe OSA.

In obese patients with NAFLD, OSA was associated with elevated alanine aminotransferase levels and a trend toward histologic evidence of progressive liver disease.

BackgroundMany people with COPD report difficulties falling asleep or staying asleep, insufficient sleep duration, or nonrestorative sleep. Cognitive behavioral therapy for insomnia (CBT-I) has proved effective not only in people with primary insomnia but also in people with insomnia comorbid with psychiatric and medical illness (eg, depression, cancer, and chronic pain). However, CBT-I has rarely been tested in those with COPD who have disease-related features that interfere with sleep and may lessen the effectiveness of such therapies. The purpose of this study was to determine the feasibility of applying a CBT-I intervention for people with COPD and to assess the impact of CBT-I on insomnia severity and sleep-related outcomes, fatigue, mood, and daytime functioning.MethodsThe study had two phases. In Phase 1, a 6-weekly session CBT-I intervention protocol in participants with COPD was assessed to examine feasibility and acceptability. Phase 2 was a small trial utilizing a prospective two-group pre- and post-test design with random assignment to the six-session CBT-I or a six-session wellness education (WE) program to determine the effects of each intervention, with both interventions being provided by a nurse behavioral sleep medicine specialist.ResultsFourteen participants (five in Phase 1 and nine in Phase 2) completed six sessions of CBT-I and nine participants completed six sessions of WE. Participants indicated that both interventions were acceptable. Significant positive treatment-related effects of the CBT-I intervention were noted for insomnia severity (P = 0.000), global sleep quality (P = 0.002), wake after sleep onset (P = 0.03), sleep efficiency (P = 0.02), fatigue (P = 0.005), and beliefs and attitudes about sleep (P = 0.000). Significant positive effects were noted for depressed mood after WE (P = 0.005).ConclusionResults suggest that using CBT-I in COPD is feasible and the outcomes compare favorably with those obtained in older adults with insomnia in the context of other chronic illnesses.

At short-term follow-up, weight loss occurred with minimal complications, leading to early resolution of major obesity-related comorbidities. Continued evaluation of the long-term safety and efficacy of LAGB as a surgical adjunct to a comprehensive obesity treatment program is warranted.

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M ore than 24 million Americans have diabetes mellitus (DM), and nearly one million new cases of diabetes are diagnosed every year. 1 Type 2 diabetes accounts for 90% to 95% of all cases of diabetes. Diabetes mellitus was the sixth leading cause of death in 2002, with the risk of death almost twice that of non-diabetic patients of similar age. 2 According to the Centers for Disease Control and Prevention, African Americans have a 1.8-fold increase and Hispanic Americans have a 1.7-fold increase in the prevalence of diabetes mellitus compared to Caucasian Americans. 2 In addition to ethnicity, sleep disordered breathing (SDB) is independently associated with glucose intolerance and insulin resistance, 3,4 and may also contribute to the pathogenesis of type 2 DM. These findings were reported by the Sleep Heart Health Study, which comprised 93.4% Caucasian Americans. 4 The Wisconsin Sleep Cohort study reported a high prevalence of type 2 DM with SDB in a population that comprised 96% Caucasian Americans, 5 but the incidence was not increased after 4 and 8 years of follow-up. The relationship between SDB and type 2 DM has not been defined in Hispanic or African Americans. The objective of our study is to determine whether obstructive sleep apnea (OSA) is associated with type 2 DM in a sample consisting of predominantly Hispanic and African Americans.Studies have suggested that REM related SDB is more common in mild to moderate cases of OSA, 6 and thus, may be a marker of early obstructive sleep apnea. We hypothesized that the relationship of REM related OSA and type 2 DM could be independent in this racially diverse sample. RESEARCH DESIGN AND METHODS Study DesignThis was a retrospective study in which we reviewed the records of 1008 consecutive patients who had polysomnography in the Sleep Science Center at the University of Illinois at