Obstructive Sleep Apnea and Insulin Resistance: A Role for Microcirculation?

Wiernsperger, Nicolas; Nivoit, Pierre

doi:10.1590/s1807-59322006000300011

Cited by 14 publications

(10 citation statements)

References 153 publications

(165 reference statements)

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“…In patients with documented coronary artery disease, increased catecholamine response to sleep apnea may increase the risk of arrhythmias and ischemic events, including angina, myocardial infarction and sudden death (73). Some authors admit that severe microcirculation dysfunction would be OSAHS common physiopathologic pathway, leading to complications such as insulin resistance, hypertension and possibly heart failure, as well as the progression of sleep apnea (88).…”

Section: Consequences Of Osahsmentioning

confidence: 99%

Obesity and obstructive sleep apnea‐hypopnea syndrome

et al. 2008

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Obstructive sleep apnea-hypopnea syndrome involves recurring episodes of total obstruction (apnea) or partial obstruction (hypopnea) of airways during sleep. Obstructive sleep apnea-hypopnea syndrome affects mainly obese individuals and it is defined by an apnea-hypopnea index of five or more episodes per hour associated with daytime somnolence. In addition to anatomical factors and neuromuscular and genetic factors, sleep disorders are also involved in the pathogenesis of sleep apnea. Obesity affects upper airway anatomy because of fat deposition and metabolic activity of adipose tissue. Obstructive sleep apnea-hypopnea syndrome and metabolic syndrome have several characteristics such as visceral obesity, hypertension and insulin resistance. Inflammatory cytokines might be related to the pathogenesis of sleep apnea and metabolic syndrome. Sleep apnea treatment includes obesity treatment, use of equipment such as continuous positive airway pressure, drug therapy and surgical procedures in selected patients. Currently, there is no specific drug therapy available with proven efficacy for the treatment of obstructive sleep apnea-hypopnea syndrome. Body-weight reduction results in improvement of sleep apnea, and obesity treatment must be emphasized, including lifestyle changes, anti-obesity drugs and bariatric surgery.

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Section: Consequences Of Osahsmentioning

confidence: 99%

Obesity and obstructive sleep apnea‐hypopnea syndrome

et al. 2008

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“…However, new, sophisticated techniques as well as devoted investigations increasingly support the notion that defects in regulation or direct functioning of mechanisms specific to MIC, in particular, on a long‐term repetitive basis, could lead to impairments in tissue metabolism. The likely bidirectional link between OSA and IR/MS might illustrate this concept if confirmed [ 439 ]. As a whole, this review reveals that indeed numerous experimental as well as clinical data are available, while disseminated throughout the literature, to support a cardinal role of microcirculation in the new worldwide epidemic represented by the metabolic syndrome.…”

Section: Does Microcirculation Play a Causal Role In Metabolic Syndrome?mentioning

confidence: 80%

“…A complete review can be referred to, which is largely devoted to the relationship between IR, MS, and obstructive sleep apnea (OSA) [ 439 ]. This pathology and its association with MS are now widely recognized by physicians due to high prevalence and medical consequences of OSA.…”

Section: Metabolic Syndrome: a Condition Present In Many Diseasesmentioning

confidence: 99%

Microcirculation and the Metabolic Syndrome

et al. 2007

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The present review, to the authors' knowledge, is the first to specifically address the relationships between microcirculation and metabolic syndrome, a cluster of metabolic and cardiovascular modifications highly prevalent in the general population. Its close link to overweight and insulin resistance makes it the main cause of the worldwide burden of type 2 diabetes. However, metabolic syndrome is also observed in many other diseases, particularly, but not exclusively, those where insulin resistance is a main feature. Analysis of the literature reveals that this clinical situation is invariably linked to microvascular disturbances, such as abnormalities in arteriolar reactivity, capillary recruitment, permeability, and hemorheology. A particularly interesting observation is that these defects in small vessel structure and function are seen very early in life or disease. Very importantly, they further suggest that microcirculatory abnormalities may be not only secondary but also causal to the development and/or aggravation of insulin resistance and metabolic syndrome. Mechanisms responsible for these modifications remain largely unknown, but insulin's vascular effects in the microvascular network, detailed in this review, are at least one example of such connections. The existing data point to a clear, at least bidirectional, relationship between microcirculation and metabolic syndrome. Additional studies should determine the level of reciprocal causality.

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“…The benefit of CPAP treatment on BP therefore seems to be independent of IR modifications. Intermittent experimental hypoxia and clinical SAHS lead to an elevated sympathetic tone that persists throughout the day [26]. This elevation results in a high heart rate and elevated BP.…”

Section: Discussionmentioning

confidence: 99%

Continuous Positive Airway Pressure Therapy Reduces Oxidative Stress Markers and Blood Pressure in Sleep Apnea–Hypopnea Syndrome Patients

Murri

García-Delgado

Alcázar-Ramírez

et al. 2011

Biol Trace Elem Res

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Sleep apnea-hypopnea syndrome (SAHS) is characterized by recurrent episodes of hypoxia/reoxygenation, which seems to promote oxidative stress. SAHS patients experience increases in hypertension, obesity and insulin resistance (IR). The purpose was to evaluate in SAHS patients the effects of 1 month of treatment with continuous positive airway pressure (CPAP) on oxidative stress and the association between oxidative stress and insulin resistance and blood pressure (BP). Twenty-six SAHS patients requiring CPAP were enrolled. Measurements were recorded before and 1 month after treatment. Cellular oxidative stress parameters were notably decreased after CPAP. Intracellular glutathione and mitochondrial membrane potential increased significantly. Also, total antioxidant capacity and most of the plasma antioxidant activities increased significantly. Significant decreases were seen in BP. Negative correlations were observed between SAHS severity and markers of protection against oxidative stress. BP correlated with oxidative stress markers. In conclusion, we observed an obvious improvement in oxidative stress and found that it was accompanied by an evident decrease in BP with no modification in IR. Consequently, we believe that the decrease in oxidative stress after 1 month of CPAP treatment in these patients is not contributing much to IR genesis, though it could be related to the hypertension etiology.

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Obstructive Sleep Apnea and Insulin Resistance: A Role for Microcirculation?

Cited by 14 publications

References 153 publications

Obesity and obstructive sleep apnea‐hypopnea syndrome

Obesity and obstructive sleep apnea‐hypopnea syndrome

Microcirculation and the Metabolic Syndrome

Continuous Positive Airway Pressure Therapy Reduces Oxidative Stress Markers and Blood Pressure in Sleep Apnea–Hypopnea Syndrome Patients

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