Cardiovascular Autonomic Neuropathy Contributes to Sleep Apnea in Young and Lean Type 1 Diabetes Mellitus Patients

Janovsky, Carolina Castro Porto Silva; Rolim, Luiz Clemente; Sá, João Roberto de; Poyares, Dalva; Tufik, Sérgio; Silva, Ademir Baptista; Dib, Sérgio Atala

doi:10.3389/fendo.2014.00119

Cited by 35 publications

(45 citation statements)

References 22 publications

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“…While obesity is a major risk factor for OSA, Janovsky et al showed that OSA was common in lean patients with T1DM and that OSA can be associated with CAN 65. Unpublished data from our group showed that OSA was associated with weaker sympathetic and parasympathetic tone in patients with T2DM and that patients who were compliant with OSA treatment (continuous positive airway pressure) had improvements in several autonomic parameters over the follow-up period 66,67…”

Section: Pathogenesis Of Canmentioning

confidence: 67%

Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives

Fisher

Tahrani

2017

DMSO

111

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Cardiac autonomic neuropathy (CAN) is a common and often-underdiagnosed complication of diabetes mellitus (DM). CAN is associated with increased mortality, cardiovascular disease, chronic kidney disease, and morbidity in patients with DM, but despite these significant consequences CAN often remains undiagnosed for a prolonged period. This is commonly due to the disease being asymptomatic until the later stages, as well as a lack of easily available screening strategies. In this article, we review the latest developments in the epidemiology, pathogenesis, diagnosis, consequences, and treatments of CAN in patients with DM.

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Section: Pathogenesis Of Canmentioning

confidence: 67%

Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives

Fisher

Tahrani

2017

DMSO

111

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“…The precise basis of the association between diabetes and OSA is unknown and could be driven by mechanical (secondary to obesity), metabolic (hyperglycaemia‐induced neuropathy) and/or inflammatory processes . OSA, obesity and Type 2 diabetes are probably linked by increased systemic inflammation , while Type 1 diabetes is linked to OSA through autonomic neuropathy . Aurora and Punjabi suggested the inflammatory effects of OSA may result in glucose metabolism dysfunction and eventually lead to Type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…These relatively straightforward methods should be simple to use within the primary care setting, as a first step to diagnosing OSA. Given the high prevalence of OSA reported in some studies of people with Type 1 diabetes and its relative under‐detection in routine clinical practice, a case could also be made for application of such questionnaires in the care of those with Type 1 diabetes, irrespective of their BMI .…”

Section: Discussionmentioning

confidence: 99%

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Obstructive sleep apnoea in Type 2 diabetes mellitus: increased risk for overweight as well as obese people included in a national primary care database analysis

et al. 2019

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Aims To determine obstructive sleep apnoea prevalence in people with Type 2 or Type 1 diabetes in a national primary care setting, stratified by BMI category, and to explore the relationship between patient characteristics and obstructive sleep apnoea. Methods Using the Royal College of General Practitioners Research and Surveillance Centre database, a cross‐sectional analysis was conducted. Diabetes type was identified using a seven‐step algorithm and was grouped by Type 2 diabetes, Type 1 diabetes and no diabetes. The clinical characteristics of these groups were analysed, BMI‐stratified obstructive sleep apnoea prevalence rates were calculated, and a multilevel logistic regression analysis was completed on the Type 2 diabetes group. Results Analysis of 1 275 461 adult records in the Royal College of General Practitioners Research and Surveillance Centre network showed that obstructive sleep apnoea was prevalent in 0.7%. In people with Type 2 diabetes, obstructive sleep apnoea prevalence increased with each increasing BMI category, from 0.5% in those of normal weight to 9.6% in those in the highest obesity class. By comparison, obstructive sleep apnoea prevalence rates for these BMI categories in Type 1 diabetes were 0.3% and 4.3%, and in those without diabetes 1.2% and 3.9%, respectively. Obstructive sleep apnoea was more prevalent in men than women in both diabetes types. When known risk factors were adjusted for, there were increased odds ratios for obstructive sleep apnoea in people with Type 2 diabetes in the overweight and higher BMI categories. Conclusions Obstructive sleep apnoea was reported in people with both types of diabetes across the range of overweight categories and not simply in the highest obesity class.

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“…van Dijk et al 44 did not find significant differences in scores on a measure of sleep disturbance, but they found that more adults with T1DM met the clinical cutoff for impairment relative to those without diabetes. Janovsky et al 48 reported that a greater number of adult patients with T1DM met the cutoff on a measure of sleepiness than those without T1DM. In the aforementioned study that compared individuals with T1DM to a convenience sample from different age spans, adults who had T1DM evidenced more sleep-related complaints.…”

Section: Sleep Disturbancesmentioning

confidence: 99%

<p>Sleep-related disorders in patients with type 1 diabetes mellitus: current insights</p>

Perfect

2020

NSS

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Type 1 diabetes mellitus (T1DM) is an autoimmune condition that results from destruction of beta cells in the pancreas. Several reviews have concluded that sleep contributes to poor glycemic control, diabetes management, and diabetes-related complications in individuals with T1DM and represents an untapped opportunity for intervention. However, at the current juncture, the American Diabetes Association's Standards of Medical Care are devoid of recommendations about how to address sleep in the management of T1DM. This article summarizes reviews of sleep in youth and adults with T1DM and empirical studies that have examined various sleep parameters ranging from sleep disturbances (general, perceived sleep quality, sleepiness, awakenings, and sleep efficiency), sleep duration, sleep consistency, sleep-disordered breathing (SDB), and sleep architecture. The data show that many individuals with T1DM sleep less than recommendations; individuals with the poorest sleep have difficulties with diabetes management; and sleep deficiency including SDB often corresponds to several disease morbidities (neuropathy, nephropathy, etc). Mixed findings exist regarding direct associations of various sleep parameters and glycemic control. SDB appears to be just as prevalent, if not more, than other conditions that have been recommended for universal screening in individuals with T1DM. The article concludes with recommendations for collaborative research efforts to further elucidate the role of sleep in diabetes-related outcomes; investigations to test behavioral strategies to increase sleep quantity and consistency; and considerations for clinical care to address sleep.

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Cardiovascular Autonomic Neuropathy Contributes to Sleep Apnea in Young and Lean Type 1 Diabetes Mellitus Patients

Cited by 35 publications

References 22 publications

Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives

Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives

Obstructive sleep apnoea in Type 2 diabetes mellitus: increased risk for overweight as well as obese people included in a national primary care database analysis

<p>Sleep-related disorders in patients with type 1 diabetes mellitus: current insights</p>

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