Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes

Aronsohn, Renee S.; Whitmore, Heidi; Cauter, Eve Van; Tasali, Esra

doi:10.1164/rccm.200909-1423oc

Cited by 400 publications

(291 citation statements)

References 52 publications

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“…Risk factors include obesity and increased neck circumference. 4 The relationship between sleep apnea and the incidence of myocardial infarction, 5,6 stroke 7,8 and metabolic dysfunction [9][10][11][12] have been well established in the able-bodied population. Specific issues related to SDB in SCI include what is the incidence and prevalence and what are associated factors that are related to the presence of SDB in patients with SCI.…”

mentioning

confidence: 99%

Sleep disordered breathing in spinal cord injury: A systematic review

Chiodo

Sitrin

Bauman

2016

The Journal of Spinal Cord Medicine

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Context: Spinal cord injury commonly results in neuromuscular weakness that impacts respiratory function. This would be expected to be associated with an increased likelihood of sleep-disordered breathing. Results: Given the current literature limitations, sleep disordered breathing as currently defined is high in patients with spinal cord injury, approaching 60% in motor complete persons with tetraplegia. Central apnea is more common in patients with tetraplegia than in patients with paraplegia. Conclusion: Early formal sleep study in patients with acute complete tetraplegia is recommended. In patients with incomplete tetraplegia and with paraplegia, the incidence of sleep-disordered breathing is significantly higher than the general population. With the lack of correlation between symptoms and SDB, formal study would be reasonable. There is insufficient evidence in the literature on the impact of treatment on morbidity, mortality and quality of life outcomes.

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confidence: 99%

Sleep disordered breathing in spinal cord injury: A systematic review

Chiodo

Sitrin

Bauman

2016

The Journal of Spinal Cord Medicine

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“…OSA is a cause of hypertension (5-7) and has strong association with atherosclerosis (8)(9)(10), coronary heart disease (11,12), diabetes (13,14), stroke (15)(16)(17)(18), and fatal cardiovascular events (4). Endothelial dysfunction is a preclinical vascular abnormality that predicts subsequent development of vascular disease (19,20).…”

mentioning

confidence: 99%

Endothelial Dysfunction in the Microcirculation of Patients with Obstructive Sleep Apnea

Patt¹,

Jarjoura²,

Haddad³

et al. 2010

Am J Respir Crit Care Med

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Rationale: Obstructive sleep apnea (OSA) is a risk factor for cardiovascular disease. We hypothesized that patients with OSA and no cardiovascular disease have oxidant-related microcirculatory endothelial dysfunction. Objectives: To evaluate the microcirculation in OSA. Methods: This study included seven patients with OSA and seven ageand weight-matched control subjects (mean age, 38 yr; mean body mass index, 32.5 kg/m 2 ). All participants were free of cardiovascular risk factors. Participants received measurement of brachial artery flow-mediated dilation and forearm subcutaneous biopsy. Patients underwent repeated tests 12 weeks after treatment. Microcirculatory endothelial cells were isolated, and immunohistochemistry staining for peroxynitrite in the microcirculation was performed. Measurements and Main Results: Flow-mediated dilation was lower in patients than in control subjects at baseline (mean 6 SEM: 5.7 6 0.5 vs. 9.5 6 0.6; P 5 0.02) and increased after treatment (5.7-7.3; change, 1.7 6 0.6; P 5 0.04). Microcirculatory peroxynitrite deposit was higher in patients compared with control subjects (44.0 6 1.6 vs. 21.8 6 1.9 stain density units; P , 0.001) and decreased after treatment from 44.0 to 30.5 stain density units (change, 213.5 6 2.9; P 5 0.009). In patients, transcription of endothelial nitric oxide synthase decreased from 5.2 to 21.3 after treatment (change, 6.5 6 2.5; P 5 0.05), and transcription of superoxide dismutase1 decreased from 24.0 to 212.3 after treatment (change, 28.3 6 2.1; P 5 0.01). These changes persisted after adjustment for weight and underlying severity of OSA. Conclusions: This is the first direct evaluation of the microcirculation in OSA. Patients with OSA with low cardiovascular risk status had increased oxidant production in the microcirculation and endothelial dysfunction, both of which improved with treatment. Endothelial nitric oxide synthase transcription decreased with treatment.

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“…In adults with T2DM, increasing severity of untreated OSA is associated with worsening glycemic control [3]. Similarly, prior research has shown that the combination of SDB and obesity predicts increased insulin resistance in children [4].…”

Section: Discussionmentioning

confidence: 94%

Glycemic Improvement with Sleep-Disordered Breathing Treatment in Prader–Willi Syndrome

Chin

Combs

2017

Sleep Vigilance

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15q11-q13. Frequent comorbidities include obesity, sleepdisordered breathing (SDB) and impaired glucose metabolism. Patients with PWS are at high risk for SDB due to obesity, hypotonia and facial dysmorphism including micrognathia and small nasopharynx and/or oropharynx. We report a morbidly obese 11-year-old girl with PWS, SDB and insulin-dependent type 2 diabetes mellitus (T2DM) with dramatic glycemic improvement following improved control of SDB with positive airway pressure (PAP) therapy treatment after a hospitalization for obesity hypoventilation syndrome and cor pulmonale. Case HistoryThe patient was diagnosed with PWS by genetic testing at 3 months of age. Three years later, she was diagnosed with severe obstructive sleep apnea (OSA) with an apnea-hypopnea index (AHI) of 59 events per hour (normal < 1.5). She subsequently underwent adenotonsillectomy and uvulopalatopharyngoplasty. Four months following surgery, she had a repeat polysomnogram that showed a post-surgical residual AHI of 13 and she was started on PAP therapy. She was diagnosed with T2DM at 6 years of age and was started on basal-bolus insulin therapy and metformin. Due to her severe obesity, T2DM and SDB, she has not been treated with growth hormone. Additionally, while there is some promising research suggesting that bariatric surgery may have a role in weight management for children with PWS [1], bariatric surgery is not available for children at our center. By 8 years of age, she no longer tolerated PAP therapy and was instead initiated on nocturnal supplemental oxygen therapy. Repeat polysomnogram performed on 4 LPM O 2 via nasal cannula at 9 years of age showed persistent OSA (AHI of 7.1) and nocturnal hypoventilation, and PAP Abstract Prader-Willi syndrome (PWS) is a genetic condition frequently associated with extreme obesity, sleep-disordered breathing (SDB) and impaired glucose metabolism. We report an 11-year-old girl with PWS, morbid obesity, SDB and insulin-dependent type 2 diabetes mellitus who had a marked decrease in her hemoglobin A1c following improved control of her SDB. SDB has been shown to impair glucose metabolism though trials of SDB treatment have reported mixed effects on glucose metabolism. This case shows an association between improved control of SDB with optimal positive airway pressure therapy and improved glycemic control in a patient with PWS, extreme obesity and poorly controlled type 2 diabetes mellitus. These findings highlight the need for further investigation into the effects of SDB treatment on glucose regulation in children, particularly in the setting of PWS.

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Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes

Cited by 400 publications

References 52 publications

Sleep disordered breathing in spinal cord injury: A systematic review

Sleep disordered breathing in spinal cord injury: A systematic review

Endothelial Dysfunction in the Microcirculation of Patients with Obstructive Sleep Apnea

Glycemic Improvement with Sleep-Disordered Breathing Treatment in Prader–Willi Syndrome

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