MECHANISMS OF ENDOCRINOLOGY: Mechanisms of disease: the endocrinology of obstructive sleep apnoea

Abstract

Obstructive sleep apnoea (OSA) is a common disorder that is associated with serious comorbidities with a negative impact on quality of life, life expectancy and health costs. As OSA is related to obesity and is associated with sleep disruption, increased inflammation and oxidative stress, it is not surprising that OSA has an impact on the secretion of multiple hormones and is implicated in the development of many endocrine conditions. On the other hand, many endocrine conditions that can affect obesity and/or upper airways anatomy and stability have been implicated in the development or worsening of OSA. This bidirectional relationship between OSA and the endocrine system has been increasingly recognised in experimental and epidemiological studies and there are an increasing number of studies examining the effects of OSA treatment on endocrine conditions and vice versa. In this review article, we will critically appraise and describe the impact of OSA on the endocrine system including obesity, dysglycaemia, the pituitary, the thyroid, the adrenals, the reproductive system and the bones. In each section, we will assess whether a bidirectional relationship exists, and we will describe the potential underlying mechanisms. We have focused more on recent studies and randomised controlled trials where available and attempted to provide the information within clinical context and relevance.

Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study

“…10,11,12,13,14,15 Our group has previously shown a cross-sectional association between OSA and peripheral neuropathy (PN), sight threatening retinopathy, and chronic kidney disease (CKD) in patients with type 2 diabetes. 8,16 We have also shown that OSA was associated with increased risk of renal function decline and development of CKD, and pre-proliferative/proliferative retinopathy in patients with type 2 diabetes in longitudinal studies. 17,18,19 However, these studies were in a relatively small and were from secondary/tertiary care centres.…”

“…6 Obstructive sleep apnoea (OSA) is common in patients with type 2 diabetes (24-86%) and patients with type 2 diabetes are at increased risk of developing OSA compared to patients without diabetes. 7,8,9 Epidemiological studies in patients without diabetes showed that OSA was associated with increased risk of mortality and CVD (including stroke) which was improved with continuous positive airway pressure (CPAP) in non-randomised studies. 10,11,12,13,14,15 Our group has previously shown a cross-sectional association between OSA and peripheral neuropathy (PN), sight threatening retinopathy, and chronic kidney disease (CKD) in patients with type 2 diabetes.…”

Metformin: Mechanisms in Human Obesity and Weight Loss

“…OSA is a common complication of obesity [91]. Metformin has been examined through cross sectional and retrospective studies on its impacts on OSA severity.…”

Prevalence of undiagnosed glucose intolerance and type 2 diabetes in patients with moderate-to-severe obstructive sleep apnea syndrome

“…In healthy adults, slow wave sleep suppression has been shown to reduce insulin resistance [41]. In summary, common features observed in OSAS such as nocturnal hypoxemia, arousals from sleep, increased inflammation, and oxidative stress contribute to the development of GMD [42].…”