Nocturnal hyperglycaemia in type 2 diabetes with sleep apnoea syndrome

Fendri, S.; Rose, D. K.; Myambu, Sonia; Jeanne, Sandrine; Lalau, Jean–Daniel

doi:10.1016/j.diabres.2010.09.029

Cited by 23 publications

(19 citation statements)

References 18 publications

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“…Two recent studies that performed continuous interstitial glucose monitoring simultaneously with PSG directly support our hypothesis that REM-related OSA may have adverse metabolic consequences (33,34). One of these studies included 13 obese patients with type 2 diabetes with severe OSA and compared them with 13 obese patients with type 2 diabetes without OSA with similar demographic characteristics.…”

Section: Discussionsupporting

confidence: 74%

Association of Obstructive Sleep Apnea in Rapid Eye Movement Sleep With Reduced Glycemic Control in Type 2 Diabetes: Therapeutic Implications

et al. 2014

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OBJECTIVESeverity of obstructive sleep apnea (OSA) has been associated with poorer glycemic control in type 2 diabetes. It is not known whether obstructive events during rapid eye movement (REM) sleep have a different metabolic impact compared with those during non-REM (NREM) sleep. Treatment of OSA is often limited to the first half of the night, when NREM rather than REM sleep predominates. We aimed to quantify the impact of OSA in REM versus NREM sleep on hemoglobin A1c (HbA1c) in subjects with type 2 diabetes.RESEARCH DESIGN AND METHODSAll participants underwent polysomnography, and glycemic control was assessed by HbA1c.RESULTSOur analytic cohort included 115 subjects (65 women; age 55.2 ± 9.8 years; BMI 34.5 ± 7.5 kg/m2). In a multivariate linear regression model, REM apnea–hypopnea index (AHI) was independently associated with increasing levels of HbA1c (P = 0.008). In contrast, NREM AHI was not associated with HbA1c (P = 0.762). The mean adjusted HbA1c increased from 6.3% in subjects in the lowest quartile of REM AHI to 7.3% in subjects in the highest quartile of REM AHI (P = 0.044 for linear trend). Our model predicts that 4 h of continuous positive airway pressure (CPAP) use would leave 60% of REM sleep untreated and would be associated with a decrease in HbA1c by approximately 0.25%. In contrast, 7 h of CPAP use would cover more than 85% of REM sleep and would be associated with a decrease in HbA1c by as much as 1%.CONCLUSIONSIn type 2 diabetes, OSA during REM sleep may influence long-term glycemic control. The metabolic benefits of CPAP therapy may not be achieved with the typical adherence of 4 h per night.

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Section: Discussionsupporting

confidence: 74%

Association of Obstructive Sleep Apnea in Rapid Eye Movement Sleep With Reduced Glycemic Control in Type 2 Diabetes: Therapeutic Implications

et al. 2014

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“…Indeed, fluctuations in blood glucose levels were found to play a significant role in vascular endothelial dysfunction assessed by RHI in TD2 [73]. Nocturnal hyperglycemia has been reported in patients with TD2 and OSA particulary during REM sleep apneas with marked oxygen desaturations [74]. However, no significant association was observed between RHI values and increasing nocturnal hypoxemia in the present study.…”

Section: Discussioncontrasting

confidence: 58%

Association between obstructive sleep apnea severity and endothelial dysfunction in patients with type 2 diabetes

Bironneau

Goupil

Ducluzeau

et al. 2017

Cardiovasc Diabetol

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BackgroundObstructive sleep apnea (OSA) and type 2 diabetes (T2D) are associated with endothelial dysfunction a main predictor of late cardiovascular (CV) events. Despite the high prevalence of OSA in patients with T2D, the impact of OSA severity on endothelial function has not been clearly elucidated. The aim of this cross-sectional study was to determine whether increasing OSA severity is associated with poorer endothelial function in patients with T2D.Methods140 patients with T2D and no overt CV disease underwent polysomnography, peripheral arterial tonometry, clinic blood pressure (BP) measurement, biological assessment for CV risk factors, daytime sleepiness and health related quality of life (HRQL) questionnaires. The following commonly used cut-offs for apnea-hypopnea index (AHI) were used to define 3 categories of disease severity: AHI < 15 (no OSA or mild OSA), 15 ≤ AHI < 30 (moderate OSA), and AHI ≥ 30 (severe OSA). The primary outcome was the reactive hyperemia index (RHI), a validated assessment of endothelial function.Results21.4% of patients had moderate OSA and 47.6% had severe OSA. Increasing OSA severity and nocturnal hypoxemia were not associated with a significant decrease in RHI. Endothelial dysfunction (RHI < 1.67) was found in 47.1, 44.4 and 39.2% of patients with no OSA or mild OSA, moderate OSA and severe OSA, respectively (p = 0.76). After adjustment for confounders including body mass index, increasing OSA severity was associated with higher systolic BP (p = 0.03), lower circulating levels of adiponectin (p = 0.0009), higher levels of sP-selectin (p = 0.03), lower scores in 3 domains of HRQL including energy/vitality (p = 0.02), role functioning (p = 0.01), and social functioning (p = 0.04).ConclusionsModerate to severe OSA is very common but has no impact on digital micro-vascular endothelial function in patients with T2D.

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“…Also, the glycemic profile during the short period of admission might have differed from that in their daily life. On the other hand, using CGM, recent studies have shown that the presence of OSA may increase nocturnal glucose levels, especially during REM sleep [21]. Bialasiewicz et al have also reported that the presence of OSA in REM sleep reversed the downward trend in glucose level [22].…”

Section: Discussionmentioning

confidence: 94%

Association between severity of obstructive sleep apnea and glycated hemoglobin level in Japanese individuals with and without diabetes

et al. 2018

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Abstract. Aim of this study was to examine the association between the severity of obstructive sleep apnea (OSA) and dysglycemia in Japanese individuals with and without type 2 diabetes (T2DM). We enrolled 115 individuals diagnosed with OSA with an apnea hypopnea-index (AHI) ≥ 20 in whom continuous positive airway pressure (CPAP) therapy was introduced (N = 115, 44 with T2DM, age 62 ± 11 years, BMI 27.0 ± 4.4 kg/m 2 and AHI median 36.1; interquartile range 27.2-48.1). During admission, the severity of OSA was evaluated by polysomnography, and its association with glycated hemoglobin (HbA1c) level was examined. Continuous glucose monitoring (CGM) was also conducted during the admission in 94 individuals. Apnea-hypopnea index (AHI), non-rapid eye movement (REM) AHI, minimum peripheral capillary oxygen saturation (SpO 2 ) and percentage of sleep time (%TST) with SpO 2 < 90% were significantly associated with HbA1c level in total and non-diabetic individuals (all p < 0.05) but not in those with T2DM, the majority of whom were treated with antidiabetic medications. The associations of the non-REM AHI and %TST with SpO 2 < 90% with HbA1c level remained significant after adjustment for age, sex and BMI in non-diabetic and T2DM subjects treated with dietary therapy only. Mean glucose level, but not SD or coefficient of variation of glucose, assessed by CGM was significantly associated with AHI and non-REM AHI in non-diabetic subjects after adjustment for age, sex and BMI. In conclusion, the severity of OSA was associated with increased HbA1c level independently of BMI in Japanese individuals, especially in those without diabetes.

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Nocturnal hyperglycaemia in type 2 diabetes with sleep apnoea syndrome

Cited by 23 publications

References 18 publications

Association of Obstructive Sleep Apnea in Rapid Eye Movement Sleep With Reduced Glycemic Control in Type 2 Diabetes: Therapeutic Implications

Association of Obstructive Sleep Apnea in Rapid Eye Movement Sleep With Reduced Glycemic Control in Type 2 Diabetes: Therapeutic Implications

Association between obstructive sleep apnea severity and endothelial dysfunction in patients with type 2 diabetes

Association between severity of obstructive sleep apnea and glycated hemoglobin level in Japanese individuals with and without diabetes

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