Obstructive sleep apnea, coronary calcification and arterial stiffness in patients with diabetic kidney disease

Nielsen, Sebastian; Nyvad, Jakob; Christensen, Kent Lodberg; Poulsen, Per Løgstrup; Laugesen, Esben; Grove, Erik Lerkevang; Buus, Niels

doi:10.1016/j.atherosclerosis.2023.06.076

Cited by 1 publication

(1 citation statement)

References 48 publications

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“…Increased arterial stiffness has been detected in normotensive patients with minimally symptomatic OSA, suggesting that subclinical vascular damage affects OSA patients from the onset of the disorder and precedes the development of arterial hypertension. In addition, OSA severity correlates with the degree of arterial stiffening [ 51 , 53 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 ]. Systematic reviews and meta-analyses confirm that OSA is a risk factor for reduced arterial distensibility, independent of conventional cardiovascular factors [ 109 , 110 , 111 ].…”

Section: Obstructive Sleep Apnea Is Associated With Insulin Resistanc...mentioning

confidence: 99%

Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review

Adeva-Andany,

Domínguez-Montero,

Castro-Quintela

et al. 2024

Rev. Cardiovasc. Med.

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Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- ) downregulation. In human adipose tissue, PPAR- activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.

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Section: Obstructive Sleep Apnea Is Associated With Insulin Resistanc...mentioning

confidence: 99%

Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review

Adeva-Andany,

Domínguez-Montero,

Castro-Quintela

et al. 2024

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

Obstructive sleep apnea, coronary calcification and arterial stiffness in patients with diabetic kidney disease

Cited by 1 publication

References 48 publications

Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review

Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review

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