Obstructive sleep apnoea and diabetes mellitus: the role of cardiovascular autonomic neuropathy

Ficker, Joachim H.; Dertinger, Stefan; Siegfried, Wolfgang; König, Helena; Pentz, Mary Ann; Sailer, D; Katalinic, Alexander; Hahn, Eckhart G.

doi:10.1183/09031936.98.11010014

Cited by 121 publications

(89 citation statements)

References 39 publications

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“…In addition, several smaller studies have looked at whether people with diabetes are more likely to have disordered breathing during sleep. It has been proposed that the autonomic dysfunction that may occur in those with DM could lead to this breathing instability (34)(35)(36)(37)(38). There are not enough subjects in our cohort with diabetes at baseline to have adequate power to examine whether they are more likely to develop SDB or have worsening of their AHI.…”

Section: Discussionmentioning

confidence: 73%

Association of Sleep Apnea and Type II Diabetes

Reichmuth

Austin²,

Skatrud³

et al. 2005

Am J Respir Crit Care Med

675

444

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Rationale: Cross-sectional association has been reported between sleep-disordered breathing (SDB) and insulin resistance, but no prospective studies have been performed to determine whether SDB is causal in the development of diabetes. Objectives: The purpose of our study was to investigate the prevalence and incidence of type II diabetes in subjects with SDB and whether an independent relationship exists between them. Methods: A cross-sectional and longitudinal analysis was performed in 1,387 participants of the Wisconsin Sleep Cohort. Full polysomnography was used to characterize SDB. Diabetes was defined in two ways: (1 ) physician-diagnosis alone or (2 ) for those with glucose measurements, either fasting glucose у 126 mg/dl or physician diagnosis. Measurements and Main Results:There was a greater prevalence of diabetes in subjects with increasing levels of SDB. A total of 14.7% of subjects with an apnea-hypopnea index (AHI) of 15 or more had a diagnosis of diabetes compared with 2.8% of subjects with an AHI of less than 5. The odds ratio for having a physician diagnoses of diabetes mellitus with an AHI of 15 or greater versus an AHI of less than 5 was 2.30 (95% confidence interval, 1.28-4.11; p ϭ 0.005) after adjustment for age, sex, and body habitus. The odds ratio for developing diabetes mellitus within 4 yr with an AHI of 15 or more compared with an AHI of less than 5 was 1.62 (95% confidence interval, 0.67-3.65; p ϭ 0.24) when adjusting for age, sex, and body habitus. Conclusions: Diabetes is more prevalent in SDB and this relationship is independent of other risk factors. However, it is not clear that SDB is causal in the development of diabetes.Keywords: diabetes; incidence; prevalence; sleep apnea Sleep-disordered breathing (SDB) and diabetes mellitus (DM) are prevalent diseases that share several risk factors, including advanced age and obesity (1, 2). Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2003 and is associated with a higher incidence of cardiovascular, cerebrovascular, and renal disease (3, 4). There is also mounting evidence that SDB may be an independent risk factor for cardiovascular and cerebrovascular disease (5). Interest in a potential independent link between the two diseases continues to grow.Several studies have explored this relationship with conflicting results. Four recent studies demonstrated an inverse relationship between apnea-hypopnea index (AHI) and insulin sensitiv- ity (6-9). The relationship was independent of body mass index (BMI) and age in all three studies. Another study found a relationship between fasting insulin levels and increasing AHI in patients with BMI of 29 or greater, but not in those with lower BMIs (10). Finally, Stoohs and colleagues found the relationship between worsening insulin sensitivity and SDB in a group of 50 "healthy, normotensive individuals" was completely accounted for by increased BMI (11). The primary objective of these studies was to explore the relationship between insulin sensitivity, or surroga...

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Section: Discussionmentioning

confidence: 73%

Association of Sleep Apnea and Type II Diabetes

Reichmuth

Austin²,

Skatrud³

et al. 2005

Am J Respir Crit Care Med

675

444

View full text Add to dashboard Cite

show abstract

“…There are a multitude of factors that influence subsequent glucose concentrations in diabetes patients, including, but not limited to, insulin dosage, carbohydrate and nutritional intake, lifestyle (e.g., sleep-wake cycles and sleep quality, and exercise), and emotional states (e.g., stress, depression, and contentment). [4][5][6][7][8][9][10][11][12][13][14] The effect of these various factors on subsequent glucose levels is not fully understood and may be patient specific or similar across all diabetes patients. In order to optimize control in diabetes patients, there needs to be some method for quantifying or predicting future occurrences of dysglycemia (i.e., high and low blood glucose concentration, also referred to as hyperglycemia and hypoglycemia, respectively).…”

Section: Introductionmentioning

confidence: 99%

Development of a Neural Network for Prediction of Glucose Concentration in Type 1 Diabetes Patients

Pappada

Cameron

Rosman

2008

J Diabetes Sci Technol

108

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“…CAN is often present in subjects with diabetic autonomic neuropathy, which may be often associated with ventilator dysfunction [1]. CAN is associated with increased mortality or adverse cardiac events.…”

Section: Discussionmentioning

confidence: 99%

“…For example, Ficker et al found OSA in 26% of diabetic patients with diabetic autonomic neuropathy [1]. Cardiac autonomic neuropathy (CAN) is commonly observed early in diabetic patients, but most patients are asymptomatic.…”

mentioning

confidence: 99%