Obstructive sleep apnoea increases lipolysis and deteriorates glucose homeostasis in patients with type 2 diabetes mellitus

Abstract

Obstructive sleep apnoea (OSA) is associated with type 2 diabetes mellitus (T2DM). However, mechanisms mediating association between these two conditions remain unclear. This study investigated, whether the OSA-associated changes in adipose tissue lipolysis might contribute to impaired glucose homeostasis in patient with T2DM. Thirty-five matched subjects were recruited into three groups: T2DM + severe OSA (T2DM + OSA, n = 11), T2DM with mild/no OSA (T2DM, n = 10) and healthy controls (n = 14). Subcutaneous abdominal adipose tissue microdialysis assessed spontaneous, epinephrine- and isoprenaline-stimulated lipolysis. Glucose metabolism was assessed by intravenous glucose tolerance test. Spontaneous lipolysis was higher in the T2DM + OSA compared with the T2DM (60.34 ± 23.40 vs. 42.53 ± 10.16 μmol/L, p = 0.013), as well as epinephrine-stimulated lipolysis (236.84 ± 103.90 vs. 167.39 ± 52.17 µmol/L, p < 0.001). Isoprenaline-stimulated lipolysis was unaffected by the presence of OSA (p = 0.750). The α2 anti-lipolytic effect was decreased in T2DM + OSA by 59% and 315% compared with T2DM and controls (p = 0.045 and p = 0.007, respectively). The severity of OSA (AHI) was positively associated with spontaneous (p = 0.037) and epinephrine-stimulated (p = 0.026) lipolysis. The α2-adrenergic anti-lipolytic effect (p = 0.043) decreased with increasing AHI. Spontaneous lipolysis was positively associated with Insulin resistance (r = 0.50, p = 0.002). Epinephrine-stimulated lipolysis was negatively associated with the Disposition index (r = − 0.34, p = 0.048). AHI was positively associated with Insulin resistance (p = 0.017) and negatively with the Disposition index (p = 0.038). Severe OSA in patients with T2DM increased adipose tissue lipolysis, probably due to inhibition of the α2-adrenergic anti-lipolytic effect. We suggest that dysregulated lipolysis might contribute to OSA-associated impairments in insulin secretion and sensitivity.

Impact of obstructive sleep apnea complicated with type 2 diabetes on long-term cardiovascular risks and all-cause mortality in elderly patients

“…Conversely, type 2 diabetes may increase predisposition to, or accelerate the progression of OSA, possibly through the development of peripheral neuropathy and abnormalities of ventilatory and upper airway neural control [ 7 , 8 ]. The prevalence of OSA in patients with type 2 diabetes ranges from 50 to 80% [ 9 , 10 ]. A cross-sectional study confirmed an association between OSA and type 2 diabetes [ 11 ].…”

Associations of Chronic Diabetes Complications and Cardiovascular Risk with the Risk of Obstructive Sleep Apnea in Patients with Type 2 Diabetes

“…We also assumed that about 30% of the subjects could decline participation in the study, as well as 12% of the subjects with incomplete STOP-Bang questionnaires. Taking these data into account, we estimated that at least 529 patients were required in order to have a confidence level of 95% [ 8 , 9 ]. As presented in Figure 1 , 553 answered the STOP-Bang questionnaire, 529 having complete data were enrolled in the study.…”

“…T2DM and OSA are two conditions that increase their mutual risk [ 2 , 7 ]. It was estimated that in patients with T2DM, OSA has a prevalence of 50–80% [ 8 , 9 ].…”

Impact of Obstructive Sleep Apnea Complicated With Type 2 Diabetes on Long‐term Cardiovascular Risks and All-cause Mortality in Elderly Patients

“…Conversely, type 2 diabetes may increase predisposition to, or accelerate the progression of OSA, possibly through the development of peripheral neuropathy and abnormalities of ventilatory and upper airway neural control [7][8] . The prevalence of OSA in patients with type 2 diabetes ranges from 50-80% [9][10] . A cross-sectional study con rmed an association between OSA and type 2 diabetes [11] .…”