Risk of Incident Obstructive Sleep Apnea Among Patients With Type 2 Diabetes

Subramanian, Anuradhaa; Adderley, Nicola J; Tracy, Alexander; Taverner, Tom; Hanif, Wasim; Toulis, Konstantinos; Thomas, G. Neil; Tahrani, Abd A; Nirantharakumar, Krishnarajah

doi:10.2337/dc18-2004

Cited by 67 publications

(63 citation statements)

References 39 publications

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“…Symptoms and diagnoses are recorded using Read codes. The THIN database has been used previously by the authors' group and others to examine chronic non‐communicable disease (such as diabetes, CVD, obesity and its related complications) and mortality.…”

Section: Methodsmentioning

confidence: 99%

Impact of bariatric surgery on cardiovascular outcomes and mortality: a population-based cohort study

Singh

Subramanian

Adderley

et al. 2020

British Journal of Surgery

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Background Cohort studies have shown that bariatric surgery may reduce the incidence of and mortality from cardiovascular disease (CVD), but studies using real‐world data are limited. This study examined the impact of bariatric surgery on incident CVD, hypertension and atrial fibrillation, and all‐cause mortality. Methods A retrospective, matched, controlled cohort study of The Health Improvement Network primary care database (from 1 January 1990 to 31 January 2018) was performed (approximately 6 per cent of the UK population). Adults with a BMI of 30 kg/m2 or above who did not have gastric cancer were included as the exposed group. Each exposed patient, who had undergone bariatric surgery, was matched for age, sex, BMI and presence of type 2 diabetes mellitus (T2DM) with two controls who had not had bariatric surgery. Results A total of 5170 exposed and 9995 control participants were included; their mean(s.d.) age was 45·3(10·5) years and 21·5 per cent (3265 of 15 165 participants) had T2DM. Median follow‐up was 3·9 (i.q.r. 1·8– 6·4) years. Mean(s.d.) percentage weight loss was 20·0(13·2) and 0·8(9·5) per cent in exposed and control groups respectively. Overall, bariatric surgery was not associated with a significantly lower CVD risk (adjusted hazard ratio (HR) 0·80; 95 per cent c.i. 0·62 to 1·02; P = 0·074). Only in the gastric bypass group was a significant impact on CVD observed (HR 0·53, 0·34 to 0·81; P = 0·003). Bariatric surgery was associated with significant reduction in all‐cause mortality (adjusted HR 0·70, 0·55 to 0·89; P = 0·004), hypertension (adjusted HR 0·41, 0·34 to 0·50; P < 0·001) and heart failure (adjusted HR 0·57, 0·34 to 0·96; P = 0·033). Outcomes were similar in patients with and those without T2DM (exposed versus controls), except for incident atrial fibrillation, which was reduced in the T2DM group. Conclusion Bariatric surgery is associated with a reduced risk of hypertension, heart failure and mortality, compared with routine care. Gastric bypass was associated with reduced risk of CVD compared to routine care.

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Section: Methodsmentioning

confidence: 99%

Impact of bariatric surgery on cardiovascular outcomes and mortality: a population-based cohort study

Singh

Subramanian

Adderley

et al. 2020

British Journal of Surgery

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“…It also mediates the activation of the hypothalamic-adrenal axis and reduces β-cell function [ 36 ]. This is indicated in the high prevalence of OSA amongst people with T2D, which has been reported to be at minimum 24%, and which can reach about 86% [ 37 ]. This is particularly alarming as OSA has been associated with increased vascular complications, as well as worse glycaemic control [ 38 , 39 , 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, T2D has also been identified as a risk factor for the development of OSA, suggesting a bidirectional relationship between T2D and OSA. In a retrospective study examining 360,250 people with T2D and 1,296,489 people without T2D, Subramanian et al showed that T2D patients are at an increased risk of OSA, especially male patients with a high BMI with diabetic foot diseases, depression, hypertension, or CVD, as well as patients taking insulin [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Targeted Metabolomics Analysis on Obstructive Sleep Apnea Patients after Multilevel Sleep Surgery

et al. 2020

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Background: Obstructive sleep apnea (OSA) is caused by partial or complete obstruction of the upper airways. Corrective surgeries aim at removing obstructions in the nasopharynx, oropharynx, and hypopharynx. OSA is associated with an increased risk of various metabolic diseases. Our objective was to evaluate the effect of surgery on the plasma metabolome. Methods: This study included 39 OSA patients who underwent Multilevel Sleep Surgery (MLS). Clinical and anthropometric measures were taken at baseline and five months after surgery. Results: The mean Apnea-Hypopnea Index (AHI) significantly dropped from 22.0 ± 18.5 events/hour to 8.97 ± 9.57 events/hour (p-Value < 0.001). Epworth’s sleepiness Score (ESS) dropped from 12.8 ± 6.23 to 2.95 ± 2.40 (p-Value < 0.001), indicating the success of the surgery in treating OSA. Plasma levels of metabolites, phosphocholines (PC) PC.41.5, PC.42.3, ceremide (Cer) Cer.44.0, and triglyceride (TG) TG.53.6, TG.55.6 and TG.56.8 were decreased (p-Value < 0.05), whereas lysophosphatidylcholines (LPC) 20.0 and PC.39.3 were increased (p-Value < 0.05) after surgery. Conclusion: This study highlights the success of MLS in treating OSA. Treatment of OSA resulted in an improvement of the metabolic status that was characterized by decreased TG, PCs, and Cer metabolites after surgery, indicating that the success of the surgery positively impacted the metabolic status of these patients.

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“…It also mediates the activation of the hypothalamic-adrenal axis and reduce β-cell function [33]. This is indicated in the high prevalence of OSA amongst people with T2D, which has been reported to be at minimum as 24% and can reach about 86% [34]. This is particularly alarming as OSA has been associated with increased vascular complications as well as worse glycaemic control [35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Metabolites Changes on Obstructive Sleep Apnea Patients After Multilevel Sleep Surgery

Alterki¹,

Joseph²,

Thanaraj³

et al. 2020

Preprint

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Background: Obstructive sleep apnea (OSA) is caused by partial or complete obstruction of the upper airways. Corrective surgeries aim at removing obstructions in the nasopharynx, oropharynx, and hypopharynx. OSA is associated with increased risk of various metabolic diseases. Our objective was to evaluate the effect of surgery on the plasma metabolome. Methods: This study included 39 OSA patients who underwent Multilevel Sleep Surgery (MLS). Clinical and anthropometric measures were taken at baseline and 5 months after surgery. Results: The mean Apnea Hypopnea Index (AHI) significantly dropped from 22.0 ± 18.5 events/hour to 8.97 ± 9.57 events/hour (p-Value <0.001). The Epworth’s sleepiness Score (ESS) dropped from 12.8 ± 6.23 to 2.95 ± 2.40 (p-Value <0.001) indicating success of the surgery in treating OSA. Plasma levels of metabolites, phosphocholines (PC) PC.41.5, PC.42.3, ceremide (Cer) Cer.44.0, and triglyceride (TG) TG.53.6, TG.55.6 and TG.56.8 were decreased (p-Value<0.05) whereas lysophosphatidylcholines (LPC) 20.0 and PC.39.3 were increased (p-Value<0.05) after surgery. Conclusion: This study highlights the success of MLS in treating OSA. Treatment of OSA resulted in improvement in metabolic status that was characterized by decreased TG, PCs and Cer metabolites post-surgery indicating that the success of the surgery positively impacted the metabolic status of these patients.

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Risk of Incident Obstructive Sleep Apnea Among Patients With Type 2 Diabetes

Cited by 67 publications

References 39 publications

Impact of bariatric surgery on cardiovascular outcomes and mortality: a population-based cohort study

Impact of bariatric surgery on cardiovascular outcomes and mortality: a population-based cohort study

Targeted Metabolomics Analysis on Obstructive Sleep Apnea Patients after Multilevel Sleep Surgery

Analysis of Metabolites Changes on Obstructive Sleep Apnea Patients After Multilevel Sleep Surgery

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