Sleep Apnea and its Association with the Stress System, Inflammation, Insulin Resistance and Visceral Obesity

Trakada, Georgia; Chrousos, George P.; Pejovic, Slobodanka; Vgontzas, Alexandros N.

doi:10.1016/j.jsmc.2007.04.003

Cited by 46 publications

(36 citation statements)

References 101 publications

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“…The significant correlations between serum A-FABP levels and insulin resistance remained after adjustment for obesity, simulating the finding in animal experiments that serum A-FABP deficiency protected against development of insulin resistance, independent of the effects of obesity [14]. An independent association between OSA and insulin resistance has been reported and multiple mechanisms may be involved, in particular intermittent hypoxia, sleep fragmentation, sympathetic overactivity or even activation of the hypothalamic pituitary axis [3,29,30]. Multiple biomediators may be involved and A-FABP may well be one of them.…”

Section: Discussionsupporting

confidence: 58%

Serum adipocyte-fatty acid binding protein level is elevated in severe OSA and correlates with insulin resistance

Lam¹,

Xu²,

Lam³

et al. 2008

European Respiratory Journal

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Obstructive sleep apnoea (OSA) is associated with insulin resistance and metabolic syndrome. There is evidence that adipocyte-fatty acid binding protein (A-FABP) may be involved in the development of cardiometabolic dysfunction. The present authors hypothesise that A-FABP is upregulated in OSA.A total of 124 males without hypertension, diabetes mellitus, hyperlipidaemia or cardiovascular disease were recruited and underwent polysomnography. Serum A-FABP levels showed significant positive correlations with duration of oxygen desaturation and minimal oxygen saturation, fasting insulin and insulin resistance index by homeostasis model assessment. When subjects were divided into tertiles according to apnoea/hypopnoea index (AHI), serum A-FABP levels were significantly higher in the group with AHI o34.4 events?h -1 than the groups with AHI 13.2-34.4 events?h -1 or with AHI ,13.2 events?h -1 . Serum A-FABP levels were significantly higher in the AHI o34.4 group than obesity-matched subjects with AHI ,34.4 events?h -1 .Serum adipocyte-fatty acid binding protein levels correlated with obstructive sleep apnoea and insulin resistance, independently of obesity, and were significantly higher in severe obstructive sleep apnoea. Adipocyte-fatty acid binding protein may play a role in obstructive sleep apnoea and metabolic dysfunction.

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Section: Discussionsupporting

confidence: 58%

Serum adipocyte-fatty acid binding protein level is elevated in severe OSA and correlates with insulin resistance

Lam¹,

Xu²,

Lam³

et al. 2008

European Respiratory Journal

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“…One potential mediating mechanism is the elevation of sympathetic activity [33]. Our regression analysis for predictors of changes in insulin sensitivity at 1 week supported this postulated mechanism, albeit the regression model indicated that it only accounted for a small degree of the variance.…”

Section: Discussionmentioning

confidence: 53%

“…Although the physical mass is static, the composites of adiposity might have changed at the molecular levels after treatment. A number of inflammatory and neurohumoral mediators are produced from the adipose tissues, especially from the visceral adipose tissues which have been demonstrated to be involved in the pathogenesis of insulin resistance [33,36]. With the application of nCPAP treatment in the obese apnoeic group, the changes of these mediators and, hence, insulin sensitivity might have been more pronounced than the nonobese apnoeic group.…”

Section: Sleep-related Disordersmentioning

confidence: 99%

A randomised controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea

Lam¹,

Lam²,

Yao³

et al. 2009

European Respiratory Journal

152

128

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The effects of treatment of obstructive sleep apnoea (OSA) on glucose metabolism have been investigated previously with conflicting results. This study evaluated the impact of nasal continuous positive airway pressure (nCPAP) treatment of OSA on insulin sensitivity.Males with moderate/severe OSA and no significant comorbidity were randomised to a therapeutic or sham nCPAP treatment group for 1 week and then reassessed. Those who received therapeutic nCPAP were further evaluated at 12 weeks. Insulin sensitivity (Kitt) was estimated by the short insulin tolerance test. Other evaluations included blood pressure, metabolic profile, urinary catecholamines and intra-abdominal fat.In total, 61 Chinese subjects were randomised. 31 subjects receiving therapeutic nCPAP showed an increase in Kitt (6.6¡2.9 to 7.6¡3.2 %?min -1 ; p50.017), while the 30 patients on sham CPAP had no significant change, and the changes in Kitt were different between the two groups (p50.022). At 12 weeks, improvement in Kitt was seen in 20 subjects with BMI o25 kg?m -2(median (interquartile range) 28.3 (26.6-31.5); p50.044), but not in the nine subjects with BMI,25 kg?m -2 , or the entire group.The findings indicate that therapeutic nCPAP treatment of OSA for 1 week improved insulin sensitivity in nondiabetic males, and the improvement appeared to be maintained after 12 weeks of treatment in those with moderate obesity.

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“…Due to its association with chronic somatic diseases, UARS has been postulated to activate the hypothalamicpituitary-adrenal axis (HPA) (Gold 2010), although not all studies support the association of sleep disordered breathing with these somatic functional disorders. (Vgontzas & FernandezMendoza 2011, Trakada 2007. A number of studies compare the clinical characteristics of UARS patients to those of SAHS subjects.…”

Section: Symptomsmentioning

confidence: 99%

Upper Airway Resistance Syndrome - A Twenty-Five Years Experience

Campo¹,

Albi²,

Sanz³

2012

Sleep Disorders

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Sleep Apnea and its Association with the Stress System, Inflammation, Insulin Resistance and Visceral Obesity

Cited by 46 publications

References 101 publications

Serum adipocyte-fatty acid binding protein level is elevated in severe OSA and correlates with insulin resistance

Serum adipocyte-fatty acid binding protein level is elevated in severe OSA and correlates with insulin resistance

A randomised controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea

Upper Airway Resistance Syndrome - A Twenty-Five Years Experience

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