Sleep architecture, insulin resistance and the nasal cycle: Implications for positive airway pressure therapy

Abstract

Aim: To explore the relationship between sleep, especially sleep architecture and the nasal cycle, on insulin secretion in obstructive sleep apnoea (OSA) with comorbid metabolic disease. This review includes a discussion of the potential role of Rest-Activity-Cycler positive airway pressure (RACer-PAP), a novel non-pharmacological OSA treatment strategy. Methods:A narrative review of all the relevant papers known to the authors was conducted. This review also included results from a polysomnographic sleep clinic pilot study (n = 3) comparing sleep efficiency of RACer-PAP to nasal continuous positive airways pressure (n-CPAP) in OSA patients.Results: Metabolic disease is strongly associated with disturbed sleep. Sleep architecture influences cerebral hormonal secretion, lateral shifts in the autonomic nervous system and nasal airflow dominance. Disturbed sleep shortens short-wave sleep periods, decreasing insulin sensitivity and glucose tolerance. Improvements to metabolic function during n-CPAP treatment are inconsistent. If RACer-PAP demonstrates superior effects on sleep architecture and autonomic function, it may offer advantages in OSA patients with comorbid metabolic disease. Conclusion:Improving sleep architecture by maintaining the nasal cycle proposes a novel non-pharmacological treatment paradigm for treating OSA with comorbid metabolic disease.Research is required to demonstrate if RACer-PAP therapy influences whole night sleep architecture, sympathovagal balance and markers of metabolic disease.

Dynamics and periods in the nasal cycle during night sleep by separate measurement of nostril respiration

“…In the previous study, the author and co-authors have shown that the recovery of a sick 90-year-old woman with a stroke is accompanied by a transition to a normal nasal cycle 17 . In the case of sick patients, the study of the nasal cycle is also of interest in parallel with other already established methodologies (EEG, EOG, ECG) in the case of patients with metabolic diseases 20 .…”

Metabolic Phenotypes and Step by Step Evolution of Type 2 Diabetes: A New Paradigm

“…Therefore, a pulsatile secretory pattern plausibly is more effective in regulating blood glucose levels [7]. In addition to contributing to sympathovagal balance, there is a tight coupling between the pancreatic ultradian periodicity and the neuroendocrine, cardiovascular and autonomic nervous systems [37].…”

Repeatability characteristics of insulin response patterns and measures of insulin resistance

“…Changes to insulin responses can occur for a variety of reasons, including sub-acute illnesses, menstrual cycle, stress or even poor sleep patterns. 8,23,24 This suggests that insulin response patterning should only be conducted during times of stable clinical condition or with an understanding of these caveats. Concurrent assessment of inflammatory markers such as c-reactive protein or cortisol could also be considered.…”

“…Unlike many other biomarkers, insulin is a hormone that is secreted in response to potentially rapidly changing needs as well as the body's natural oscillations, stress, food and exercise to maintain glycaemic control. 8 This means that blood insulin levels, especially fasting insulin, are highly variable.…”