Sleep-disordered breathing in nonobese diabetic subjects with autonomic neuropathy

Bottini, Paolo; Dottorini, Maurizio; Cordoni, M; Casucci, G; Tantucci, Claudio

doi:10.1183/09031936.03.00070402

Cited by 75 publications

(47 citation statements)

References 49 publications

(70 reference statements)

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“…By contrast, we did not observe periodic breathing pattern in any participant in our study. Consistent with our findings, two previous studies in patients with diabetes with autonomic neuropathy have reported a high frequency of obstructive, rather than central, respiratory events (29,30). The finding of predominantly obstructive disease in patients with diabetes has important clinical implications, as it would indicate that the available therapies to improve obstructive disease, such as positive airway pressure therapy, oral appliances, and surgical options (31), could have a significant effect on glucose control in patients with type 2 diabetes and OSA.…”

Section: Discussionsupporting

confidence: 82%

Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes

Aronsohn

Whitmore

Cauter

et al. 2010

Am J Respir Crit Care Med

400

255

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Rationale: Obstructive sleep apnea (OSA), a treatable sleep disorder that is associated with alterations in glucose metabolism in individuals without diabetes, is a highly prevalent comorbidity of type 2 diabetes. However, it is not known whether the severity of OSA is a predictor of glycemic control in patients with diabetes. Objectives: To determine the impact of OSA on hemoglobin A1c (HbA1c), the major clinical indicator of glycemic control, in patients with type 2 diabetes. Methods: We performed polysomnography studies and measured HbA1c in 60 consecutive patients with diabetes recruited from outpatient clinics between February 2007 and August 2009. Measurements and Main Results: A total of 77% of patients with diabetes had OSA (apnea-hypopnea index [AHI] >5). Increasing OSA severity was associated with poorer glucose control, after controlling for age, sex, race, body mass index, number of diabetes medications, level of exercise, years of diabetes and total sleep time. Compared with patients without OSA, the adjusted mean HbA1c was increased by 1.49% (P 5 0.0028) in patients with mild OSA, 1.93% (P 5 0.0033) in patients with moderate OSA, and 3.69% (P , 0.0001) in patients with severe OSA (P , 0.0001 for linear trend). Measures of OSA severity, including total AHI (P 5 0.004), rapid eye movement AHI (P 5 0.005), and the oxygen desaturation index during total and rapid eye movement sleep (P 5 0.005 and P 5 0.008, respectively) were positively correlated with increasing HbA1c levels. Conclusions: In patients with type 2 diabetes, increasing severity of OSA is associated with poorer glucose control, independent of adiposity and other confounders, with effect sizes comparable to those of widely used hypoglycemic drugs.

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Section: Discussionsupporting

confidence: 82%

Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes

Aronsohn

Whitmore

Cauter

et al. 2010

Am J Respir Crit Care Med

400

255

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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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“…However, insulin sensitivity improved after CPAP treatment in diabetic OSAS patients [235][236][237][238]. Sleep apnoeas are also frequent in children with type-1 diabetes [239] and adult patients with diabetic neuropathy [240,241], but this probably reflects the consequence of abnormalities of ventilatory control associated with diabetes rather than a direct effect of obstructive apnoeas [242][243][244].…”

Section: Type-2 Diabetesmentioning

confidence: 99%

Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities

Mr²

2006

European Respiratory Journal

779

479

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Considerable evidence is available in support of an independent association between obstructive sleep apnoea syndrome (OSAS) and cardiovascular disease, which is particularly strong for systemic arterial hypertension and growing for ischaemic heart disease, stroke, heart failure, atrial fibrillation and cardiac sudden death.The pathogenesis of cardiovascular disease in OSAS is not completely understood but likely to be multifactorial, involving a diverse range of mechanisms including sympathetic nervous system overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism.The present report, which arose out of a European Union Cooperation in the field of Scientific and Technical Research (COST) action on OSAS (COST B26), reviews the current evidence for an independent association and proposes research priorities to identify the underlying mechanisms involved, with a view to identifying novel therapeutic strategies.Large-scale collaborative studies of carefully defined patient populations with obstructive sleep apnoea syndrome, adequately controlled for potential confounders, are needed. Such studies carry the prospect of evaluating potential interactions between different basic mechanisms operating in obstructive sleep apnoea syndrome and cardiovascular disease, and interactions with other related disorders, such as obesity, diabetes and dyslipidaemia. Furthermore, translational studies involving cell culture and animal models linked to studies of obstructive sleep apnoea syndrome patients are necessary to integrate basic mechanisms with the clinical disorder.

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Sleep-disordered breathing in nonobese diabetic subjects with autonomic neuropathy

Cited by 75 publications

References 49 publications

Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes

Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes

Association of Sleep Apnea and Type II Diabetes

Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities

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