Sleep-disordered breathing, glucose intolerance, and insulin resistance

Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
Respiratory Physiology & Neurobiology (Impact Factor: 1.97). 08/2003; 136(2-3):167-78. DOI: 10.1016/S1569-9048(03)00079-X
Source: PubMed

ABSTRACT Sleep-disordered breathing (SDB) is a common condition with prevalence estimates of 2-4% in the general population. Epidemiological data suggest that SDB is an independent risk factor for cardiovascular disease. Glucose intolerance and insulin resistance are also well-recognized risk factors for the development of cardiovascular disease. A number of recent clinic-based studies suggest that, independent of obesity, SDB may adversely affect glucose tolerance and insulin sensitivity. The purpose of this study was to systematically review the evidence for the link between SDB, glucose intolerance, and insulin resistance. A MEDLINE search for SDB and metabolic disorders was performed and 24 articles that met the inclusion criteria were identified. Population-based studies indicate that habitual snoring is independently associated with glucose intolerance and insulin resistance. Studies that have used objective measures of SDB (e.g. polysomnography) provide further support for an independent link between SDB, glucose intolerance, and insulin resistance. However, studies on the treatment of SDB with continuous positive airway pressure (CPAP) have yielded inconsistent results and overall do not reveal an improvement in the metabolic disturbance after treatment. Although population-based prospective data on the metabolic implications of SDB are still lacking, current data point to an independent association between SDB and impaired glucose homeostasis. Potential mediators of this association include altered adrenergic function, the direct effects of hypoxemia on glucose regulation, and release of proinflammatory cytokines that affect metabolism.

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    • "A parallel increase in the severity of OSAS and the cardiovascular events has also been described. OSAS is often associated with cardiovascular risk factors, such as diabetes mellitus, hyperlipidemia and obesity [8]. Untreated OSAS is also associated with dysglycemia, systemic inflammation, endothelial dysfunction, platelet activation, and other cardiovascular consequences such as cardiac arrhythmias especially atrial fibrillation (AF), coronary artery disease, asymptomatic early atherosclerosis, and silent brain infarction [9]. "
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    ABSTRACT: Background In patients with Obstructive sleep apnea (OSA), the risks of fatal and non-fatal cardiovascular diseases and coronary artery disease are increased and measuring carotid intima-media thickness (CIMT) can assess these complications. Aim Studying the effect of OSA syndrome in the carotid artery wall thickness as an indicator to cardiovascular complications, and the effect of CPAP on these changes. Subjects and methods Polysomnography (PSG) was done for 45 patients; 29 patients of them proved to have OSA, and 10 obese subjects with normal PSG were included as a control group. All of them had ultrasonographic assessment of CIMT. 17 patients with OSA used CPAP overnight for 6 months and the CIMT was remeasured. Results 29 were diagnosed with OSA (12 severe, 9 moderate and 8 mild OSA). There was a highly significant difference (p < 0.01) in CIMT between patient and control groups, and also between severe and mild OSA patients with non-significant difference (p > 0.05) between severe and moderate OSA. Regarding the different risk factors predispose to atherosclerosis, only factors related to OSA syndrome were correlated with CIMT. There was a highly significant reduction (p < 0.01) in CIMT after six months of CPAP usage. Conclusions CIMT as a marker of atherosclerosis is significantly increased in patients with OSA and the use of CPAP in those patients is very important not only for improving sleep efficiency but also for reducing cardiovascular complications associated with OSAS.
    01/2013; 63(1). DOI:10.1016/j.ejcdt.2013.10.006
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    • "Findings from epidemiological studies indicate that sleep apnea is independently associated with hypertension [28] and cardiovascular disease [29]. A growing body of literature suggests that sleep apnea is associated with fasting hyperglycemia, insulin resistance, and DM [30]. "
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    ABSTRACT: Sleep needs in adults are estimated to be 7 to 8 hours per night. During the last forty years, sleep duration has decreased by about 2 hours per night, as a result of our lifestyle, workload, social activities and access to technology. There are several social, economic and public health consequences due to chronic sleep deprivation. Current data suggests that sleep deprivation as well as poor quality of sleep have an impact on the incidence and prevalence of both obesity and type 2 diabetes. Screening for sleep disorders and obstructive sleep apnea (OSA) should be routinely performed in an increased number of patients, particularly those at high risk, i.e. obese, diabetic and hypertensive patients.
    Revue médicale suisse 06/2012; 8(344):1198-200, 1202-3.
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    • "The mechanisms by which OSAS exerts its detrimental effects remain to be established, and future studies should actively pursue the identification of OSAS patients at high risk of cardiovascular diseases. Epidemiological studies have convincingly shown that type 2 diabetes is often associated with OSAS and daytime sleepiness [23] [24] [25]. For example, in a large series of OSAS patients, type 2 diabetes and impaired glucose tolerance showed a 30 and 20% prevalence, respectively [26], and studies in snorers reached similar conclusions [27] [28]. "
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    ABSTRACT: . Previous population-based studies found association between duration of sleep and cardiovascular and metabolic comorbidities. Our aim was to investigate the association between the duration of sleep and cardiovascular and metabolic comorbidities in OSAS. . The study enrolled 312 patients, who had polysomnography (PSG) during 2006-2007 and responded to a telephone-administered questionnaire providing information on characteristics of sleep on average 12 months after PSG. . Of the patients, 90 were female (28.8%), 173 (58.5) received the diagnosis of OSAS, 150 (45%) had no comorbidities, 122 had hypertension (HT), 44 had diabetes mellitus (DM), and 38 had coronary heart disease (CHD). Mean ± SD of age in years was 47.2 ± 10.6, 56.5 ± 9.3, 53.2 ± 8.9, and 59.9 ± 9.0 for the no comorbidity, HT, DM, and CHD groups, respectively. Reported duration of sleep was not associated with any of the comorbidities in the overall group. In the analysis restricted to OSAS patients, sleep duration ≤6 hours was significantly associated with CHD after the adjustment for age, gender, and other associated factors (OR: 5.8, 95% CI: 1.0-32.6). . Confirmation of the association between shorter duration of sleep and CHD will provide prognostic information and help for the management of OSAS.
    01/2012; 2012:316232. DOI:10.1155/2012/316232
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