Article

Obstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes

Temple University, Philadelphia, Pennsylvania, USA.
Diabetes care (Impact Factor: 8.57). 03/2009; 32(6):1017-9. DOI: 10.2337/dc08-1776
Source: PubMed

ABSTRACT To assess the risk factors for the presence and severity of obstructive sleep apnea (OSA) among obese patients with type 2 diabetes.
Unattended polysomnography was performed in 306 participants.
Over 86% of participants had OSA with an apnea-hypopnea index (AHI) >or=5 events/h. The mean AHI was 20.5 +/- 16.8 events/h. A total of 30.5% of the participants had moderate OSA (15 <or= AHI <30), and 22.6% had severe OSA (AHI >or=30). Waist circumference (odds ratio 1.1; 95% CI 1.0-1.1; P = 0.03) was significantly related to the presence of OSA. Severe OSA was most likely in individuals with a higher BMI (odds ratio 1.1; 95% CI 1.0-1.2; P = 0.03).
Physicians should be particularly cognizant of the likelihood of OSA in obese patients with type 2 diabetes, especially among individuals with higher waist circumference and BMI.

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Available from: Xavier Pi-Sunyer, Aug 30, 2015
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    • "Obstructive sleep apnea (OSA) has been associated with insulin resistance, glucose intolerance, decreased insulin secretion and type 2 diabetes (Punjabi et al., 2002, 2004; Punjabi and Beamer, 2009; Pamidi et al., 2010; Pamidi and Tasali, 2012; Foster et al., 2009). OSA leads to chronic intermittent hypoxia (IH) during sleep (Gastaut et al., 1966). "
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    ABSTRACT: Obstructive sleep apnea causes intermittent hypoxia (IH) and is associated with insulin resistance and type 2 diabetes. IH increases plasma catecholamine levels, which may increase insulin resistance and suppress insulin secretion. The objective of this study was to determine if adrenal medullectomy (MED) prevents metabolic dysfunction in IH. MED or sham surgery was performed in 60 male C57BL/6J mice, which were then exposed to IH or control conditions (intermittent air) for 6 weeks. IH increased plasma epinephrine and norepinephrine levels, increased fasting blood glucose and lowered basal and glucose-stimulated insulin secretion. MED decreased baseline epinephrine and prevented the IH induced increase in epinephrine, whereas the norepinephrine response remained intact. MED improved glucose tolerance in mice exposed to IH, attenuated the impairment in basal and glucose-stimulated insulin secretion, but did not prevent IH-induced fasting hyperglycemia or insulin resistance. We conclude that the epinephrine release from the adrenal medulla during IH suppresses insulin secretion causing hyperglycemia.
    Respiratory Physiology & Neurobiology 08/2014; 203. DOI:10.1016/j.resp.2014.08.018 · 1.97 Impact Factor
    • "Studies based on full polysomnography suggest that the prevalence of OSA in type 2 DM is high. Resnick et al., in a survey of 216 diabetic men, who participated in the Sleep Heart Health Study, found that 58% of the respondents had mild OSA (AHI ≥ 5) while 24% had moderate-severe OSA (AHI > 15).16 Foster et al., also observed in an analysis of the data of 122 obese men with type 2 diabetes enrolled in the Sleep Action for Health in Diabetes (AHEAD) study trial, 86.6% of the participants had some degree of OSA.17 Similarly, Aronsohn et al., in another report based on physician diagnosed DM in a primary care setting, noted that 77% of the patients had OSA based on AHI of at least 5.18 "
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    ABSTRACT: Introduction: Obstructive sleep apnea (OSA) and Diabetes Mellitus (DM) are growing health challenges worldwide. However, the relation of OSA with type 2 diabetes is not well understood in developing countries. This study described the prevalence and predictors of OSA in type 2 DM patients using a screening questionnaire. Materials and Methods: Patients aged 40years and above with type 2 diabetes mellitus were recruited into the study consecutively from the outpatient clinics of a university hospital. They were all administered the Berlin questionnaire and the Epworth sleepiness scale (ESS) to assess the risk of OSA and the tendency to doze off, respectively. Anthropometric details like height, weight and body mass index (BMI) were measured and short-term glycaemic control was determined using fasting blood glucose. Results: A total of 117 patients with type 2 diabetes mellitus were recruited into the study. The mean (SD) age, height and BMI was 63 years (11), 160 cm (9) and 27.5 kg/ m2 (5.7), respectively. Twenty-seven percent of the respondents had a high risk for OSA and 22% had excessive daytime sleepiness denoted by ESS score above 10. In addition, the regression model showed that for every 1 cm increase in neck circumference, there is a 56% independent increase in the likelihood of high risk of OSA after adjusting for age, sex, BMI, waist, hip circumferences and blood glucose. Conclusion: Our study shows a substantial proportion of patients with type 2 diabetes may have OSA, the key predictor being neck circumference after controlling for obesity.
    Journal of the Nigeria Medical Association 03/2014; 55(1):24-8. DOI:10.4103/0300-1652.128154
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    • "The precise mechanisms linking obesity status and T2D remain unclear, but the progress of insulin resistance is considered as the key to this link [5]. Sleep problems are common among those obese subjects who are at a great risk for developing T2D [6]. The emerging evidence indicates that sleep-related problems may play a role in the development of these concurrent illnesses [7]. "
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    ABSTRACT: To examine the association between sleep disorders, obesity status, and the risk of diabetes in adults, a total of 3668 individuals aged 40+ years from the NHANES 2009-2010 without missing information on sleep-related questions, measurements related to diabetes, and BMI were included in this analysis. Subjects were categorized into three sleep groups based on two sleep questions: (a) no sleep problems; (b) sleep disturbance; and (c) sleep disorder. Diabetes was defined as having one of a diagnosis from a physician; an overnight fasting glucose > 125 mg/dL; Glycohemoglobin > 6.4%; or an oral glucose tolerance test > 199 mg/dL. Overall, 19% of subjects were diabetics, 37% were obese, and 32% had either sleep disturbance or sleep disorder. Using multiple logistic regression models adjusting for covariates without including BMI, the odds ratios (OR, (95% CI)) of diabetes were 1.40 (1.06, 1.84) and 2.04 (1.40, 2.95) for those with sleep disturbance and with sleep disorder, respectively. When further adjusting for BMI, the ORs were similar for those with sleep disturbance 1.36 (1.06, 1.73) but greatly attenuated for those with sleep disorders (1.38 [0.95, 2.00]). In conclusion, the impact of sleep disorders on diabetes may be explained through the individuals' obesity status.
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