Obstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes

Temple University, Philadelphia, Pennsylvania, USA.
Diabetes care (Impact Factor: 8.42). 03/2009; 32(6):1017-9. DOI: 10.2337/dc08-1776
Source: PubMed


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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    • "Prevalence of OSA has increased tremendously in the past few decades and this is partly due to the growing of the number of obese population (Young et al., 1993). Moreover, there is evidence that prevalence of OSA increases in patients with morbid obesity (Foster et al., 2009). "

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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.
    Full-text · Article · Aug 2014 · Respiratory Physiology & Neurobiology
    • "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.
    No preview · Article · Mar 2014 · Journal of the Nigeria Medical Association
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