Type 2 diabetes and obstructive sleep apnea (OSA) are diseases with high prevalence and major public health impact. There is evidence that regular snoring and OSA are independently associated with alterations in glucose metabolism. Thus, OSA might be a risk factor for the development of type 2 diabetes. Possible causes might be intermittent hypoxia and sleep fragmentation, which are typical features of OSA. OSA might also be a reason of ineffective treatment of type 2 diabetes. There is further evidence that the treatment of OSA by continuous positive airway pressure (CPAP) therapy might correct metabolic abnormalities in glucose metabolism. It is assumed that this depends on therapy compliance to CPAP. On the other hand, there are also hints in the literature that type 2 diabetes per se might induce sleep apnea, especially in patients with autonomic neuropathy. Pathophysiological considerations open up new insights into that problem. Based on the current scientific data, clinicians have to be aware of the relations between the two diseases, both from the sleep medical and the diabetological point of view. The paper summarizes the most important issues concerning the different associations of OSA and type 2 diabetes.

Type 2 diabetes and obstructive sleep apnoea (OSA) are diseases with high prevalence and major public health impact. There is evidence that OSA is independently associated with alterations in glucose metabolism. Furthermore, OSA is a significant risk factor for the development of type 2 diabetes. Possible causes might be intermittent hypoxaemia and sleep fragmentation with increased oxidative stress and sympathetic activity, which are typical features of OSA. OSA might also be a reason for ineffective treatment of type 2 diabetes. There is further evidence that the treatment of OSA by continuous positive airway pressure (CPAP) therapy might improve glucose metabolism. On the other hand, there are also hints in the literature that type 2 diabetes might induce sleep apnoea, especially in patients with autonomic neuropathy, but that OSA also facilitates the development of neuropathy in terms of mutual interactions between OSA, type 2 diabetes and diabetic neuropathy. Based on the current scientific data, clinicians have to be aware of the relations between OSA and type 2 diabetes, both from the sleep medical and the diabetological point of view.

Ultrasonography is frequently used to measure the rectus femoris muscle cross-section area, and has been suggested to associate with poor health condition. However, no validation studies have been performed to compare rectus femoris muscle ultrasonography (RFMS) with anatomical planimetry when measuring the muscle cross-sectional area (CSA). This validation study compared the two methods of CSA measurement of unfixed (frozen) and fixed (unfrozen) rectus femoris muscle specimens obtained from elderly human cadavers. Agreement between tests was studied by Bland–Altman analysis. We found a significant difference between planimetry and RFMS of unfixed (frozen) muscle specimens (mean difference, -0.389 cm2; 95% CI, -0.144 to -0.634), p = 0.022. No significant difference was observed between the two methods when measuring fixed (unfrozen) muscle specimens (mean difference, 0.032 cm2, 95% CI, -0.007 to -0.070), p = 0.107. In fixed specimens, the 95% limit of agreement between the two methods ranged between 0.12 cm2 and -0.06 cm2 (<10% deviation); while in unfixed muscle specimens, the range was between 0.28 cm2 and -1.06 cm2 (~50% deviation). In light of the similar results obtained in fixed specimens, ultrasound is a safe and accurate method of rectus femoris muscle size assessment. In clinical practice, RFMS may be used to detect a decrease in rectus femoris muscle mass, typically associated with malnutrition of the elderly, and may therefore be a simple and practical tool for the screening of malnutrition.

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DefinitionUnter obstruktiver Schlafapnoe/-hypopnoe wird ein periodisches Sistieren (Apnoe) oder eine periodische Reduktion (Hypopnoe) der Atmung bedingt durch eine komplette oder inkomplette Okklusion der oberen Atemwege im Schlaf mit daraus resultierender Weckreaktion (Arousal) bei fortbestehender Aktivität der Atmungsmuskulatur verstanden (Abb.1). Ein obstruktives Schlafapnoe-Syndrom (OSAS) liegt dann vor, wenn aufgrund der schlafbezogenen Atmungsstörung Folgesymptome entstehen. Als Leitsymptome des OSAS finden sich exzessive Tagesschläfrigkeit, lautes und unregelmäßiges Schnarchen und Atemstillstände während des Schlafens (1, 12, 13). Klassifikation schlafbezogener Atmungsstörungen