Diabetes Mellitus Prevalence and Control in Sleep-Disordered Breathing

Kent, Brian D.; Grote, Ludger; Ryan, Suzanne; Pépin, Jean‐Louis; Bonsignore, Maria R.; Tkáčová, Ružena; Saaresranta, Tarja; Verbraecken, Johan; Lévy, Patrick; Hedner, Jan; McNicholas, Walter T.

doi:10.1378/chest.13-2403

Cited by 215 publications

(143 citation statements)

References 24 publications

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“…Multiple epidemiological studies have provided evidence implicating the presence of SAS as a risk factor for insulin resistance and type 2 diabetes [9], the latter of which was reported to be associated with SAS independently of age, sex, and body habitus [10]. It has also been reported that the prevalence of type 2 diabetes increases with the severity of SAS and that the severity of SAS is associated with poor diabetic control in patients with type 2 diabetes [11]. The association between nocturnal IH and the risk of developing type 2 diabetes among community-dwelling Japanese participants was also reported [12].…”

Section: Introductionmentioning

confidence: 99%

Intermittent Hypoxia in Pancreatic beta Cells

Ota¹,

Takasawa²,

Yamauchi³

et al. 2015

Pancreat Disord Ther

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Sleep apnea syndrome (SAS) a highly prevalent disorder, and characterized by repetitive episodes of intermittent hypoxia (IH), i.e. recurrent episodes of oxygen desaturation during sleep, the development of daytime sleepiness, and deterioration in the quality of life. Multiple epidemiological studies have provided evidence implicating the presence of SAS as a risk factor for insulin resistance and type 2 diabetes and have reported that type 2 diabetes is associated with SAS independently of age, sex, and body habitus. One of the postulated mechanisms for the metabolic alterations associated with SAS is that IH leads to substantial alterations in both pancreatic β cell function and organ glucose homeostasis. On the other hand, hyperglycemia is known to increase the rate of β cell replication, which can provide an increased source of insulin to combat insulin resistance. Although accumulating evidence suggests associations between SAS and type 2 diabetes, the direct effect of IH on pancreatic β cell has been unknown. In this review, we focus on the impact of IH on pancreatic β cells, particularly β cell dysfunction and cell proliferation.

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Section: Introductionmentioning

confidence: 99%

Intermittent Hypoxia in Pancreatic beta Cells

Ota¹,

Takasawa²,

Yamauchi³

et al. 2015

Pancreat Disord Ther

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“…OSA is an independent risk factor for the development of hypertension, and appears to have independent associations with the development of atherosclerosis and diabetes mellitus prevalence and control (83)(84)(85). The potential causative role of OSA in the development of these important comorbidities is the subject of recent dedicated reviews in the Journal of Thoracic Disease (7,86), and will not be discussed in detail here.…”

Section: Conventional Ckd Risk Factors and Osamentioning

confidence: 99%

Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer

Gildeh¹,

Drakatos²,

Higgins³

et al. 2016

J. Thorac. Dis.

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Obstructive sleep apnea (OSA) causes daytime fatigue and sleepiness, and has an established relationship with cardiovascular and metabolic disease. Recent years have seen the emergence of an evidence base linking OSA with an increased risk of degenerative neurological disease and associated cognitive impairment, an accelerated rate of decline in kidney function with an increased risk of clinically significant chronic kidney disease (CKD), and with a significantly higher rate of cancer incidence and death. This review evaluates the evidence base linking OSA with these seemingly unrelated co-morbidities, and explores potential mechanistic links underpinning their development in patients with OSA, including intermittent hypoxia (IH), sleep fragmentation, sympathetic excitation, and immune dysregulation.

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“…Sleep disordered breathing is associated with increased cardiovascular morbidity and shares many of the metabolic features of DCAN [29]. Increasing severity of obstructive sleep apnea has been linked to increased prevalence, and worsened control, of the metabolic syndrome and type 2 DM [30].…”

Section: Diabetic Cardiac Autonomic Neuropathy (Dcan)mentioning

confidence: 99%

Diabetes Mellitus and the Cardiovascular System

Kolakalapudi¹,

Omar²

2015

J Endocrinol Metab

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Diabetes mellitus (DM) is an epidemic which affects close to 100 million patients worldwide; the majority being type 2 diabetes mellitus. The rising incidence has resulted in a proportional increase in the frequency of cardiovascular disease attributable to DM, as revealed by various population-based studies. Over the past 50 years, DM has been shown to be an important and independent risk factor in the development of a variety of cardiac conditions, especially vascular disease, primarily through accelerated atherosclerosis. Diabetic neuropathy is a serious complication of DM, which leads to the impairment of cardiovascular autonomic control. Diabetic cardiac autonomic neuropathy results in heart rate abnormalities, exercise intolerance, orthostatic blood pressure abnormalities, QT interval prolongation, silent ischemia and diabetic cardiomyopathy, all of which lead to increased morbidity and mortality related to diabetes. This conditions remains difficult to diagnose and treat, requiring a multifaceted approach. Inflammation appears to play a central role in accelerating many of the injurious effects of DM on the cardiovascular system. Expression of specific inflammatory markers has been directly linked to some of the known harmful effects of DM on the cardiovascular system, in addition to indirectly potentiating the deleterious effects of other major cardiovascular disease risk factors. Hyperglycemia results in increased intracellular glucose which triggers several pro-inflammatory reactions leading to the production of harmful free radicals and the formation of advanced glycation end products. These have been linked to the development of diabetic atherogenic dyslipidemia, in addition to glycation and loss of the protective effect of high density lipoproteins in diabetic subjects, thereby worsening the atherosclerotic burden in DM. Addressing hyperglycemia, therefore, is only one of many vital components in the treatment of diabetes. Traditional risk factors for heart disease and stroke tend to be further potentiated by the presence of DM, however, even after adequate control of hyperglycemia. Clinical evidence and major clinical guidelines address this conundrum by pointing out unmet needs of adequate cardiovascular protection, and call for aggressive control of risk factors in the diabetic population.

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Diabetes Mellitus Prevalence and Control in Sleep-Disordered Breathing

Cited by 215 publications

References 24 publications

Intermittent Hypoxia in Pancreatic beta Cells

Intermittent Hypoxia in Pancreatic beta Cells

Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer

Diabetes Mellitus and the Cardiovascular System

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