Meta-analyses of the Association of Sleep Apnea with Insulin Resistance, and the Effects of CPAP on HOMA-IR, Adiponectin, and Visceral Adipose Fat

Iftikhar, Imran H.; Hoyos, Camilla M.; Phillips, Craig L.; Magalang, Ulysses J.

doi:10.5664/jcsm.4610

Cited by 108 publications

(82 citation statements)

References 62 publications

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“…Increased fatty acid-triacylglycerol cycling may alter fat distribution - shifting fat from subcutaneous to visceral depots, to the liver, or into circulating lipoproteins. Some [67–70] but not other studies [71, 72] have shown regression of visceral adiposity in OSA patients after chronic CPAP therapy. In terms of hepatic fat, OSA is associated with non-alcoholic fatty liver disease [73–77].…”

Section: Empirical Datamentioning

confidence: 99%

Sleep apnea: An overlooked cause of lipotoxicity?

Younas

Jun

2017

Medical Hypotheses

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Obstructive sleep apnea (OSA) is a common sleep disorder associated with diabetes and cardiovascular disease. However, the mechanisms by which OSA causes cardiometabolic dysfunction are not fully elucidated. OSA increases plasma free fatty acids (FFA) during sleep, reflecting excessive adipose tissue lipolysis. In animal studies, intermittent hypoxia simulating OSA also increases FFA, and the increase is attenuated by beta-adrenergic blockade. In other contexts, excessive plasma FFA can lead to ectopic fat accumulation, insulin resistance, vascular dysfunction, and dyslipidemia. Herein, we propose that OSA is a cause of excessive adipose tissue lipolysis contributing towards systemic “lipotoxicity”. Since visceral and upper-body obesity contributes to OSA pathogenesis, OSA-induced lipolysis may further aggravate the consequences of this metabolically harmful state. If this hypothesis is correct, then OSA may represent a reversible risk factor for cardio-metabolic dysfunction, and this risk might be mitigated by preventing OSA-induced lipolysis during sleep.

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Section: Empirical Datamentioning

confidence: 99%

Sleep apnea: An overlooked cause of lipotoxicity?

Younas

Jun

2017

Medical Hypotheses

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“…17 Randomized, controlled trials have shown that treatment with continuous positive airway pressure (CPAP) lowers systolic blood pressure by 2 to 3 mm Hg in patients with normotensive obstructive sleep apnea 18 and by 6 to 7 mm Hg in patients with resistant hypertension, 19 improves endothelial function, 20 and increases insulin sensitivity. 21 Observational clinical studies have shown that the use of CPAP is associated with lower rates of cardiovascular complications and of death from cardiovascular causes, especially among patients who are adherent to treatment. 10,13 Obstructive sleep apnea is a common condition among patients with cardiovascular disease, affecting 40 to 60% of such patients.…”

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confidence: 99%

CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea

et al. 2016

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BACKGROUNDObstructive sleep apnea is associated with an increased risk of cardiovascular events; whether treatment with continuous positive airway pressure (CPAP) prevents major cardiovascular events is uncertain. METHODSAfter a 1-week run-in period during which the participants used sham CPAP, we randomly assigned 2717 eligible adults between 45 and 75 years of age who had moderate-tosevere obstructive sleep apnea and coronary or cerebrovascular disease to receive CPAP treatment plus usual care (CPAP group) or usual care alone (usual-care group). The primary composite end point was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack. Secondary end points included other cardiovascular outcomes, health-related quality of life, snoring symptoms, daytime sleepiness, and mood. RESULTSMost of the participants were men who had moderate-to-severe obstructive sleep apnea and minimal sleepiness. In the CPAP group, the mean duration of adherence to CPAP therapy was 3.3 hours per night, and the mean apnea-hypopnea index (the number of apnea or hypopnea events per hour of recording) decreased from 29.0 events per hour at baseline to 3.7 events per hour during follow-up. After a mean follow-up of 3.7 years, a primary end-point event had occurred in 229 participants in the CPAP group (17.0%) and in 207 participants in the usual-care group (15.4%) (hazard ratio with CPAP, 1.10; 95% confidence interval, 0.91 to 1.32; P = 0.34). No significant effect on any individual or other composite cardiovascular end point was observed. CPAP significantly reduced snoring and daytime sleepiness and improved health-related quality of life and mood. 920T h e ne w e ngl a nd jou r na l o f m e dicine O bstructive sleep apnea causes episodic hypoxemia and nocturnal sympathetic nervous system activation 1 and elevates blood pressure 2 and markers of oxidative stress, inflammation, and hypercoagulation. 3,4

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“…85 Other uncontrolled/observational studies suggested beneficial effects of CPAP on ED, and RCTs showed that sildenafil was superior to CPAP for managing ED. 84,[86][87][88] Impact of CPAP on glucose metabolism, CVD and QoL CPAP improved insulin sensitivity in patients with and without T2D in non-randomised trials 89,90 and in meta-analyses, 89,91,92 especially for patients using CPAP >4 hours/night. 93 Uncontrolled studies in patients with T2D89, [94][95][96][97] showed that CPAP improves postprandial hyperglycaemia, 94 glycaemic variability 95 and/or HbA1c .…”

Section: Osa Is Associated With Erectile Dysfunctionmentioning

confidence: 99%

Obstructive sleep apnoea: a diabetologist’s perspective

Tahrani

2016

Br J Diabetes

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Obstructive sleep apnoea (OSA) is very common in patients with type 2 diabetes (T2D), which is unsurprising given that obesity is a major risk factor for both conditions. OSA has been associated with impaired quality of life, many cardiovascular disease (CVD) risk factors and cardiovascular disease in general. Continuous positive airway pressure treatment has beneficial impacts on CVD risk factors and CVD. However, the true impact of OSA in patients with T2D remains unclear. The International Diabetes Federation recommended routine screening for OSA in patients with T2D, but two-thirds of diabetes healthcare professionals were unaware of these recommendations. The aim of this review is to attempt to answer the following questions. Is OSA diagnosis and treatment important in patients with T2D and why? What is the relevance of OSA to the practising diabetologist? Br J Diabetes 2016;16:107-113

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Meta-analyses of the Association of Sleep Apnea with Insulin Resistance, and the Effects of CPAP on HOMA-IR, Adiponectin, and Visceral Adipose Fat

Cited by 108 publications

References 62 publications

Sleep apnea: An overlooked cause of lipotoxicity?

Sleep apnea: An overlooked cause of lipotoxicity?

CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea

Obstructive sleep apnoea: a diabetologist’s perspective

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