Polysomnographic predictors of incident diabetes and pre-diabetes: an analysis of the DREAM study

Wojeck, Brian S.; Inzucchi, Silvio E.; Qin, Li; Yaggi, H. Klar

doi:10.5664/jcsm.10414

Cited by 5 publications

(5 citation statements)

References 49 publications

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“…The severity of sleep-related desaturations has been shown to be more significant contributor to daytime sleepiness compared to AHI [ 25 ]. Moreover, night-time desaturation has also been shown to be associated with memory impairment in adults and increased incidence of diabetes [ 26 , 27 ]. It could be assumed that surgery induced marked decrease in desaturation time is one reason for beneficial overall effects on obesity-related comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea: The Effect of Bariatric Surgery After Five Years—A Prospective Multicenter Trial

Peromaa-Haavisto,

Luostarinen,

Juusela

et al. 2024

OBES SURG

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Background The prevalence of obstructive sleep apnea (OSA) is high among the bariatric surgery candidates. Obesity is the most important individual risk factor for OSA. The aim of this study was to investigate the effect of a laparoscopic Roux-en-Y gastric bypass (LRYGB) on OSA 5 years after the surgery. Patients and Methods In this prospective multicenter study, standard overnight cardiorespiratory recording was conducted to 150 patients at baseline prior to bariatric surgery. A total of 111 (73.3%) patients of those had OSA. Cardiorespiratory recordings at 5 years after surgery were available for 70 OSA patients. The changes in anthropometric and demographic measurements including age, weight, body mass index (BMI), and waist and neck circumference were evaluated. Also, a quality of life (QoL) questionnaire 15D administered in a baseline was controlled at 5-year follow-up visit. Results At 5-year OSA was cured in 55% of patients, but moderate or severe OSA still persisted in 20% of patients after operation. Mean total AHI decreased from 27.8 events/h to 8.8 events/h (p < 0.001) at 5-year follow-up. A clinically significant difference in QoL was seen in mobility, breathing, sleeping, usual activities, discomfort and symptoms, vitality and sexual activity. The QoL total score improved more in OSA patient at 5-year follow-up. Conclusions LRYGB is an effective treatment of OSA in obese patients and the achieved beneficial outcomes are maintained at 5-year follow-up. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea: The Effect of Bariatric Surgery After Five Years—A Prospective Multicenter Trial

Peromaa-Haavisto,

Luostarinen,

Juusela

et al. 2024

OBES SURG

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“…The link between extended sleep in rural areas and heightened dysglycemia likelihood can be attributed to multiple factors. Excessive sleeping may indicate underlying health issues, such as sleep apnea or depression, which are acknowledged risk factors for dysglycemia [ 66 , 67 ]. Furthermore, longer sleep durations could reflect a sedentary lifestyle, with diminished time dedicated to PA, thereby elevating the chances of dysglycemia.…”

Section: Discussionmentioning

confidence: 99%

Key influences on dysglycemia across Fujian’s urban-rural divide

Lin,

Hu,

Liu

et al. 2024

PLoS ONE

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Background Screening and treatment of dysglycemia (prediabetes and diabetes) represent significant challenges in advancing the Healthy China initiative. Identifying the crucial factors contributing to dysglycemia in urban-rural areas is essential for the implementation of targeted, precise interventions. Methods Data for 26,157 adults in Fujian Province, China, were collected using the Social Factors Special Survey Form through a multi-stage random sampling method, wherein 18 variables contributing to dysglycemia were analyzed with logistic regression and the random forest model. Objective Investigating urban-rural differences and critical factors in dysglycemia prevalence in Fujian, China, with the simultaneous development of separate predictive models for urban and rural areas. Result The detection rate of dysglycemia among adults was 35.26%, with rates of 34.1% in urban areas and 35.8% in rural areas. Common factors influencing dysglycemia included education, age, BMI, hypertension, and dyslipidemia. For rural residents, higher income (OR = 0.80, 95% CI [0.74, 0.87]), average sleep quality (OR = 0.89, 95% CI [0.80, 0.99]), good sleep quality (OR = 0.89, 95% CI [0.80, 1.00]), and high physical activity (PA) (OR = 0.87, 95% CI [0.79, 0.96]) emerged as protective factors. Conversely, a daily sleep duration over 8 hours (OR = 1.46, 95% CI [1.03, 1.28]) and middle income (OR = 1.12, 95% CI [1.03, 1.22]) were specific risk factors. In urban areas, being male (OR = 1.14, 95% CI [1.02, 1.26]), cohabitation (OR = 1.18, 95% CI [1.02, 1.37]), and central obesity (OR = 1.35, 95% CI [1.19, 1.53]) were identified as unique risk factors. Using logistic regression outcomes, a random forest model was developed to predict dysglycemia, achieving accuracies of 75.35% (rural) and 76.95% (urban) with ROC areas of 0.77 (rural) and 0.75 (urban). Conclusion This study identifies key factors affecting dysglycemia in urban and rural Fujian residents, including common factors such as education, age, BMI, hypertension, and dyslipidemia. Notably, rural-specific protective factors are higher income and good sleep quality, while urban-specific risk factors include being male and central obesity. These findings support the development of targeted prevention and intervention strategies for dysglycemia, tailored to the unique characteristics of urban and rural populations.

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“…Non-diabetic patients with OSA have increased levels of fasting glucose, postprandial glucose, and glycosylated hemoglobin, compared to control subjects, after adjustment for confounding factors [ 1 , 21 , 45 , 46 , 52 , 60 , 66 , 80 , 177 , 178 ]. Likewise, cross-sectional [ 1 , 43 , 179 , 180 ] and longitudinal [ 181 , 182 , 183 ] studies reveal an independent association between OSA and T2D. The prevalence of T2D is greater in OSA patients compared to control subjects, regardless of general obesity and other risk factors.…”

Section: Obstructive Sleep Apnea Is Associated With Insulin Resistanc...mentioning

confidence: 99%

“…Longitudinal studies reveal that decreased oxygen saturation at baseline predicts incident T2D at follow-up in OSA patients, after adjustment for BMI and other risk factors, suggesting that more severe hypoxemia drives insulin resistance and predisposes to T2D. Unlike the apnea-hypopnea index, the time spent with oxygen saturation of less than 90% is associated with incident diabetes in adjusted models [ 1 , 32 , 56 , 181 , 182 , 183 ].…”

Section: Oxyhemoglobin Desaturation (Leading To Tissue Hypoxia) Induc...mentioning

confidence: 99%

Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review

Adeva-Andany,

Domínguez-Montero,

Castro-Quintela

et al. 2024

Rev. Cardiovasc. Med.

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Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- ) downregulation. In human adipose tissue, PPAR- activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.

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Polysomnographic predictors of incident diabetes and pre-diabetes: an analysis of the DREAM study

Cited by 5 publications

References 49 publications

Obstructive Sleep Apnea: The Effect of Bariatric Surgery After Five Years—A Prospective Multicenter Trial

Obstructive Sleep Apnea: The Effect of Bariatric Surgery After Five Years—A Prospective Multicenter Trial

Key influences on dysglycemia across Fujian’s urban-rural divide

Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review

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