The Association Between Obstructive Sleep Apnea Syndrome and Microvascular Complications in Well-Controlled Diabetic Patients

Kosseifi, Semaan G.; Bailey, Beth Nordstrom; Price, Robert M.; Roy, Thomas M.; Byrd, Ryland P.; Peiris, Alan N.

doi:10.7205/milmed-d-10-00131

Cited by 51 publications

(44 citation statements)

References 26 publications

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“…Furthermore, multifactor logistic regression analysis indicated that AHI, the gold standard for diagnosing OSAHS, was independently related to DN. These results are consistent with previous findings reported by other groups [25,26]. (2) The prevalence of DN in patients with mild OSAHS, moderate OSAHS, and severe OSAHS was higher than in patients without OSAHS; (3) AHI is positively correlated with UACR, while L-SaO 2 is negatively correlated with UACR; (4) With the increasing severity of OSAHS, patients with T2DM are more prone to affect DN.…”

Section: Discussionsupporting

confidence: 92%

Association of diabetic nephropathy with the severity of obstructive sleep apnea-hypopnea syndrome in patients with type 2 diabetes mellitus

et al. 2020

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This study aimed to analyze the effect of the severity of obstructive sleep apnea-hypopnea syndrome (OSAHS) on diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). A total of 322 patients with T2DM participated in this cross-sectional study. OSAHS was diagnosed according to the apnea-hypopnea index (AHI) and it was categorized as follows: normal, mild, moderate, and severe. Relevant clinical data retrieved from medical charts were cross-analyzed between different groups. The relationship between urinary albumin/creatinine ratio(UACR) and OSAHS parameters, which included AHI, lowest oxygen saturation (L-SaO 2 ), and mean oxygen saturation (M-SaO 2 ), was evaluated by partial correlation analysis. DN stages were classified into a non-DN group, a microalbuminuria group, and a macroalbuminuria group. Multiple factor logistic regression analysis was employed to analyze factors influencing DN. The results showed that mild OSAHS, moderate OSAHS, and severe OSAHS patients had a higher Body mass index (BMI), creatinine (CR) level, UACR, and a longer duration of T2DM (p < 0.05) than the non-OSAHS group. The prevalence of DN in the non-OSAHS, mild OSAHS, moderate OSAHS, and severe OSAHS groups was 18.4%, 19.2%, 34.6%, and 49.4%, respectively (p < 0.05). Multiple factor logistic regression analysis revealed that systolic blood pressure (SBP) (OR = 1.03), AHI (OR = 1.02), and duration of T2DM (OR = 1.04) were correlated with DN (p < 0.05). These findings revealed that OSAHS is highly prevalent in T2DM and AHI is independently associated with the presence of DN.OBSTRUCTIVE SLEEP APNEA-HYPOPNEA SYN-DROME (OSAHS) is characterized by the collapse of the upper airway, which leads to hypoxemia and sleep fragmentation. The main symptoms of OSAHS include interval snoring, periods of stopped breathing and waking up during sleep, sweating and excessive urine at night, dizziness and headache in the morning, and daytime fatigue and sleepiness. The prevalence of OSAHS was estimated to be 2-4% in 2004 [1], which increased with increasing age and diagnostic levels. Currently, the mean prevalence of OSAHS among male was 22% (9-37%), while it was 17% (4-50%) among female [2]. However, the majority of OSAHS cases have not been diagnosed and treated in a timely and effective manner.Type 2 diabetes mellitus (T2DM) is a major public health problem due to high rates of morbidity, mortality,

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Section: Discussionsupporting

confidence: 92%

Association of diabetic nephropathy with the severity of obstructive sleep apnea-hypopnea syndrome in patients with type 2 diabetes mellitus

et al. 2020

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“…In patients with type II diabetes who also have sleep apnoea with more than 5 dips per night, retinopathy is more severe and occurs earlier, than in a control groups matched for other variables [57][58][59]. Thus, even short periods of reduced oxygen supply to the retina exacerbate diabetic retinopathy.…”

Section: The Link Between Retinal Hypoxia and Retinal Damage In Diabetesmentioning

confidence: 88%

The pathogenesis of early retinal changes of diabetic retinopathy

Arden

Sivaprasad

2012

Doc Ophthalmol

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Recent successful trials of antibodies to vascular endothelial growth factor (VEGF) in diabetic retinopathy implicate this cytokine as a major cause of diabetic retinopathy (DR) and diabetic macular oedema (DME). The mechanisms which cause VEGF to be over-expressed to cause the vasculopathy are not entirely clear. This review explores the earliest changes to the retina in DR and the factors that predispose or prevent DR, including sleep apnoea, receptor degenerations laser treatment and VEGF polymorphism. The review also presents the evidence that retinal hypoxia, existing in the earliest stages, causes DR. This hypoxia is much increased by dark adaptation, indicating a new and possibly superior therapy.

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“…Several studies (n ¼ 31-92) showed that OSA and OSA severity are associated with poorer glycaemic control (HbA1c and/or fasting plasma glucose) despite adjustment for confounders (demographics, BMI, medications, exercise, diabetes duration, and total sleep time) in some studies [69,[73][74][75][76]. The adjusted mean increase in HbA1c between patients with and without OSA was 0.7-3.7% depending on the study population and OSA severity.…”

Section: Metabolic Controlmentioning

confidence: 99%