Obstructive sleep apnea:Overlooked comorbidity in patients with diabetes

In this review article,we explore the interplay between obstructive sleep apnea(OSA)and type 2 diabetes mellitus(T2DM),highlighting a significant yet often overlooked comorbidity.We delve into the pathophysiological links between OSA and diabetes,specifically how OSA exacerbates insulin resistance and disrupts glucose metabolism.The research examines the prevalence of OSA in diabetic patients and its role in worsening diabetes-related complications.Emphasizing the importance of comprehensive management,including weight control and positive airway pressure therapy,the study advocates integrated approaches to improve outcomes for patients with T2DM and OSA.This review underscores the necessity of recognizing and addressing OSA in diabetes care to ensure more effective treatment and better patient outcomes.

Intermittent hypoxia is involved in gut microbial dysbiosis in type 2 diabetes mellitus and obstructive sleep apnea-hypopnea syndrome

BACKGROUND Obstructive sleep apnea(OSA)-hypopnea syndrome(OSAHS)has been recognized as a comorbidity of type 2 diabetes mellitus(T2DM);more than half of T2DM patients suffer from OSAHS.Intermittent hypoxia(IH)plays an important role in metabolic diseases,such as obesity and OSAHS,through various mechanisms,including altering the gut microecological composition and function.Therefore,it is important to study the role of gut microbiota in T2DM patients with OSAHS,which has a high incidence and is prone to several complications.AIM To assess whether IH is involved in altering the fecal microbiome in T2DM patients with OSAHS.METHODS Seventy-eight participants were enrolled from Henan Province People’s Hospital and divided into healthy control(HC,n=26),T2DM(n=25),and T2DM+OSA(n=27)groups based on their conditions.The fecal bacterial DNA of the research participants was extracted and subjected to 16S ribosomal RNA sequencing.The clinical indices,such as insulin resistance index,homocysteine(HCY)concentration,and the concentrations of inflammatory factors in the peripheral blood,were assessed and recorded.RESULTS Group T2DM+OSA had the highest apnea-hypopnea index(AHI)(2.3 vs 3.7 vs 13.7),oxygen desaturation index(0.65 vs 2.2 vs 9.1),HCY concentration(9.6μmol/L vs 10.3μmol/L vs 13.81μmol/L)and C-reactive protein(CRP)concentrations(0.3 mg/L vs 1.43 mg/L vs 2.11 mg/L),and lowest mean oxygen saturation(97.05%vs 96.6%vs 94.7%)among the three groups.Twelve and fifteen key differences in amplicon sequence variants were identified when comparing group T2DM+OSA with groups T2DM and HC,respectively.We found progressively decreased levels of Faecalibacterium,Eubacterium,and Lachnospiraceae,and an increase in the level of Actinomyces,which strongly correlated with the HCY,CRP,fasting plasma glucose,and hemoglobin A1c concentrations,AHI,mean oxygen saturation,and insulin resistance index in group T2DM+OSA(P<0.05).CONCLUSION For T2DM patients with OSAHS,IH may be involved in selective alterations of the gut microbiota,which may affect the pathophysiological development of T2DM and DM-related complications.

Relation between the Severity of Obstructive Sleep Apnea and the Severity of Type 2 Diabetes Mellitus and Hypertension

Background: Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia, insulin resistance, and hypertension (HTN). Purpose: To evaluate if there is a relationship between the severity of OSA and the severity of type 2 diabetes mellitus (T2DM) and HTN in our patients, aiming to understand and optimize the control for comorbidities. Materials and Methods: Patients referred for polysomnography (PSG) were retrospectively recruited during the period from October 2017 to August 2020. A STOP-BANG questionnaire formed eight questions was used to assess the risk of OSAS. We divided the patients into two groups;group 1, who have snoring without T2DM, and group 2, who have snoring with T2DM. PSG was completed for all subjects and data were collected for each patient including apnoea hypopnea index (AHI), mean arterial oxygen saturation (SaO2), and Nadir SaO2 recorded during PSG. Anthropometric data, medical history, and medications for T2DM (for group 2) and HTN and HbA1c were collected (for group 2). AHI was used to evaluate the severity of OSA and its relation to T2DM and HTN. Results: The study included 300 patients who met the inclusion criteria with mean age of 49.9 ± 13.6 years. The majority of subjects (56.3%) were males and the mean body mass index (BMI) was 38.0 ± 8.4 kg/m2. Forty-two percent had HTN and 32.7% had T2DM. OSA was diagnosed in 209 patients (69.7%). OSA was more detected among those with increased age, increased BMI, and those with HTN and T2DM. The severity of both HTN and T2DM was significantly higher among patients with OSA. Conclusions: There is a relation between OSA and T2DM and HTN. The risk of OSA is higher among patients with uncontrolled T2DM and HTN. OSA should be suspected in subjects with obesity, especially with uncontrolled HTN and T2DM.

Effect of obstructive sleep apnea on type 2 diabetes mellitus:A comprehensive literature review

Obstructive sleep apnea(OSA)is frequently associated with obesity and metabolic syndrome.Also frequently associated with metabolic syndrome is type 2 diabetes mellitus(T2DM).Therefore,it is common to find OSA and T2DM together in individuals with metabolic syndrome.Additionally,both OSA and T2DM have a common pathophysiological link with development of insulin resistance.Individuals with severe insulin resistance are likely to have inadequate glycemic control.Long standing poorly controlled T2DM is associated with debilitating microvascular complications such as retinopathy,nephropathy,neuropathy and macrovascular complications such as coronary artery and cerebrovascular disease.There is extensively published literature exploring the cause-effect relationship between OSA and T2DM.In this article we provide an in-depth review of the complex pathophysiological mechanisms linking OSA to T2DM.Specifically,this review focusses on the effect of OSA on the microvascular complications of T2DM such as retinopathy,nephropathy and neuropathy.Additionally,we review the current literature on the effect of continuous positive airway pressure use in individuals with T2DM and OSA.

Diabetes, sleep apnea, obesity and cardiovascular disease: Why not address them together?

Obesity, sleep apnea, diabetes and cardiovascular diseases are some of the most common diseases encountered by the worldwide population, with high social and economic burdens. Significant emphasis has been placed on obtaining blood pressure, body mass index, and placing importance on screening for signs and symptoms pointing towards cardiovascular disease. Symptoms related to sleep, or screening for sleep apnea has been overlooked by cardiac, diabetic, pulmonary and general medicine clinics despite recommendations for screening by several societies. In recent years, there is mounting data where obesity and obstructive sleep apnea sit at the epicenter and its control can lead to improvement and prevention of diabetes and cardiovascular complications. This editorial raises questions as to why obstructive sleep apnea screening should be included as yet another vital sign during patient initial inpatient or outpatient visit.

Continuous positive airway pressure to improve insulin resistance and glucose homeostasis in sleep apnea

Obstructive sleep apnea syndrome(OSAS)is a relatively common disorder in the adult population.It is associated with alterations in glucose metabolism and increases the risk for diabetes mellitus.Continuous positive airway pressure(CPAP)is the treatment of choice for OSAS.It may also have a favorable effect on insulin resistance and glucose metabolism,although relevant data is conflicting.Additional research is still needed to fully establish the effect of CPAP on glucose homeostasis.It should ascertain which patients may benefit most and how long treatment takes to induce favorable changes.Finally,patient compliance is being appreciated as a major factor influencing therapeutic outcomes,and this needs to be further examined.

Effect of diabetes mellitus on sleep quality

Diabetes mellitus(DM) is a highly prevalent condition affecting about 347 million people worldwide. In addition to its numerous clinical implications, DM also exerts a negative effect on patient's sleep quality.Impaired sleep quality disrupts the adequate glycemic control regarded as corner stone in DM management and also lead to many deleterious effects causing a profound impact on health related quality of life. This article outlines various factors leading to impaired sleep quality among diabetics and delineates how individual factor influences sleep. The article also discusses potential interventions and lifestyle changes to promote healthy sleep among diabetics.

2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征的列线图预测模型构建

目的 构建2型糖尿病(T2DM)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的列线图预测模型。方法 选取2018年9月至2020年4月自贡市第四人民医院完成多导睡眠监测的526例T2DM患者为研究对象,并按照7∶3的比例随机分为训练组和验证组。通过对T2DM患者进行单变量和多变量的logistic回归分析,本研究确定了OSAHS的风险因素,并据此构建了一个预测模型。模型的有效性通过计算受试者工作特征曲线下的面积(AUC)、使用校正曲线和决策曲线(DCA)进行评估。结果 多因素logistic分析结果显示,体重指数(OR=1.09,95%CI:1.01~1.17)、高血压病史(OR=3.80,95%CI:3.43~4.26)、血清低密度脂蛋白(OR=1.35,95%CI:1.03~1.56)及25(OH)维生素D(OR=0.94,95%CI:0.91~0.96)水平是T2DM合并OSAHS发生的独立预测因素(P <0.05)。根据上述变量建立列线图预测模型,并在训练组和验证组中预测T2DM合并OSAHS发生的AUC分别为0.742和0.789。Hosmer-Lemeshow拟合优度检验显示模型具有较好的拟合度(P> 0.05)。DCA显示预测模型能够获得净收益的风险阈值大于0.9。结论 本研究成功建立并验证了一种性能良好的列线图预测模型,有助于提高T2DM患者合并OSAHS的早期识别和筛选能力。

Effect of Continuous Positive Airway Pressure Therapy on Glycemic Excursions and Insulin Sensitivity in Patients with Obstructive Sleep Apnea-hypopnea Syndrome and Type 2 Diabetes

Background： For patients with obstructive sleep apnea-hypopnea syndrome （OSAHS） and type 2 diabetes mellitus （T2DM）, the night sleep interruption and intermittent hypoxia due to apnea or hypopnea may induce glycemic excursions and reduce insulin sensitivity. This study aimed to investigate the effect of continuous positive airway pressure （CPAP） therapy in patients with OSAHS and T2DM. Methods： Continuous glucose monitoring system （CGMS） was used in 40 patients with T2DM and newly diagnosed OSAHS. The measurements were repeated after 30 days of CPAP treatment. Subsequently, insulin sensitivity and glycohemoglobin （HbAlc） were measured and compared to the pretreatment data. Results： After CPAP therapy, the CGMS indicators showed that the 24-h mean blood glucose （MBG） and the night time MBG were significantly reduced （P 〈 0.05 and P = 0.03, respectively）. The mean ambulatory glucose excursions （MAGEs） and the mean of daily differences were also significantly reduced （P 〈 0.05 and P = 0.002, respectively） compared to pretreatment levels. During the night, MAGE also significantly decreased （P = 0.049）. The differences between the highest and lowest levels of blood glucose over 24 h and during the night were significantly lower than prior to CPAP treatment （P 〈 0.05 and P = 0.024, respectively）. The 24 h and night time durations of high blood glucose （〉7.8 mmol/L and 〉 11.1 mmol/L） decreased （P 〈 0.05 and P 〈 0.05, respectively） after the treatment. In addition, HbA 1 c levels were also lower than those before treatment （P 〈 0.05）, and the homeostasis model assessment index of insulin resistance was also significantly lower than before CPAP treatment （P = 0.034）. Conclusions： CPAP therapy may have a beneficial effect on improving not only blood glucose but also upon insulin sensitivity in T2DM patients with OSAHS. This suggests that CPAP may be an effective treatment for T2DM in addition to intensive diabetes management.

2型糖尿病患者发生阻塞性睡眠呼吸暂停低通气综合征的影响因素分析

目的:分析2型糖尿病患者发生阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的影响因素。方法:选取2020年2月—2023年2月酒泉市人民医院收治的100例2型糖尿病患者作为研究对象,依据是否发生OSAHS分为发生组、未发生组,各50例。统计并比较两组临床资料,分析2型糖尿病患者发生OSAHS的单因素及独立影响因素。结果:发生组糖尿病病程、24 h尿微量白蛋白、糖化血红蛋白(HbA1c)、空腹血糖、平均夜间血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)、夜间血糖水平标准差(SDBG)、日间血糖平均绝对差、血糖波动系数、合并微血管并发症占比高于未发生组,差异有统计学意义(P<0.05)。糖尿病病程、HbA1c、MAGE、LAGE、SDBG、血糖波动系数是2型糖尿病患者发生OSAHS的独立影响因素(P<0.05)。结论:糖尿病病程、血糖水平、血糖波动情况是2型糖尿病患者发生OSAHS的影响因素,临床应加强血糖检测,控制血糖水平,减小血糖波动。

阻塞性睡眠呼吸暂停综合征与代谢性疾病的研究进展

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)是一种睡眠障碍性疾病,通常以睡眠期间呼吸突然暂停和睡眠节律中断为特征。OSAS病理机制与包括2型糖尿病(type 2 diabetes mellitus,T2DM)、胰岛素抵抗、非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)和肥胖在内的多种代谢性疾病密切相关。代谢性疾病参与了OSAS的发生和发展。充分认识OSAS与T2DM、高血压、NAFLD和肥胖之间的联系,对OSAS的临床诊治具有重要意义。

肠道菌群介导阻塞性睡眠呼吸暂停患者代谢及心血管异常的作用及相关机制进展

阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)是一种常见的以间歇性缺氧和睡眠片段化为主要病理特征的睡眠障碍性疾病,与高血压、动脉粥样硬化、胰岛素抵抗等多种代谢疾病的发生、发展关系密切。大量研究已发现OSA会引起肠道菌群紊乱从而对人体健康产生影响。本文就临床与动物模型中OSA引起肠道菌群紊乱以及相关代谢和心血管变化的可能机制以及由此衍生的辅助治疗新方法进行综述,旨在以肠道菌群为切入点,重新认识OSA和代谢及心血管异常之间的关系,为OSA及相关并发症的早期干预提供新思路。

糖尿病性视网膜病变危险因素的研究进展

糖尿病视网膜病变(DR)是糖尿病血管病变最严重的并发症,且在早期缺乏明确症状,现已成为中老年人群首要的致盲眼病。DR的危险因素错综复杂,其与糖尿病病程、血糖、血压、胰岛素使用、血清维生素D水平、贫血、肾功能、阻塞性睡眠呼吸暂停等有明确相关性,而与血脂、亚临床甲状腺功能减退症等因素之间的相关性仍存在争议。分析探究DR的危险因素已成为目前研究的热点,通过多方面认识DR的危险因素,可以综合管理糖尿病患者全身状况,降低DR的患病率和致盲率,提高患者生存质量。

T2DM继发周围神经病变发生风险的预测列线图模型研究

目的构建2型糖尿病(T2DM)继发周围神经病变风险的预警模型,并对该模型进行验证,旨在为临床评估T2DM继发周围神经病变提供可靠模型。方法选取2021年9月至2023年10月收治的T2DM继发周围神经病变患者100例作为观察组,选取单纯T2DM患者100例作为对照组。收集2组临床资料、骨代谢标志物,随机森林算法筛选T2DM继发周围神经病变的因素,构建T2DM继发周围神经病变风险的预警列线图模型,受试者工作特征(ROC)曲线、Hosmer-Lemeshow检验评价风险预警模型的预测能力。结果观察组病程、阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者占比、收缩压、糖化血红蛋白(HbA1c)、稳态模型胰岛素抵抗指数(HOMA-IR)、同型半胱氨酸(Hcy)高于对照组(P<0.05);观察组25-羟维生素D[25-(OH)D]、Ⅰ型前胶原N-端前肽(PⅠNP)低于对照组,β-异构C-端肽(β-CTX)高于对照组(P<0.05)。随机森林算法得出T2DM继发周围神经病变前7的重要排序变量为β-CTX、HOMA-IR、HbA1c、25-(OH)D、PⅠNP、OSAHS、Hcy。基于以上因素构建T2DM继发周围神经病变风险列线图预警模型,ROC曲线显示该模型具有较高预测能力,Hosmer-Lemeshow检验显示该模型具有良好的校准能力。结论T2DM继发周围神经病变风险的因素分别为β-CTX、HOMA-IR、HbA1c、OSAHS、Hcy、25-(OH)D、PⅠNP,基于以上因素构建列线图预警模型具有良好预测能力和校准能力,可为临床防治T2DM继发周围神经病变提供参考。

语言及视空间异常检测在中青年2型糖尿病认知功能障碍预测中的应用价值

目的观察语言及视空间异常检测在中青年2型糖尿病认知功能障碍预测中的应用价值。方法研究方法为前瞻性分析,观察对象为2022年1月至2023年6月沧州市人民医院收治入院的80例中青年2型糖尿病患者,将蒙特利尔认知评估量表(MoCA)筛查结果作为分组依据,将糖尿病合并认知功能障碍与单纯糖尿病患者分别纳入观察组(<26分,n=47)与对照组(≥26分,n=33)。记录两组受试者的性别、年龄、体重指数、血压(收缩压、舒张压)水平、文化程度、病程、合并疾病[冠心病、高血压、脑卒中、阻塞性睡眠呼吸暂停低通气综合征(OSAHS)]。检测并比较两组患者的MoCA评分、视空间及语言能力评分,分析其与中青年2型糖尿病认知功能障碍的关联性。结果两组的年龄、体重指数、文化程度、病程、合并OSAHS患者比率比较,差异均有统计学意义(P<0.05)。观察组患者MoCA评分各项目评分及总分均明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者视空间及语言能力评分均明显低于对照组,差异均有统计学意义(P<0.05)。Pearson相关系数分析发现,MoCA评分与视空间、阅读、书写、听理解、复述、语言能力总分均呈正相关(r=0.840、0.849、0.859、0.857、0.867、0.892,P<0.05)。以MoCA量表评分结果为自变量,分别以视空间评分、语言功能总评分作为因变量,进行逐步回归分析,视空间与语言功能评分对MoCA量表总分具有显著的正向预测作用(P<0.05)。结论中青年2型糖尿病患者认知功能受年龄、文化程度、病程及OSAHS的影响;且语言及视空间异常检测可作为正向预测中青年2型糖尿病认知功能受损的重要工具,具有较高临床价值。

2型糖尿病合并阻塞性睡眠呼吸暂停的临床特点分析

探讨合并阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的2型糖尿病患者的临床特点,作为进一步研究和治疗的基础。选取2016年7月—2021年3月在丽水市中心医院接受治疗的350例2型糖尿病患者为研究对象,由睡眠中心完成多导睡眠监测检查。根据睡眠呼吸暂停低通气指数(apneaHyponea index,AHI)将患者分成AHI≥15组(中重度OSA组,156例),AHI<15组(正常或轻度OSA组,194例)。对比两组患者血糖波动特点、胰岛素抵抗程度及心脑肾并发症发生率。结果显示,AHI≥15组空腹、餐后及夜间血糖偏高,血糖波动大,差异有统计学意义(P<0.05);两组胰岛素抵抗HOMA-IR值分别为3.75±1.79、2.32±1.59,提示AHI≥15组胰岛素抵抗更为严重;AHI≥15组糖尿病肾病发生率为38.5%,心脑血管病发生率为39.1%,较AHI<15组高(P<0.05)。研究发现,合并中重度OSA的糖尿病患者血糖曲线变化、夜间及空腹血糖增高,胰岛素抵抗更加明显,并发症发生风险更高,临床上需要积极干预。

Are diabetic patients being screened for sleep related breathing disorder?

Prevalence of both diabetes mellitus and obstructive sleep apnea(OSA)is high among general population.Both of these conditions are associated with significant morbidity.OSA affects approximately 25%of men and 9%of women,and its prevalence is even higher among obese,Hispanics,African American and diabetic patients.Diabetes on the other hand besides having high prevalence in general population has even higher prevalence among ethnic populations as Hispanics and African American.Despite the availability of several simple screening tools for OSA,as Berlin questionnaire,STOP-BANG questionnaire,NAMES Criteria,the utility for screening of OSA among the diabetic population remains marginal.This in turn can lead to significant morbidity and complications related to OSA as well as worsening of diabetes mellitus and increase in diabetic complications due to untreated sleep related breathing disorder.It is therefore imperative for the primary care giver to screen for OSA among the diabetic population as a part of their routine evaluation to prevent worsening of diabetes,and its cardiovascular,renal,ophthalmologic and neurological complications.

阻塞性睡眠呼吸暂停低通气综合征患者胰岛素抵抗发生机制及治疗研究进展

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种常见的慢性疾病,近年来其与2型糖尿病的关系被很多学者关注。胰岛素抵抗是将T2DM与OSAHS联系起来的关键因素。OSAHS的慢性间歇性缺氧和睡眠碎片化激活交感神经系统和下丘脑-垂体-肾上腺轴,引起全身炎症和自噬等,促进胰岛素抵抗的发展,进展为葡萄糖耐量减低,并最终导致T2DM。但OSAHS和胰岛素抵抗之间的具体通路尚不明确,需要进一步研究来验证。本文针对OSAHS患者胰岛素抵抗的发生机制以及治疗措施方面的研究进展做一综述,以期为OSAHS患者胰岛素抵抗的临床和基础研究提供参考。

卡格列净和二甲双胍在2型糖尿病合并轻度阻塞性睡眠呼吸暂停综合征中的应用效果

目的比较卡格列净和二甲双胍在2型糖尿病(T2DM)合并轻度阻塞性睡眠呼吸暂停综合征(OSAHS)中的应用效果。方法选取2020年6月至2021年6月广西壮族自治区百色市人民医院收治的60例T2DM合并轻度OSAHS患者,根据随机数字表法将其分为卡格列净组和二甲双胍组,每组30例。卡格列净组口服卡格列净,二甲双胍组口服二甲双胍,均治疗12周。比较两组治疗前后血糖指标、血脂指标、体重指数(BMI)、血压、通气功能和治疗期间不良反应发生情况。结果治疗后,两组空腹血糖、餐后2 h血糖、糖化血红蛋白、胰岛素抵抗指数均低于治疗前,差异有统计学意义(P<0.05),但两组组间比较,差异无统计学意义(P>0.05)。治疗后,两组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)均低于治疗前,高密度脂蛋白胆固醇(HDL-C)高于治疗前,且卡格列净组TC、TG、LDL-C低于二甲双胍组,HDL-C高于二甲双胍组,差异有统计学意义(P<0.05)。治疗后,卡格列净组BMI、收缩压、舒张压、呼吸紊乱指数(AHI)低于治疗前,最低经皮动脉血氧饱和度(LSpO_(2))高于治疗前,且卡格列净组BMI、收缩压、舒张压、AHI低于二甲双胍组,LSpO_(2)高于二甲双胍组,差异有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论与二甲双胍比较,卡格列净不仅有效改善T2DM合并轻度OSAHS患者血糖、血脂水平,还能有效改善血压、通气功能和减轻体重。

阻塞性睡眠呼吸暂停与单纯鼾症患者的睡眠效率与糖尿病患病率的相关性研究

目的分析睡眠效率在阻塞性睡眠呼吸暂停(obstructive sleep apnea syndrome,OSA)和单纯鼾症患者中与糖尿病(diabetes mellitus,DM)患病率的相关性。方法以2002年10月至2021年9月在首都医科大学宣武医院呼吸科睡眠医学中心接受睡眠监测的3124例患者为研究对象。所有患者根据睡眠效率比例不同分为≥85%、80%~84.9%和<80%三个等级,并以呼吸暂停低通气指数(apnea hypopnea index,AHI)≥5次/h将纳入患者分为OSA组及单纯鼾症组,以多因素Logistic模型分析睡眠效率与DM之间的相关性。结果在OSA组患者中,校正潜在混杂因素后,与睡眠效率≥85%相比,睡眠效率<80%者发生DM的概率明显升高(OR=1.563,95%CI:1.005~2.431,P=0.047),而在单纯鼾症组差异无统计学意义(OR=0.957,95%CI:0.509~1.799,P=0.891)。结论在OSA患者中,睡眠效率低的患者糖尿病的发生风险明显增加,而在单纯鼾症患者中差异无统计学意义。