Obstructive sleep apnea: Role in the risk and severity of diabetes

doi:10.1016/j.beem.2010.08.009

Best Practice & Research Clinical Endocrinology & Metabolism

Volume 24, Issue 5, October 2010, Pages 703-715

https://doi.org/10.1016/j.beem.2010.08.009 Get rights and content

Obstructive sleep apnea (OSA) is a treatable sleep disorder that is pervasive among overweight and obese individuals. Current evidence supports a robust association between OSA and insulin resistance, glucose intolerance and the risk of type 2 diabetes, independent of obesity. Up to 83% of patients with type 2 diabetes suffer from unrecognized OSA and increasing severity of OSA is independently associated with poorer glucose control. Evidence from animal and human models that mimic OSA supports a potential causal role for OSA in altered glucose metabolism. Robust prospective and randomized clinical trials are still needed to test the hypothesis that effective treatment of OSA may prevent the development of type 2 diabetes and its complications, or reduce its severity. Type 2 diabetes is occurring at alarming rates worldwide and despite available treatment options, the economic and public health burden of this epidemic remains enormous. OSA might represent a novel, modifiable risk factor for the development of prediabetes and type 2 diabetes.

Section snippets

OSA: definition, diagnosis and treatment

OSA is characterized by repetitive upper airway closures or partial collapses that occur during sleep. These respiratory disturbances have two main consequences: 1) intermittent hypoxia which is characterized by cyclic hypoxic episodes alternating with periods of normoxia 2) transient arousals which restore airflow but lead to sleep fragmentation and poor sleep quality. Clinical characteristics of OSA may variably include daytime symptoms such as excessive sleepiness, fatigue, impaired

Prevalence of OSA in type 2 diabetics

When the prevalence of OSA in patients with type 2 diabetes was assessed by methods other than the gold standard full PSG (e.g., limited PSG or overnight oximetry), estimates have been highly variable, ranging from 2 to 70%.30, 31, 32, 33 One study using limited PSG found a higher OSA prevalence in diabetics as compared to non-diabetics, but both groups had a very low prevalence.³²

To date, four studies including a total number of nearly 900 type 2 diabetic patients have reported a striking

Insulin resistance and glucose intolerance in patients with OSA

Numerous population and clinic-based cross-sectional studies have consistently found a robust independent association between the presence and severity of OSA and insulin resistance and glucose intolerance. A comprehensive review of the details of all these studies is beyond the scope of this article, but has been the topic of recent reviews.14, *15, *16, *17, 18 Notably, the majority of these studies were conducted in men. The most commonly used markers of severity of OSA were AHI and the

Mechanistic pathways linking OSA to insulin resistance and glucose intolerance

The potential mechanisms linking OSA and alterations in glucose metabolism are likely to be multiple. OSA is intrinsically associated with chronic intermittent hypoxia and sleep fragmentation, both of which could potentially be detrimental to glucose metabolism via intermediate mechanisms including activations of sympathetic nervous system, hypothalamic-pituitary axis and inflammatory pathways.¹⁶

Animal models mimicking OSA have used intermittent hypoxia stimuli when rodents are most likely to

Acknowledgements

The authors would like to acknowledge the grant support from the National Institutes of Health P01 AG11412, R01 HL086459, and RC1HL100046-01.

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To examine whether built environment and food metrics are associated with glycemic control in people with type 2 diabetes.
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Patients (mean age = 59.4 SD = 13.2, 49.5% female, 16.6% Asian, 9.8% Black, 5.5% Latino/Hispanic, 57.1% White, 20% insulin dependent, mean BMI = 32.7±7.7) had an average of 6 HbA1c measures available. Participants in the 1st tertile of residential density (lowest) had a greater decline in HbA1c (−0.42, −0.43, and −0.44 in years 1, 3, and 5 respectively) than those in the 3rd tertile (HbA1c = −0.37 at 1- and 3-years and −0.36 at 5-years; all p-values <0.05). Having any supermarkets within 1600 m of home was associated with a greater decrease in HbA1c at 1-year and 3-years compared to having none (all p-values <0.05).
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The aim was to design a meta-analysis evaluating the positron emission tomography (PET) uptake and cerebrospinal fluid (CSF), circulating levels of amyloid-β (Aβ), and tau proteins OSA group versus control group, as well as the association of these biomarkers with the severity of OSA.
Four databases were searched until April 17, 2023, without any restrictions. The effect sizes were the standardized mean difference (SMD) along with a 95% confidence interval (CI).
A total of 21 articles were entered into the meta-analysis. The pooled SMDs of the CSF levels in OSA adults compared to controls were: –0.82 (P = 0.004) for Aβ42, –1.13 (P < 0.001) for Aβ40, 0.17 (P = 0.23) for p-tau, 0.04 (P = 0.65) for t-tau, 0.08 (P = 0.89) for Aβ42/Aβ40 ratio, and 0.81 (P = 0.001) for t-tau/Aβ42 ratio. The pooled SMD for the PET uptake of Aβ burden in OSA adults compared to controls was 0.30 (P = 0.03). The pooled SMDs of the circulating levels in OSA adults compared to controls were: 0.67 (P = 0.002) for Aβ42, 0.11 (P = 0.82) for Aβ40, 0.35 (P = 0.06) for p-tau, and 1.41(P = 0.005) for t-tau. The pooled SMDs for levels of Aβ42, Aβ40, total Aβ, p-tau, t-tau, and Aβ42/Aβ40 ratio in severe OSA adults compared to mild/moderate OSA adults were –0.15 (P = 0.33), 0.25 (P = 35), 0.04 (P = 87), –2.53 (P = 0.24), –0.24 (P = 0.52), and –0.28 (P = 0.30), respectively.
The results indicated that CSF levels of Aβ42 and Aβ40 in OSA adults were significantly lower, but the CSF level of t-tau/Aβ42 ratio and PET Aβ burden uptake in OSA adults significantly were higher than in controls.
Role of obstructive sleep apnea in metabolic risk in PCOS
2021, Current Opinion in Endocrine and Metabolic Research
Women with polycystic ovary syndrome (PCOS) have a substantially increased risk for diabetes and cardiovascular disease. Obstructive sleep apnea (OSA) is the most common sleep disorder in PCOS. Recent population-based studies indicate a high incidence of OSA among adult women with PCOS. Obesity and increasing age are the main factors for this association. There is strong evidence indicating that OSA is an important modulator of metabolic risk in the general population. There is also some evidence to suggest that OSA may contribute to insulin resistance and glucose intolerance among women PCOS, and thus increase their metabolic risk. The potential mechanisms for adverse metabolic consequences of OSA are likely to be multiple. Whether treatment of OSA in PCOS improves metabolic outcomes requires further rigorous research.
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2Obstructive sleep apnea: Role in the risk and severity of diabetes

Section snippets

OSA: definition, diagnosis and treatment

Prevalence of OSA in type 2 diabetics

Insulin resistance and glucose intolerance in patients with OSA

Mechanistic pathways linking OSA to insulin resistance and glucose intolerance

Acknowledgements

Lancet

Journal of the American College of Cardiology

Chest

Clinics in Chest Medicine

Respiratory Medicine

Chest

Diabetes Research and Clinical Practice

Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

Diabetes Research And Clinical Practice

The American Journal of Medicine

Respiratory Medicine

Diabetes Research and Clinical Practice

Chest

Sleep Medicine

Sleep Medicine

Chest

Sleep Medicine

Sleep Medicine

Translational Research: the Journal of Laboratory and Clinical Medicine

Chest

The occurrence of sleep-disordered breathing among middle-aged adults

The New England Journal of Medicine

Epidemiology of obstructive sleep apnea: a population health perspective

American Journal of Respiratory and Critical Care Medicine

Excess weight and sleep-disordered breathing

Journal of Applied Physiology

Longitudinal study of moderate weight change and sleep-disordered breathing

The Journal of the American Medical Association

Progression and regression of sleep-disordered breathing with changes in weight: the sleep heart health study

Archives of Internal Medicine

National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007

Standards of medical care in diabetes–2009

Diabetes Care

Impaired fasting glucose and impaired glucose tolerance: implications for care

Diabetes Care

The insulin resistance syndrome: physiological considerations

Diabetes & Vascular Disease Research : Official Journal of The International Society of Diabetes and Vascular Disease

Sleep disordered breathing and mortality: eighteen-year follow-up of the wisconsin sleep cohort

Sleep

Obstructive sleep apnea as a risk factor for stroke and death

The New England Journal of Medicine

Obstructive sleep apnea and metabolic syndrome: alterations in glucose metabolism and inflammation

Proceedings of the American Thoracic Society

Metabolic consequences of sleep-disordered breathing

ILAR Journal/National Research Council, Institute of Laboratory Animal Resources

Sleep, sleep-disordered breathing and metabolic consequences

The European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology

Disorders of glucose metabolism in sleep apnea

Journal of Applied Physiology

The gender bias in sleep apnea diagnosis. are women missed because they have different symptoms?

Archives of Internal Medicine

The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specification

Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task force of the American Academy of Sleep Medicine

Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine

Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome

Annals of Internal Medicine

A survey screen for prediction of apnea

Sleep

Adherence to continuous positive airway pressure therapy: the challenge to effective treatment

Proceedings of the American Thoracic Society

Adherence to positive airway pressure therapy

Current Opinion in Pulmonary Medicine

Sleep breathing disorders

2
Obstructive sleep apnea: Role in the risk and severity of diabetes