Diabetes is an independent risk factor for severe nocturnal hypoxemia in obese patients. A case-control study

Albert Lecube, Gabriel Sampol, Patricia Lloberes, Odile Romero, Jordi Mesa, Cristina Hernández, Rafael Simó, Albert Lecube, Gabriel Sampol, Patricia Lloberes, Odile Romero, Jordi Mesa, Cristina Hernández, Rafael Simó

Abstract

Background: Type 2 diabetes mellitus (T2DM) and obesity have become two of the main threats to public health in the Western world. In addition, obesity is the most important determinant of the sleep apnea-hypopnea syndrome (SAHS), a condition that adversely affects glucose metabolism. However, it is unknown whether patients with diabetes have more severe SAHS than non-diabetic subjects. The aim of this cross-sectional case-control study was to evaluate whether obese patients with T2DM are more prone to severe SAHS than obese non-diabetic subjects.

Methodology/principal findings: Thirty obese T2DM and 60 non-diabetic women closely matched by age, body mass index, waist circumference, and smoking status were recruited from the outpatient Obesity Unit of a university hospital. The exclusion criteria included chronic respiratory disease, smoking habit, neuromuscular and cerebrovascular disease, alcohol abuse, use of sedatives, and pregnancy. Examinations included a non-attended respiratory polygraphy, pulmonary function testing, and an awake arterial gasometry. Oxygen saturation measures included the percentage of time spent at saturations below 90% (CT90). A high prevalence of SAHS was found in both groups (T2DM:80%, nondiabetic:78.3%). No differences in the number of sleep apnea-hypopnea events between diabetic and non-diabetic patients were observed. However, in diabetic patients, a significantly increase in the CT90 was detected (20.2+/-30.2% vs. 6.8+/-13,5%; p = 0.027). In addition, residual volume (RV) was significantly higher in T2DM (percentage of predicted: 79.7+/-18.1 vs. 100.1+/-22.8; p<0.001). Multiple linear regression analyses showed that T2DM but not RV was independently associated with CT90.

Conclusions/significance: T2DM adversely affects breathing during sleep, becoming an independent risk factor for severe nocturnal hypoxemia in obese patients. Given that SAHS is a risk factor of cardiovascular disease, the screening for SAHS in T2DM patients seems mandatory.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Marin JM, Carrizo SJ, Vicente E, Agustí AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046–1053.
    1. Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol. 2005;99:1592–1599.
    1. Tasali E, Mokhlesi B, Van Cauter E. Obstructive sleep apnea and type 2 diabetes. Interacting epidemics. Chest. 2008;133:496–506.
    1. Peltier AC, Consens FB, Sheikh K, Wang L, Song Y, et al. Autonomic dysfunction in obstructive sleep apnea is associated with impaired glucose regulation. Sleep Med. 2007;8:149–155.
    1. Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol. 2005;99:1998–2007.
    1. Vgontzas A, Legro R, Bixler E, Grayev A, Kales A, et al. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab. 2001;86:517–520.
    1. Resnick HE, Redline S, Shahar E, Gilpin A, Newman A, et al. Sleep Heart Health Study: Diabetes and sleep disturbances: findings from the Sleep Heart health Study. Diabetes Care. 2003;26:702–709.
    1. Ramadan W, Dewasmes G, Petitjean M, Wiernsperger N, Delanaud S, et al. Sleep apnea is induced by a high-fat diet and reversed and prevented by metformin in non-obese rats. Obesity (Silver Spring) 2007;15:1409–1418.
    1. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2005;28:S37–S42.
    1. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–545.
    1. Lloberes P, Sampol G, Levy G, Aristizabal D, Sagales T, et al. Influence of setting on unattended respiratory monitoring in the sleep apnoea-hypopnoea syndrome. Eur Respir J. 2001;16:530–534.
    1. Quanjer PH, Tammeling GJ, Cotes LE, Pedersen OF, Peslin R, et al. Lung volumes and forced ventilatory flows. Eur Respir J. 1996;16(suppl):41–52.
    1. Roca J, Sanchis J, Agusti-Vidal A, Segarra F, Navajas D, et al. Spirometric reference values from a Mediterranean population. Bull Eur Physiopathol Respir. 1986;22:217–224.
    1. Lavie L. Obstructive sleep apnoea syndrome. An oxidative stress disorder. Sleep Med Rev. 2003;7:35–51.
    1. Hartge MM, Unger T, Kintscher U. The endothelium and vascular inflammation in diabetes. Diab Vasc Dis Res. 2007;4:84–88.
    1. Bradley TD, Martinez D, Rutherford R, Lue F, Grossman RF, et al. Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea. J Appl Physiol. 1985;59:1364–1368.
    1. Williams S, Scharf SM. Obstructive sleep apnea, cardiovascular disease, and inflammation-is NF-kappa B the key? Sleep Breath. 2007;11:69–76.
    1. Vgontzas AN, Zoumakis E, Lin HM, Bixler EO, Trakada G, et al. Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-α antagonist. J Clin Endocrinol Metab. 2004;89:4409–4413.
    1. Ficker JH, Dertinger SH, Siegfried W, König HJ, Pentz M, et al. Obstructive sleep apnoea and diabetes mellitus: the role of cardiovascular autonomic neuropathy. Eur Respir J. 1998;11:14–19.
    1. Bottini P, Dottorini ML, Cristina Cordomi M, Casucci G, Tantucci C. Sleep-disordered breathing in nonobese diabetic subjects with autonomic neuropathy. Eur Respir J. 2003;22:654–660.
    1. Campo A, Frühbeck G, Zulueta JJ, Iriarte J, Seijo LM, et al. Hyperleptinemia, respiratory drive and hypercapnia response in obese patients. Eur Respir J. 2007;30:223–231.
    1. Hein MS, Schlenker EH, Patel KP. Altered control of ventilation in streptozotocin-induced diabetic rats. Proc Soc Exp Biol Med. 1994;207:213–219.
    1. Davis WA, Knuiman M, Kendall P, Grange V, Davis TM. Fremantle Diabetes Study: Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes: the Fremantle Study. Diabetes Care. 2004;27:752–757.
    1. Guazzi M, Oreglia I, Guazzi MD. Insulin improves alveolar-capillary membrane gas conductance in type 2 diabetes. Diabetes Care. 2002;25:1802–1806.
    1. Shinohara E, Kihara S, Yamashita S, Yamane M, Nishida M, et al. Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects. J Intern Med. 1997;241:11–18.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner