Chest
Recent Advances in Chest MedicineObstructive Sleep Apnea and Type 2 Diabetes: Interacting Epidemics
Section snippets
Evidence From Population-Based Studies
A growing number of epidemiologic studies, originating from various geographic regions and involving diverse study populations, have suggested the existence of an independent link between markers of severity of OSA and an increased risk of type 2 diabetes. The association between OSA and altered glucose metabolism is well supported by a large set of cross-sectional studies, but there are still very few longitudinal studies, which may indicate a direction of causality. In some studies, the
Evidence From Clinic-Based Studies
Clinic-based studies examining the association between OSA and glucose metabolism have consistently used laboratory polysomnography to define the presence and the severity of OSA (Table 322232425262728293031868788). In the largest clinic-based sample to date, Meslier et al22 studied 595 men who were referred to a sleep laboratory for suspected OSA. The cross-sectional data from polysomnography and 2-h OGTTs revealed that type 2 diabetes was present in 30.1% of OSA patients and 13.9% of
Effects of Continuous Positive Airway Pressure Treatment on Glucose Metabolism
Numerous studies have examined the effects of continuous positive airway pressure (CPAP) treatment on glucose metabolism both in diabetic and nondiabetic populations. There is accumulating evidence suggesting that metabolic abnormalities can be partially corrected by CPAP treatment, which supports the concept of a causal link between OSA and altered glucose control. In one study, Harsch et al32 performed a hyperinsulinemic euglycemic clamp evaluation in 40 nondiabetic patients with
Potential Mechanisms Linking OSA to Alterations in Glucose Metabolism
The pathophysiologic mechanisms leading to alterations in glucose metabolism in OSA patients are likely to be multiple. High sympathetic nervous system activity, intermittent hypoxia, sleep fragmentation and sleep loss, dysregulation of the hypothalamic-pituitary axis, endothelial dysfunction, and alterations in cytokine and adipokine release have all been proposed as potential mechanisms for abnormal glucose metabolism in OSA patients. In the following sections, we will briefly discuss the
Future Directions
There is compelling evidence that OSA represents a significant risk factor for cardiovascular disease and mortality.707172 Rapidly accumulating data from several population and clinic-based studies summarized in this article also indicate that there is an independent association between OSA and altered glucose metabolism, suggesting that OSA might be a novel risk factor for the development of type 2 diabetes. Nevertheless, it should be recognized that obesity, in particular visceral adiposity,
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