Title: Impact of Obstructive Sleep Apnoea on Blood Glucose Control and Pulmonary Functions in Type 2 Diabetes mellitus

Author: Latha Sannasi

 DOI: https://dx.doi.org/10.18535/jmscr/v7i9.33

Abstract

    

Background: Obstructive sleep apnoea (OSA) has an increased prevalence in type 2 Diabetes mellitus (T2DM) .OSA as a co morbid condition in T2DM is associated with insulin resistance. Type 2 Diabetes mellitus is associated with many systemic complications and it includes involvement of lungs also  .OSA is asymptomatic disorder which is  not routinely screened in T2DM.OSA and lung involvement in diabetes are associated with poor oxygen saturation of blood. The impact of OSA in blood glucose control and pulmonary functions are poorly studied

Methods: This prospective cross sectional study was conducted on T2DM patients in a tertiary care hospital.  About 104 T2DM patients recruited from department of general medicine. Stop Bang questionnaire was used evaluate the presence of OSA. Pulmonary function test assessed with computerized spirometer. The Patient’s FBS, PPBS HbA1c and anthropometry were measured. Based on the presences of OSA, T2D Patients grouped in to two categories. Group 1 -T2 DM with OSA and group 2 T2DM without OSA. Influence of OSA  on blood glucose studied by comparing  the variables between two groups

Results: A total of 104 T2DM studied .A total of 52 patients in the OSA group and 52 in Non-OSA group were encountered.OSA scores showed a positive correlation with weight and duration of diabetes and a negative correlation with FEV1 and PEFR

Conclusions: Obstructive sleep apnoea thus causes an impairment in the blood glucose control. OSA may cause a   decreases in  the pulmonary functions

Keywords: OSA, T2DM, HbA1c, PFT, FBS, PPBS, Waist circumference and Duration of Diabetes.

References

  1. Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. Journal of the American College of Cardiology. 2013;62(7):569-76. Epub 2013/06/19.
  2. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. American journal of respiratory and critical care medicine. 2002;165(5):670-6. Epub 2002/03/05.
  3. Pillai A, Warren G, Gunathilake W, Idris I. Effects of sleep apnea severity on glycemic control in patients with type 2 diabetes prior to continuous positive airway pressure treatment. Diabetes technology & therapeutics. 2011;13(9):945-9. Epub 2011/07/01.
  4. Gallegos L, Dharia T, Gadegbeku AB. Effect of continuous positive airway pressure on type 2 diabetes mellitus and glucose metabolism. Hospital practice (1995). 2014;42(2):31-7. Epub 2014/04/29.
  5. Kopf S, Groener JB, Kender Z, Fleming T, Brune M, Riedinger C, et al. Breathlessness and Restrictive Lung Disease: An Important Diabetes-Related Feature in Patients with Type 2 Diabetes. Respiration; international review of thoracic diseases. 2018;96(1):29-40. Epub 2018/06/07.
  6. Silva JLRJ, Conde MB, Correa KS, Rabahi H, Rocha AA, Rabahi MF. Sleep-disordered breathing in patients with COPD and mild hypoxemia: prevalence and predictive variables. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia. 2017;43(3):176-82. Epub 2017/07/27.
  7. Tasali E, Mokhlesi B, Van Cauter E. Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest. 2008;133(2):496-506. Epub 2008/02/07.
  8. Tanno S, Tanigawa T, Saito I, Nishida W, Maruyama K, Eguchi E, et al. Sleep-related intermittent hypoxemia and glucose intolerance: a community-based study. Sleep medicine. 2014;15(10):1212-8. Epub 2014/08/27.
  9. Komatsu WR, Barros Neto TL, Chacra AR, Dib SA. Aerobic exercise capacity and pulmonary function in athletes with and without type 1 diabetes. Diabetes care. 2010;33(12):2555-7. Epub 2010/09/03.
  10. Leuenberger UA, Hogeman CS, Quraishi SA, Linton-Frazier L, Gray KS. Short-term intermittent hypoxia enhances sympathetic responses to continuous hypoxia in humans. Journal of applied physiology (Bethesda, Md : 1985). 2007;103(3):835-42. Epub 2007/06/09.
  11. Sherwani SI, Aldana C Fau - Usmani S, Usmani S Fau - Adin C, Adin C Fau - Kotha S, Kotha S Fau - Khan M, Khan M Fau - Eubank T, et al. Intermittent hypoxia exacerbates pancreatic beta-cell dysfunction in A mouse model of diabetes mellitus. (1550-9109 (Electronic)).
  12. Polak J, Shimoda LA, Drager LF, Undem C, McHugh H, Polotsky VY, et al. Intermittent hypoxia impairs glucose homeostasis in C57BL6/J mice: partial improvement with cessation of the exposure. Sleep. 2013;36(10):1483-90; 90A-90B. Epub 2013/10/02.
  13. S A Fau - S M, S M Fau - P G, P G Fau - C R, C R. Alveolar Gas Exchange and Pulmonary Functions in Patients with Type II Diabetes Mellitus. (2249-782X (Print)).
  14. Sinha S, Guleria R, Misra A, Pandey RM, Yadav R, Tiwari S. Pulmonary functions in patients with type 2 diabetes mellitus & correlation with anthropometry & microvascular complications. The Indian journal of medical research. 2004;119(2):66-71. Epub 2004/04/02.
  15. Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S, et al. Validation of the STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea among Different Populations: A Systematic Review and Meta-Analysis. PloS one. 2015;10(12):e0143697. Epub 2015/12/15.
  16. Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes care. 2003;26(11):3160-7. Epub 2003/10/28.
  17. Tom C, Roy B, Vig R, Kang DW, Aysola RS, Woo MA, et al. Correlations between Waist and Neck Circumferences and Obstructive Sleep Apnea Characteristics. Sleep and vigilance. 2018;2(2):111-8. Epub 2019/01/15.
  18. Deol R, Lee KA, Kandula NR, Kanaya AM. Risk of Obstructive Sleep Apnoea is Associated with Glycaemia Status in South Asian Men and Women in the United States. Obesity medicine. 2018;9:1-6. Epub 2018/01/23.
  19. Ficker JH, Dertinger SH, Siegfried W, Konig HJ, Pentz M, Sailer D, et al. Obstructive sleep apnoea and diabetes mellitus: the role of cardiovascular autonomic neuropathy. The European respiratory journal. 1998;11(1):14-9. Epub 1998/05/16.
  20. Rojas A, Morales MA. Advanced glycation and endothelial functions: a link towards vascular complications in diabetes. Life sciences. 2004;76(7):715-30. Epub 2004/12/08.
  21. Viswanathan V, Ramalingam IP, Ramakrishnan N. High Prevalence of Obstructive Sleep Apnea among People with Type 2 Diabetes Mellitus in a Tertiary Care Center. The Journal of the Association of Physicians of India. 2017;65(11):38-42. Epub 2018/01/13.
  22. Stamatakis K, Sanders MH, Caffo B, Resnick HE, Gottlieb DJ, Mehra R, et al. Fasting glycemia in sleep disordered breathing: lowering the threshold on oxyhemoglobin desaturation. Sleep. 2008;31(7):1018-24. Epub 2008/07/26.
  23. Mirrakhimov AE. Chronic obstructive pulmonary disease and glucose metabolism: a bitter sweet symphony. Cardiovascular diabetology. 2012;11:132. Epub 2012/10/30.
  24. Fujimoto K, Yamazaki H, Uematsu A. Instability of nocturnal parasympathetic nerve function in patients with chronic lung disease with or without nocturnal desaturation. International journal of chronic obstructive pulmonary disease. 2018;13:2841-8. Epub 2018/09/22.
  25. Martinez-Ceron E, Fernandez-Navarro I, Garcia-Rio F. Effects of continuous positive airway pressure treatment on glucose metabolism in patients with obstructive sleep apnea. Sleep medicine reviews. 2016;25:121-30. Epub 2015/07/07.
  26. Orth M, Rasche K, Bauer TT, Duchna HW, Kollhosser P, Schultze-Werninghaus G. [Incidence of chronic obstructive respiratory tract disease in patients with obstructive sleep apnea]. Pneumologie (Stuttgart, Germany). 1996;50(4):286-9. Epub 1996/04/01. Haufigkeit der chronisch-obstruktiven Atemwegserkrankung bei Patienten mit obstruktivem Schlafapnoesyndrom.
  27. Christou K, Kostikas K, Pastaka C, Tanou K, Antoniadou I, Gourgoulianis KI. Nasal continuous positive airway pressure treatment reduces systemic oxidative stress in patients with severe obstructive sleep apnea syndrome. Sleep medicine. 2009;10(1):87-94. Epub 2007/12/14.

Corresponding Author

Dr Latha Sannasi

Assistant Professor, Department of Physiology, Chettinad Hospital and Research Institute, Kelambakam, Kanchipuram, Tamil Nadu, India