Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There exist real and potential links between the risk factors for and co-morbidity associated with diabetes and sleep apnea. The common occurrence of obesity, hypertension, and disorders of metabolism in each disease is but one example. While the occurrence of sleep apnea with glucose intolerance or insulin resistance could present sampling bias or intersection of common human diseases, an alternative hypothesis is that the events in obstructive sleep apnea (OSA) trigger different, perhaps unique, adaptations in metabolic processes involving insulin action and glucose regulation. Further, clinical studies can be designed to define the extent and potential mechanisms for alterations in insulin and glucose levels in OSA and to determine the sample size and power for a longitudinal study that would follow the relative rates of progression of obesity (including neck size as a body characteristic), breathing abnormalities during sleep, insulin sensitivity, and subsequent risk for non-insulin-dependent diabetes mellitus (NIDDM) and/or symptomatic OSA.
 ...
PMID:Diabetes and sleep apnea. 908 17

A 57-yr-old man with idiopathic central apnea is reported. He presented at our hospital complaining of excessive daytime sleepiness. Polysomnography, including esophageal pressure monitoring, confirmed central sleep apnea with an apnea index of 27/h. He had mild non-insulin-dependent diabetes mellitus (NIDDM) but no signs of diabetic neuropathy or other background diseases. The ventilatory responses to hypoxia and hypercapnia tested while he was awake indicated increased respiratory chemosensitivity. We applied nasal continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) in an attempt to compare the possible difference in therapeutic efficacy. Although nasal CPAP completely reversed central apnea, nasal BPAP adversely affected both apnea length and frequency in an applied pressure-dependent manner. Arterial blood gas analyses while he was being treated indicted alveolar hypoventilation with CPAP and hyperventilation with BPAP. Additionally, administration of a mixed gas containing 5% CO2 through a face mask had a significant effect on the disappearance of central apnea in this patient. These findings support the theory that the arterial PCO2 level is critical in generating idiopathic central apnea and that nasal CPAP therapy may be effective in eliminating central apnea by raising the PaCO2.
 ...
PMID:Continuous versus bilevel positive airway pressure in a patient with idiopathic central sleep apnea. 910 99

Obesity is associated with the development of some of the most prevalent diseases of modern society. The greatest risk is for diabetes mellitus where a body mass index above 35 kg/m2 increases the risk by 93-fold in women and by 42-fold in men. The risk of coronary heart disease is increased 86% by a 20% rise in weight in males, whereas in obese women the risk is increased 3.6-fold. Elevation of blood pressure, hyperlipidaemia and altered haemostatic factors are implicated in this high risk from coronary heart disease. Gallbladder disease is increased 2.7-fold with an enhanced cancer risk especially for colorectal cancer in males and cancer of the endometrium and biliary passages in females. Endocrine changes are associated with metabolic diseases and infertility, and respiratory problems result in sleep apnoea, hypoventilation, arrhythmias and eventual cardiac failure. Obesity is not a social stigma but an actual disease with a major genetic component to its aetiology and a financial cost estimated at $69 billion for the USA alone.
 ...
PMID:Obesity as a disease. 924 38

Since severe obesity is frequently associated with serious metabolic, cardiovascular and psychological co-morbid conditions, and given the usually unsuccessful results of conservative therapeutic approaches, surgical treatment based on gastric restriction procedures is increasingly recognized as a treatment of choice for morbidly obese persons. Among several surgical approaches designed to promote a substantial loss of weight, two gastric restriction procedures, i.e. the vertical banded gastroplasty and the gastric bypass, have been increasingly used during the past years. Both techniques induce an impressive loss of weight, and are surprisingly well tolerated, even by severely obese persons. The usual 50-75% reduction of initial weight excess, is followed by a clear-cut reduction, or even disappearance of, obesity-related co-morbidity, such as hypertension, diabetes mellitus or sleep apnea syndrome. While serious peri- and postoperative risks are very limited, the intractable vomiting occurring after gastroplasty, and potential sequelae related to iron and calcium malabsorption after the gastric bypass, represent much more frequent complications of the surgical treatment of obesity. There is also a tendency towards a late regain of weight, but the benefit in terms of improvement in the obesity-associated co-morbidity is in general maintained despite this partial increase in weight. Gastric procedures are, therefore, an effective treatment of severe obesity and of its co-morbid conditions. However, careful medical and nutritional supervision is necessary during the follow-up after surgery, to prevent potential nutritional or digestive complications.
 ...
PMID:Surgical treatment for morbid obesity. 924 44

The effect of weight loss with anorectic medications on sleep apnea, non-insulin-dependent diabetes, and steatohepatitis is illustrated in three cases from practice in a clinical nutrition setting. Prevention of obesity, a chronic disorder, is preferable, but when obesity becomes a major obstacle in the care of patients with respiratory, cardiovascular, and metabolic disorders and osteoarthritis, an intense course of weight reduction using anorectic medications under medical and dietetic guidance is essential for patients' survival and reduction of medical cost.
 ...
PMID:Three cases of comprehensive dietary therapy and pharmacotherapy of patients with complex obesity-related diseases. 928 79

The increased mortality among patients with obstructive sleep apnoea syndrome has been explained in part by the increased incidence of pulmonary hypertension and coronary artery disease (CAD). A decreased heart rate variability has been shown to be associated with an increased mortality as well. We therefore screened 53 patients for sleep-related breathing disorders (SRBD) and heart rate variability (HRV) during the sleeping period. Standard time domain parameters were compared in a univariate multifactorial model for patients with an oxygen desaturation index (ODI) of more or less than 5 including the factors CAD, diabetes and beta-blocker use. The percentage of differences between RR-intervals that differ more than 50 ms (pNN > 50: 9.0 +/- 11.1% vs 19.2 +/- 22.2%; p < 0.05) as well as the root mean square of these differences (rMSSD: 38.0 +/- 29.0 msec vs 59.2 +/- 51.5 msec; p < 0.05) were significantly decreased in patients with SRBD. These results favour HRV for inclusion in future risk stratification models in patients with sleep-related breathing disorders.
 ...
PMID:[Heart rate variability in patients with sleep associated breathing disorders]. 934 Jun 28

The vascular endothelial cell is a multipotent cell which has several functions: transport barrier, phagocytosis, coagulation/anticoagulation, fibrinolysis, autocrine/paracrine and metabolic functions. The release of vasoactive agents, such as the vasodilators EDRF (NO) and EDHF, and vasoconstrictors, such as endothelin (ET), represents an important local mechanism altering the balance of vasodilation/ vasoconstriction of the vascular smooth muscle cell. Inhibition of the synthesis of NO by exogenous (e.g. L-NAME) or endogenous (e.g. ADMA) L-arginine analogues may cause transient or sustained hypertension. A similar effect may be achieved by continuous administration of the potent vasoconstrictor ET. Endothelial dysfunction, associated with a deficient NO production and release as well an enhanced ET generation, may be present in some forms of vascular disease, such as hypertension, atherosclerosis, diabetes mellitus or sleep apnea. Whether such alterations may be a cause of hypertension and involved in the maintenance of high blood pressure or whether they represent a consequence of the hypertensive disease remains to be concluded. Furthermore, while there is emerging evidence that endothelial dysfunction in cardiovascular disease may be reversed by therapy, it remains to be determined whether measures of endothelial function in man may serve as predictors for morbidity or mortality.
 ...
PMID:Measures of endothelial function as an endpoint in hypertension? 949 29

The periodic limb movements (PLM) are defined as stereotyped, periodic movements of the legs and/or upper limbs during sleep. The patient exhibits dorsifilexion of the ankle and extension of the big toe with occasional flexion of the knee and hip. PLM originally was described as "nocturnal myoclonus" by Symonds in 1953. Recently, the term "nocturnal myoclonus" has been replaced with PLM, because the movements are slower than true myoclonic movement. The appearance of PLM was reported in sleep apnea syndrome, delayed sleep phase syndrome, narcolepsy, spinal cord tumor, diabetes mellitus and uremia. The prevalence of PLM statistically increase with age. Patients with PLM show excessive daytime sleepiness or insomnia. Several reports show the difficulty recognizing periodic limb movement disorder (PLMD) without polysomnography (PSG). The diagnosis of PLMD is established only by PSG.
 ...
PMID:[Periodic limb movement disorder]. 950 40

Knowledge of conditions associated with an increased prevalence of obstructive sleep apnoea (OSA) may help to identify patients with OSA and might give some insight into the pathogenesis of OSA and its sequelae. A number of earlier, smaller studies hinted at an association between diabetic cardiovascular autonomic neuropathy (AN) and OSA. The present study was, therefore, conducted with the aim of establishing the prevalence of OSA in diabetics with AN and of determining whether OSA is more prevalent in diabetics with AN, than in those without. We studied two groups of diabetic patients: 23 with and 25 without AN. All patients were evaluated for possible OSA (apnoea/hypopnoea index > or = 10) using initial ambulatory screening followed by polysomnography. Six patients with AN (26%) were found to have OSA, but none of the patients without AN met the diagnostic criteria (p<0.01). When the patients with OSA were compared to those without, no differences were found in terms of age, sex, body mass index or diabetes type or duration. In conclusion, about one in four diabetic patients with autonomic neuropathy suffers from OSA. Thus, obstructive sleep apnoea is more prevalent in diabetic patients with autonomic neuropathy, than in those without.
 ...
PMID:Obstructive sleep apnoea and diabetes mellitus: the role of cardiovascular autonomic neuropathy. 954 64

Assessment of cardiorespiratory consequences of sleep apnoea syndrome (SAS) is difficult owing to confounding factors, especially obesity, that are strongly associated with SAS. This study was designed to assess the cardiorespiratory consequences of SAS by comparing the results of a comprehensive cardiorespiratory evaluation in apnoeic and nonapnoeic patients with massive obesity. In a retrospective chart-review study, we studied 60 patients with massive obesity defined by a body mass index (BMI) >40 kg.m(-2), presenting no chronic respiratory disease, who underwent an extensive assessment of cardiorespiratory consequences of obesity, including overnight polysomnography, lung function tests, arterial blood gas analysis, evaluation of vascular risk factors, myocardial scintigraphy with dipyridamole stress-test, isotopic ventriculography, Doppler echocardiography and Holter electrocardiogram recording. SAS defined by an apnoea + hypopnoea index (AHI) > or = 10 was diagnosed in 42% of patients (25 out of 60). Mean+/-SD AHI of SAS-positive (SAS+) patients was 38+/-24. Age, BMI, ventilatory function parameters, prevalence of smoking history and diabetes mellitus did not differ significantly in SAS+ versus SAS-negative (SAS-) groups. The following complications were observed more frequently in SAS+ than in SAS- patients: daytime hypoxaemia (35 vs 9%, p<0.02), pulmonary arterial hypertension (36 vs 7%, p<0.05) and increased interventricular septal thickness (50 vs 15%, p<0.03). No association was found between SAS on the one hand and systemic arterial hypertension, coronary artery disease, left ventricular dysfunction and nocturnal cardiac arrhythmias on the other. Nocturnal apnoeas in massive obesity may thus be associated with moderate daytime hypoxaemia, mild pulmonary arterial hypertension and moderate left ventricular hypertrophy, but not with severe cardiorespiratory complications.
 ...
PMID:Cardiorespiratory consequences of sleep apnoea syndrome in patients with massive obesity. 954 65


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>