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)

Ambulatory blood pressure monitoring has been steadily growing in popularity as equipment becomes more accurate, affordable, and patient-friendly. In addition, software packages are more powerful and physician-customizable, and more physicians are accepting of ambulatory blood pressure monitoring's advantages. Summarizing the studies that deal mainly with hemodialysis patients, there are clear advantages to using more than isolated pre- and posthemodialysis blood pressure readings. If enough predialysis blood pressure readings are taken and averaged, this is a reasonable guide to end-organ damage (ie, left ventricular hypertrophy). Home and ambulatory blood pressure-derived values are complementary, and only this approach can discern any further contribution from diurnal blood pressure elevation. The cross-sectional association between blood pressure and end-organ damage is very weak in end-stage renal disease patients if the blood pressure values are "casual," but the relationship is much stronger when ambulatory blood pressure monitoring-derived measurements are used. One prospective study clearly linked the sustained loss of diurnal blood pressure fall with sleep with progressive left ventricular dilatation. Loss of circadian variation in blood pressure is associated with an increased mortality rate for dialysis patients and for diabetic patients, regardless of diabetes type. The combination of nondipping in renal impairment leads to a high mortality rate. Much more work is needed to dissect out the causes for abnormal diurnal blood pressure rhythm and attempt to modulate this parameter. Obstructive sleep apnea may be a promising target for intervention.
 ...
PMID:Ambulatory blood pressure measurement in the renal patient. 1221 55

Sleep and sleep disorders play a prominent role in hormone regulation. Given that sleep disordered breathing (SDB) and diabetes mellitus (DM) are thought to result from obesity, it has been assumed that when the two coexist, the diabetes was caused by the obesity. However, new data has shed light on the effects that SDB, sleep deprivation, and snoring have on glucose regulation. It now appears that in addition to causing daytime drowsiness, cardiovascular disease, mood and memory disturbances, impotence, and car wrecks, obstructive sleep apnea (OSA) also promotes insulin resistance. Though data is still sketchy on the optimum management of coexisting DM and OSA, large-scale studies will most likely prove that homeostatic glucose control in patients with sleep apnea will require aggressive treatment of their SDB.
 ...
PMID:Sleep and the endocrine system: new associations to old diseases. 1239 57

Four basic control mechanisms of breathing (brainstem respiratory centre, peripheral and central chemoreceptors, intero- and exteroceptive reflexes and suprapontine influences), as well as their sleep-related disorders are analysed. A decrease in central chemoreceptor sensitivity to CO2 and an increase in upper airway resistance during sleep result in hypoventilation and mild hypoxaemia already in physiological conditions. Compensatory increase in ventilatory effort with synchronous inhibition of pharyngeal dilators during sleep reduces the upper airway lumen manifesting with snoring, upper airway resistance syndrome, and OSA. The resulting hypoxaemia may cause marked cardiovascular, neuro-psychic, endocrine-metabolic and behavioural disorders. The augmented ventilatory effort and hypoxaemia evoke reflex dilation of airways and arousal from sleep, stimulating the sympatho-adrenal system, which provokes autoresuscitation by gasping preventing fatal asphyxia. Failure of this autoresuscitation mechanism seems to cause SIDS. Elimination of voluntary breathing by sleep either in Ondine's curse induced by lesions of respiratory centre, or in congenital central hypoventilation syndrome caused by insufficient central chemoreceptors result in respiratory failure and death. Nocturnal attacks of bronchial and cardiac asthma, lung oedema and other consequences of pulmonary congestion are also discussed. The pathomechanism of extreme daytime sleepiness, chronic fatigue, and disorders of memory, cognitive and other brain functions, are also analysed. Severe cardiovascular consequences of SAS may manifest acutely as angina pectoris, myocardial infarction. dysrhythmias, transient ischaemic attacks and even stroke or sudden cardiac death. OSAS may result also in development of hypertension, central obesity, diabetes mellitus, erectile dysfunction, depression, and various behavioural disorders.
 ...
PMID:[Regulation of respiration and its sleep-related disorders]. 1244 39

Obstructive sleep apnea (OSA) affects almost one fifth of the male and 10% of the female middle-aged population. Only one fifth of subjects with more or less severe disorder of breathing report simultaneous daytime sleepiness. There is growing research evidence for an independent association between OSA and cardiovascular disease (CVD). The suggestion that this link is not only correlative but also causative is strongly supported by a series of recent clinical and epidemiological studies. The association between OSA and traditionally recognized cardiovascular risk factors suggests that OSA may provide an additive and synergistic risk in cases with co-existing obesity, insulin resistance, diabetes and/or dyslipidaemia. These recent insights advocate better awareness of OSA and potentially also a wider use of screening-tools for early identification and treatment of sleep related breathing disorders. Moreover, current research within the fields of obesity and cardiovascular prevention needs to identify OSA as a study confounder. Continuous intense research into pathophysiological mechanisms and therapeutic possibilities of CVD related to OSA appears to be an important and potentially rewarding area of disease prevention.
 ...
PMID:[Sleep apnea a risk factor of cardiovascular disease]. 1246 25

The prevalence of obesity is increasing worldwide. In the United States, in 1999, 27% of adults had a body mass index >30 kg/m(2), almost double the prevalence of 20 years earlier. The estimated mortality from obesity-related diseases in the United States is approximately 300,000 annually and growing. In the future, mortality related to obesity is expected to exceed that of smoking. Numerous diseases are caused or made worse by obesity. These include type 2 diabetes; hypertension; dyslipidemia; ischemic heart disease; stroke; obstructive sleep apnea; asthma; nonalcoholic steatohepatitis; gastroesophageal reflux disease; degenerative joint disease of the back, hips, knees, and feet; infertility and polycystic ovary syndrome; various malignancies; and depression. Type 2 diabetes is perhaps the most visible obesity-related problem. Present in at least 14 million Americans, it leads to serious complications and premature death. It is largely caused by obesity, and is generally cured by weight loss. The quality of life of the obese is markedly reduced, and the costs to health care systems are great. Preventive programs have yet to affect the rising prevalence. An effective solution is needed.
 ...
PMID:The extent of the problem of obesity. 1252 43

Nocturia frequently is considered a benign problem that results from aging. Nocturia can result from poorly controlled diabetes, congestive heart failure, or urinary dysfunction. Also a symptom of obstructive sleep apnea (OSA), nocturia is a significant source of sleep disruption that may result in excessive daytime sleepiness. This article examines variables that contribute to nocturia, its effect on health, and the physiological mechanisms in OSA that evoke nocturia. Evaluation requires differentiation of the underlying causes that result in either increased frequency or increased nocturnal urine production, including symptoms of OSA.
 ...
PMID:Nocturia: a problem that disrupts sleep and predicts obstructive sleep apnea. 1271 59

Although clinical experience has suggested for more than two decades that OSA is associated with impairment of cognition, emotional state, and quality of life and that treatment with nasal CPAP produces significant improvements in these areas, sound empirical evidence to support this view, especially regarding treatment outcome, has been lacking. More recent investigations have begun to provide this support from randomized, adequately controlled studies. These assessments suggest that some degree of cognitive dysfunction is associated with OSA. The effects are most apparent in the severe cases, whereas results in mild cases are more equivocal. Reported impairments include global intellectual dysfunction and deficits in vigilance, alertness, concentration, short- and long-term memory, and executive and motor function. Considerable discrepancy exists across studies with respect to type and degree of dysfunction, however. Disturbances in general intellectual function and executive function show strongest correlations with measures of hypoxemia. Not unexpectedly, alterations in vigilance, alertness, and, to some extent, memory seem to correlate more with measures of sleep disruption. Although many inadequately controlled investigations have demonstrated reversibility of most or all of these deficits with effective treatment, more recent placebo-controlled studies have raised doubts regarding whether the observed changes are truly a function of treatment. This issue requires further systematic exploration with adequate controls and step-wise analysis of treatment duration effects. A similar set of considerations exists with respect to the relationship between psychological disturbance, primarily depression, and OSA. Although several studies suggest significant depression in these patients, the results are mixed. Placebo-controlled treatment trials fail to demonstrate consistently a difference in mood improvement between active treatment groups and controls, although several methodologic considerations suggest that these results should be interpreted with caution. Numerous investigations leave little doubt about the issue of quality of life impairment among persons with OSA. Further characterization of impairment, particularly in areas specific to this population, will provide clearer understanding of the problem. Preliminary investigations of treatment response in controlled studies indicate significantly greater improvement of quality of life in response to CPAP. Although patients with OSA commonly report disturbances in cognitive and psychological function and general quality of life, the increased rates of obesity, hypertension, diabetes, cardiovascular disease, medication use, and related psychosocial complications present a host of potential etiologies that might explain the impairments noted. There can be little doubt that these covariants do, in some cases, contribute to neuropsychological dysfunctions. It is essential that future studies continue to define those disturbances that are specific to OSA, the relationship between levels of severity and impairment, the role of treatment in reversing these dysfunctions, and the correlation between test results and significant day-to-day social and occupational functional impairment.
 ...
PMID:Neuropsychological impairment and quality of life in obstructive sleep apnea. 1280 Jul 82

Obstructive sleep apnoea (OSA) is a very prevalent disorder particularly amongst middle-aged, obese men, although its existence in women as well as in lean individuals is increasingly recognized. Despite the early recognition of the strong association between OSA and obesity, and OSA and cardiovascular problems, sleep apnoea has been treated as a 'local abnormality' of the respiratory track rather than as a 'systemic illness'. In 1997, we first reported that the pro-inflammatory cytokines interleukin (IL)-6 and tumour necrosis factor-alpha (TNF alpha) were elevated in patients with disorders of excessive daytime sleepiness (EDS) and proposed that these cytokines were mediators of daytime sleepiness. Also, we reported a positive correlation between IL-6 or TNF alpha plasma levels and the body mass index (BMI). In subsequent studies, we showed that IL-6, TNF alpha, leptin and insulin levels were elevated in sleep apnoea independently of obesity and that visceral fat, was the primary parameter linked with sleep apnoea. The association of OSA with insulin resistance and diabetes type 2 has been confirmed since then in several epidemiological and clinical studies. Furthermore, our findings that women with polycystic ovary syndrome (PCOS, a condition associated with hyperandrogenism and insulin resistance) were much more likely than controls to have sleep disordered breathing (SDB) and daytime sleepiness support the pathogenetic role of insulin resistance in OSA. Other findings that support the view that sleep apnoea and sleepiness may be manifestations of a serious metabolic disorder, namely the Metabolic or Visceral Obesity Syndrome, include: obesity without sleep apnoea is associated with daytime sleepiness; PCOS and diabetes type 2 are independently associated with EDS after controlling for SDB, obesity and age; and increased prevalence of sleep apnoea in postmenopausal women, with hormonal replacement therapy associated with a significantly reduced risk for OSA. In conclusion, accumulating evidence provides support to our model of the bi-directional, feedforward, pernicious association between sleep apnoea, sleepiness, inflammation and insulin resistance, all promoting atherosclerosis and cardiovascular disease.
 ...
PMID:Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance. 1282 41

Thirty-one patients, aged 22-71 years, with nocturnal apneic episodes and/or habitual snoring were studied with magnetic resonance spectroscopy (MRS) and diagnostic polysomnography separately to determine whether accumulation of lactate caused by cerebral hypoxia during sleep is associated with sleep-disordered breathing (SDB), aging and co-morbidities related to SDB. Eight proton magnetic resonance spectra for sleep and two for periods of arousal were obtained from the right centrum semiovale. All patients were evaluated for the presence or absence of co-morbidities including hypertension, cardiac disease, diabetes mellitus, and hyperlipidemia. Significant lactate signals were found in seven patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) during sleep periods, and none during periods of arousal. Aging was significantly related to the presence or absence of significant lactate signals during sleep periods as determined by logistic regression analysis (beta=0.2480; 95% confidence interval, 0.0905-0.5094; P=0.0001). Apnea index (AI), apnea-hypopnea index (AHI), and minimum value of peripheral oxyhemoglobin saturation each significantly interacted with age (P=0.0081, 0.0284, and 0.0302, respectively). Our findings suggest that SDB combined with aging is related to accumulation of lactate during sleep.
 ...
PMID:Age-related changes in cerebral lactate metabolism in sleep-disordered breathing. 1288 83

Obesity is a life-long, progressive, life-threatening, genetically related, costly, multifactorial disease manifested by excessive fat storage. It is often accompanied by multiple comorbidities including mainly hypertension, diabetes, hyperlipidemia, hypoventilation, obstructive sleep apnea, degenerative arthritis and psychosocial impairment which influence the patients quality of life and ultimately limit their life expectancy. Conservative treatment of morbid and extreme obesity including diet, physical activity, behaviour modifications or pharmacotherapy is not effective in achieving a medically significant long-term weight loss. The costs of such therapy often exceed the costs of the surgical procedure. Surgical treatment of obesity was initiated over 50 years ago. Then the surgical methods were to lead to an increased excretion but finally did not prove useful. They were replaced by restrictive and malabsorption procedures. The first methods including vertical banded gastroplasty (VBG) were introduced in 1982 while gastric banding in 1985. The second method including gastric bypasses or biliopancreatic diversion were implemented in the years 1966-1986. There are also some methods joining these two techniques. Nowadays as a results of minimally invasive surgery development, most of the operations can be performed laparoscopically.
 ...
PMID:[Obesity and surgery]. 1292 68


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