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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sleep disturbances are associated with hormonal imbalances and may result in metabolic disorders including obesity and diabetes. Therefore, circuits controlling both sleep and metabolism are likely to play a role in these physiopathological conditions. The hypocretin (Hcrt) system is a strong candidate for mediating both sleep and metabolic imbalances because Hcrt neurons are sensitive to metabolic hormones, including leptin and ghrelin, and modulate arousal and goal-orientated behaviours. This review discusses the role of Hcrt neurons as a sensors of energy balance and arousal and proposes new ways of probing local hypothalamic circuits regulating sleep and metabolism with unprecedented cellular specificity and temporal resolution.
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PMID:The hypocretins as sensors for metabolism and arousal. 1904 1

The aim of this study was to investigate the associations between obesity and fibromyalgia syndrome (FMS). This study was conducted at the University of Utah Pain Management and Research Center, Salt Lake City, Utah. Thirty-eight FMS patients were included in this study. Neuroendocrine indices (catecholamines, cortisol, C-reactive protein [CRP], and interleukin-6), symptom measures (Fibromyalgia Impact Questionnaire), sleep indices (Actigraph), and physical functioning (treadmill testing) were measured. Body mass index (BMI) provided the primary indicator of obesity. Approximately 50% of the patients were obese and an additional 21% were overweight. Strong positive associations were found between BMI and levels of IL-6 (r=0.52) and epinephrine (r=0.54), and somewhat weaker associations with cortisol (r=0.32) and CRP (r=0.37). BMI was also related to maximal heart rate (r=0.33) and inversely related to distance walked (r= -0.41). BMI was associated with disturbed sleep: total sleep time (r= -0.56) and sleep efficiency (r= -0.44). No associations between self-reported symptoms and BMI were found. This study provides preliminary evidence suggesting that obesity plays a role in FMS-related dysfunction.
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PMID:Evaluating obesity in fibromyalgia: neuroendocrine biomarkers, symptoms, and functions. 1917 42

Dyssomnias are largely under-diagnosed in infants and toddlers. This literature review proposes an integrative model based on empirical data on determinants and consequences of sleep disturbances occurring in early life. This model proposes that parental behaviors that impede the child's autonomy toward sleep periods are primary grounds for the development of dyssomnias, e.g., parental presence until the child falls asleep, and putting an already sleeping child to bed. The model also indicates the serious potential consequences of a modest but chronic loss of sleep in childhood. At least three developmental domains could be directly affected: behavioral/social competence, cognitive performance, and physical condition. Thus, children with short nocturnal sleep duration before age 3.5 years show increased risk of high hyperactivity-impulsivity scores and low cognitive performance at 6 years compared to children who sleep 11 h per night, after controlling for potentially confounding variables. Moreover, persistent short sleep duration in early infancy increased the risk of suffering of obesity at 6 years of age, after controlling for potentially confounding variables. Finally, the importance of allowing the child to sleep at least 10 h per night in early childhood is stressed, as the National Sleep Foundation Poll suggests, for optimal child development.
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PMID:Risk factors and consequences of early childhood dyssomnias: New perspectives. 1918 19

Polycystic ovary syndrome (PCOS), the most common endocrine disorder of pre-menopausal women, is characterized by chronic hyperandrogenism, oligoanovulation, obesity and insulin resistance. Importantly, PCOS women are at increased risk for glucose intolerance, type 2 diabetes and cardiovascular disorders. Recent reports indicate an unexpectedly high prevalence of obstructive sleep apnea (OSA) in PCOS. Alterations in sex steroids (i.e. high androgen and low estrogen levels) and increased visceral adiposity in PCOS could potentially contribute to the increased prevalence of OSA in this disorder. There is some evidence to suggest that there may be strong associations between the presence and severity of OSA and the metabolic disturbances that characterize PCOS. Causal mechanisms in the link between PCOS and OSA remain to be elucidated. Clinicians who manage PCOS patients should be aware of the high prevalence of OSA in these patients and systematically evaluate these women for sleep disturbances.
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PMID:Polycystic Ovary Syndrome and Obstructive Sleep Apnea. 1925 2

Patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTSs) have a considerably higher prevalence of cardiovascular disease (CVD) than the general population in old age. Many hypotheses have been created to explain traditional clinical risk factors of CVD, including age, male gender, cigarette smoking, inheritance, high blood pressure (BP), obesity, elevated fasting plasma glucose, diabetes mellitus, dyslipidemia, decreased physical activity and metabolic syndrome; or nontraditional risk factors such as oxidative stress, inflammation, vascular calcification, malnutrition, homocysteine and genetic variation. Although these risk factors are important in CVD pathophysiology and clinical presentation, there is still no single theory sufficient to provide an adequate explanation for all the properties of CVD. We speculate that by causing nocturia-induced sleep disturbances, BP variability, increased sympathetic activity, non-dipping BP variations; BPH may be an insidious risk factor for CVD. Benign prostate hyperplasia may be related to increased BP, coronary ischemic hearth disease or other cardiovascular pathologic conditions. This attention on BPH may produce a new approach to the diagnosis and treatment of CVD. Although the underlying mechanisms are still exactly unclear, further prospective randomized controlled studies are needed to identify if patients with BPH/LUTS is higher risk for CVD.
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PMID:An insidious risk factor for cardiovascular disease: benign prostatic hyperplasia. 1935 54

Obesity continues to be a serious cause of morbidity and mortality globally and particularly in North America. Primary manifestations of obesity include obstructive sleep apnea (OSA) and depression associated with a decrease in immune defense mechanisms, possibly related to increased cytokine levels. Secondary manisfestations of obesity possibly result from a cascade of events and include insulin resistance/ hyperglycemia, hyperlipidemia, and hypertension-all of which comprise metabolic syndrome. This paper reviews sleep disturbances in general and OSA in psychiatric patients, particularly those who are obese.
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PMID:Obstructive sleep apnea, hypoxia, and metabolic syndrome in psychiatric and nonpsychiatric settings. 1972 76

Obesity, well-known as a cardiovascular risk factor is also a "respiratory" risk factor and can have profound adverse effects on the respiratory system, such as alterations in pulmonary function tests, respiratory mechanics, respiratory muscle strength and endurance, gas exchange, control of breathing and exercise capacity. ABG are frequently altered in obese subjects and abnormalities are directly proportional to BMI. Two main pathophysiological mechanisms may account for gas exchange abnormalities: V/Q inequality, responsible for isolated hypoxemia, and alveolar hypoventilation responsible for the also called "obesity hypoventilation syndrome" (OHS). Hypoventilation in obese patients includes a diversity of mechanisms frequently imbricated, among which the two most frequent are mechanical limitation and blunted ventilatory drive. Two other clinical entities (COPD and OSA) frequently present in the obese patients may potentiate or aggravate this hypoventilation. OHS is frequently underappreciated and diagnosis is rarely made at the steady state. Such diagnosis is frequently made in two situations: either during an exacerbation or when in front of symptoms of respiratory sleep disturbances. The patient is referred to sleep laboratory for screening for OSA. Ventilatory management of these patients will depend on the patient's underlying condition and on sleep study results. It includes CPAP or NIPPV but frequently additional O(2) addition is necessary. OHS represents today one of the most frequent indications of NIV worldwide.
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PMID:[The obesity-hypoventilation syndrome]. 1978 49

The association between disturbed sleep and increased risk of occupational injury has been observed in several cross-sectional and case-control studies, but prospective evidence is lacking. We examined prospectively whether sleep disturbances predicted occupational injuries in a large population of Finnish public sector employees. A total of 48 598 employees working in 10 municipalities and 21 hospitals in various parts of Finland were included. Sleep disturbances were assessed with the four-item Jenkins Sleep Problems Scale. Records of sickness absence due to occupational injury during the year following the survey were obtained from employers' registers. A proportion (9076; 22%) of participants reported disturbed sleep, and 978 (2.4%) had a recorded occupational injury. After adjustment for socio-demographic characteristics, the odds ratio (OR) for occupational injury was 1.38 [95% confidence interval (CI) 1.02-1.87] times higher for men with experiences of disturbed sleep than for those without sleep disturbances, but not significant for women. Of the sub-dimensions of sleep disturbances, the OR for occupational injury was 1.69 (95% CI 1.26-2.26) for women with difficulties initiating sleep, but not significant for men. These associations remained after additional adjustment for work stress, sleep length, obesity, alcohol use and mental health. This study suggests that sleep disturbances are a significant predictor of occupational injuries even after accounting for a range of covariates.
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PMID:Sleep disturbances as a predictor of occupational injuries among public sector workers. 1984 Feb 41

Sleep-disordered breathing (SDB) is a medical condition that has increasingly recognized adverse health effects. Obesity is the primary risk factor for the development of SDB and contributes to cardiovascular and metabolic abnormalities in this population. However, accumulating evidence suggests that SDB may be related to the development of these abnormalities independent of obesity. Periodic apneas and hypopneas during sleep result in intermittent hypoxemia, arousals, and sleep disturbances. These pathophysiologic characteristics of SDB are likely mechanisms underlying cardiovascular and metabolic abnormalities including hypertension and other cardiovascular diseases, altered adipokines, inflammatory cytokines, insulin resistance, and glucose intolerance. Treatment of SDB with continuous positive airway pressure reverses some but not all of these abnormalities; however, studies to date have demonstrated inconsistent findings. Weight loss strategies, including diet, exercise, medications, and bariatric surgery, have been evaluated as a treatment strategy for SDB. In preliminary studies, dietary intervention and exercise reduced severity of SDB. One study demonstrated improvements in SDB severity using the weight-reducing medication sibutramine. In morbidly obese subjects, bariatric surgery effectively induces weight loss and improvement in SDB severity and symptoms, but long-term benefits remain uncertain. Large randomized trials are required to determine the utility of these strategies as long-term approaches to improving SDB and reducing associated complications.
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PMID:Sleep-disordered breathing and obesity: pathophysiology, complications, and treatment. 1995 45

Sleep-disordered breathing (SDB) encompasses a group of disorders that include obstructive sleep apnoea (OSA), central sleep apnoea (CSA) and nocturnal hypoventilation. SDB commonly coexists with sleep disorders such as insomnia and restless legs syndrome, and sleep deprivation has been shown to play a role in the pathogenesis of SDB. Participants of a workshop, held at the 6th annual meeting of The International Sleep Disorders Forum: The Art of Good Sleep in 2008, evaluated whether the effective management of sleep disorders could result in a reduction in SDB. Following the workshop, a critical review of the literature in the field of sleep and SDB was conducted in order to assess the impact of improving sleep on SDB, and to determine whether measures taken to improve sleep result in a subsequent improvement in SDB. Results showed that studies evaluating the influence of improved sleep on respiratory abnormalities in patients with SDB are lacking. Studies in patients with OSA, with or without obesity-hypoventilation syndrome, show that therapy with continuous positive airways pressure and non-invasive ventilation improves sleep parameters with beneficial effects on SDB. Studies involving small numbers of patients have shown that the antidepressants fluoxetine and mirtazapine produce improvements in sleep parameters and the apnoea-hypopnoea index, and that acetazolamide may improve CSA. The benzodiazepines flurazepam, temazepam and nitrazepam, the hypnotic zolpidem, the melatonin receptor agonist ramelteon and gamma-hydroxybutyrate have all been shown to improve sleep, but are not associated with reductions or worsening in SDB. It is clear that there is a distinct knowledge gap with regard to the benefit of improving sleep disturbances for subsequent improvements in SDB. Randomized controlled clinical trials investigating the effect of pharmacological and non-pharmacological improvement of sleep disorders focusing on whether there is improvement in coexisting OSA/SDB are clearly needed. Furthermore, well-designed clinical trials investigating the role of hypnotic agents in improving SDB in certain phenotypes will enable the development of treatment recommendations for primary care physicians managing these patients in routine clinical practice.
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PMID:Can improving sleep influence sleep-disordered breathing? 2004 52


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