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Query: UMLS:C0037315 (
sleep apnea
)
8,000
document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)
Diabetic autonomic neuropathy
(
DAN
) may affect up to 30% of the diabetic population. Sometimes
DAN
becomes clinically manifest causing specific symptoms and signs; more often, however,
DAN
is responsible for subtle alterations detectable only by functional tests, as in the case of the respiratory system. At first, abnormalities both in the bronchomotor tone and aspecific airway responsiveness to different stimuli were recognised in diabetic patients with
DAN
, indicating a defective control of mechanisms which regulate the bronchial calibre in these subjects. Subsequently, peculiar changes in breathing pattern and greater ventilatory requirements have been observed during incremental exercise in diabetics with
DAN
, suggesting an altered control of breathing in stressful conditions. Alterations in either peripheral or central chemosensitivity have been repeatedly shown in these patients, with marked differences related to the severity of
DAN
, concerning the neuro-muscular and ventilatory responsiveness to CO2. Following anecdotal reports, respiratory disturbances during sleep have been more carefully investigated in diabetic subjects and greater prevalence of
sleep apnea
, mainly in the obstructive form, has been found in the presence of
DAN
. The underlying mechanisms of
sleep disordered breathing
, however, are poorly understood in
DAN
and further studies are needed to elucidate them.
...
PMID:Impairment of the respiratory system in diabetic autonomic neuropathy. 1096 93
Diabetic autonomic neuropathy
(
DAN
) is associated with a markedly reduced quality of life and poor prognosis. The manifestations of
DAN
cause multiple symptoms and involve the 1) cardiovascular system: resting tachycardia, reduced heart rate variability and circadian rhythm of heart rate and blood pressure, painless myocardial ischemia/infarction, orthostatic hypotension, exercise intolerance, perioperative instability, sudden death; 2) respiratory system: reduced ventilatory drive to hypercapnia/hypoxemia,
sleep apnea
; 3) gastrointestinal tract: esophageal motor dysfunction, diabetic gastroparesis, gallbladder atony, diabetic enteropathy, colonic hypomotility, anorectal dysfunction; and 4) genitourinary tract: diabetic cystopathy, erectile dysfunction. Treatment is based on four cornerstones: 1) causal treatment aimed at near-normoglycemia; 2) treatment based on pathogenetic mechanisms; 3) symptomatic treatment; and 4) avoidance of risk factors and complications. Pharmacologic treatment of symptomatic
DAN
may be difficult, due to limited efficacy and frequent adverse reactions. First-line treatments include midodrine for orthostatic hypotension, prokinetic drugs for gastroparesis, broad-spectrum antibiotics for diabetic diarrhea, and sildenafil for erectile dysfunction. Prior to an adequate symptomatic treatment a thorough risk-benefit estimate, aimed at maintaining the patient's quality of life, is required.
...
PMID:Diagnosis and treatment of diabetic autonomic neuropathy. 1264 2
