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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sleep apnea is associated with abnormalities in metabolic function. First, there is a strong epidemiological link between central obesity and sleep apnea. Some evidence suggests that sleep apnea may promote weight gain or prevent weight loss by several mechanisms: reduction in anabolic (growth hormone and testosterone) hormone secretion, influences on energy balance and insulin sensitivity, and altered central serotonergic tone.
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PMID:Metabolic aspects of sleep apnea. 908 15

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.
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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.
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PMID:Continuous versus bilevel positive airway pressure in a patient with idiopathic central sleep apnea. 910 99

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.
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PMID:Three cases of comprehensive dietary therapy and pharmacotherapy of patients with complex obesity-related diseases. 928 79

The pertinent literature on the prevalence, clinical manifestations and pathogenic mechanisms of sleep apnoea (SA) in endocrine diseases, namely acromegaly, Cushing syndrome, hypothyroidism and diabetes mellitus was reviewed. An increased prevalence is well documented in patients with active and treated acromegaly. While most authors report peripheral obstruction, due to hypertrophy of tongue and pharyngeal tissues, to be the cause of SA in acromegaly, some findings argue for a role of hormone-induced changes of central respiratory control. SA is also more common in hypothyroidism, especially when myxedema is present. The associated edema and myopathy appear to be of pathogenic importance. Thyroxin substitution is frequently effective for the treatment of SA but nCPAP can be necessary initially and in some patients even after remission of clinical signs of hypothyroidism. In Cushing disease and syndrome, parapharyngeal fat accumulation can cause SA, but no epidemiological information is available. In non insulin dependent diabetes (NIDDM), obesity is the common risk factor for both, nocturnal hypoxia and insulin resistance. In IDDM, the development of autonomic neuropathy may predispose to SA. Where treatment of the underlying endocrine disease is unable cure the associated SA, nCPAP is usually the treatment of first choice. More prospective studies are clearly needed to establish prevalences and resolve the controversies regarding pathogenesis.
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PMID:Sleep apnoea in endocrine diseases. 961 23

The purpose of this study was to analyze outcome following malabsorptive distal gastric bypass (D-GBP) in superobese patients who were reoperated for recurrent obesity comorbidity after a failed standard gastric bypass (S-GBP). Twenty-seven formerly superobese patients with a failed S-GBP converted to a D-GBP were studied. The small bowel was anastomosed 250 cm from the ileocecal valve to the disconnected Roux limb; the bypassed small intestine was connected to the ileum 50 cm from the ileocecal valve in five patients between 1985 and 1986 and 150 cm from the ileocecal valve in 22 patients thereafter. Comorbidity was reassessed yearly following conversion to D-GBP. Malnutrition occurred in all five patients with a 50 cm "common tract"; all required further revision and two died of hepatic failure. Three of 22 patients with a 150 cm common tract were reoperated with bowel lengthening because of malnutrition. Initial body mass index was 57+/-2 kg/m2 and fell from 46+/-2 kg/m2 before revision to 37+/-2 kg/m2 at 1 year and 32+/-2 kg/m2 at 5 years after revision; the percentage of excess weight lost went from 30+/-4% to 61+/-4% at 1 year and 69+/-5% at 5 years after revision. Preoperative comorbidity in patients undergoing revision included 14 with insulin-dependent type II diabetes mellitus, 11 with sleep apnea, 14 with hypoventilation, 13 with hypertension, and two with venous stasis ulcers. Obesity comorbidity was corrected within 1 year in all but two patients with hypertension and remained stable in all patients followed for 5 years. Revision of a failed S-GBP to a 150 cm common tract D-GBP corrects failed weight loss and severe obesity comorbidity but requires nutritional support to prevent protein-calorie malnutrition, iron and fat-soluble vitamin deficiencies, and further revision in some patients to correct malnutrition. A 50 cm common tract has an unacceptable morbidity and mortality.
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PMID:Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity. 983 87

Obesity is an increasing health problem in most developed countries and its prevalence is also increasing in developing countries. There has been no great success with dietary means and life style modification for permanent weight loss. Various surgical treatment methods for obesity are now available. They are aimed at limiting oral energy intake with or without causing dumping or inducing selective maldigestion and malabsorption. Based on current literature, up to 75% of excess weight is lost by surgical treatment with concomitant disappearance of hyperlipidaemias, type 2 diabetes, hypertension or sleep apnoea. The main indication for operative treatment is morbid obesity (body mass index greater than 40 kg/m2) or severe obesity (body mass index > 35 kg/m2) with comorbidities of obesity. Orlistat is a new inhibitor of pancreatic lipase enzyme. At doses of 120 mg three times per day with meals it results in a 30% reduction in dietary fat absorption, which equals approximately 200 kcal daily energy deficit. In the long term, orlistat has been shown to be more effective than placebo in reducing body weight and serum total and low-density lipoprotein cholesterol levels. Orlistat has a lowering effect on serum cholesterol independent of weight loss. Along with weight loss, orlistat also favourably affects blood pressure and glucose and insulin levels in obese individuals and in obese type 2 diabetic patients.
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PMID:New aspects in the management of obesity: operation and the impact of lipase inhibitors. 1009 83

The purpose of this study was to examine the prevalence of sleep disordered breathing and background factors, especially hyperinsulinemia, in diabetic patients. The subjects were 70 patients randomly selected from 143 noninsulin-dependent diabetic patients hospitalized for educational purposes. Obstructive sleep apnea syndrome (OSAS) was diagnosed in 13 subjects, equivalent to a prevalence of 18.6%. The mean +/- S.D. immunoreactive insulin (IRI) values for 11 of the 13 OSAS patients (excluding insulin-treated patients) and for 49 non-OSAS patients were 10.7 +/- 6.8 microU/ml and 5.8 +/- 3.5 microU/ml, respectively. The value for the OSAS group was higher than that for the non-OSAS group (p = 0.04). However, a positive correlation between body mass index (BMI) and IRI was observed in both the OSAS (Y = 1.148 X - 20.006, r = 0.834, p = 0.001) and non-OSAS (Y = 0.466 X - 5.820, r = 0.524, p = 0.0001) groups. Multivariate analysis demonstrated that the presence of OSAS had a statistically significant influence on IRI (p = 0.001), but not on BMI (p = 0.391). These findings suggest that hyperinsulinemia may be exacerbated in diabetic patients with OSAS regardless of BMI.
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PMID:[Relationship between diabetes mellitus-associated obstructive sleep apnea syndrome and hyperinsulinemia]. 1054 Aug 35

Oral glucose tolerance tests (OGTT) were performed on eighteen patients with suspected obstructive sleep apnoea who also completed a whole-night polygraphic recording with oximetry. Insulin resistance indices (IRI) were calculated as the product of areas under glucose and insulin curves. In the resulting multiple regression analysis the dependent variable was IRI and the independent variables were age, body mass index (BMI) and the number of nocturnal hypoxic episodes with over 4% desaturation per hour (ODI4). ODI4 was between 4.6 and 70 (median 22.3); IRI ranged from 2.20 to 33.55 (median 7.50). In the regression model the coefficient of determination (R2) for IRI was 0.441 (F-ratio = 3.681, P = 0.038). The strongest determinant of IRI was ODI4 and the regression coefficient of BMI was not significantly different from zero even when possible outliers were excluded. It was found that insulin resistance is related to the severity of sleep anoea. This may be due to a hypoxia-induced hormonal stress reaction which decreases tissue insulin sensitivity. Since upper body obesity is associated with both insulin resistance and sleep apnoea, the distribution of fat should be taken into account in future studies.
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PMID:The severity of obstructive sleep apnoea is associated with insulin resistance. 1060 72

Obstructive sleep apnoea (OSA), and snoring are associated with coronary heart disease. To assess whether OSA or snoring may contribute to this by raising fasting lipid or insulin levels, venous fasting total cholesterol, triglyceride, very-low-density lipoprotein, low-density lipoprotein, high-density lipoprotein, and insulin were measured in 15 untreated OSA patients and 18 snorers. Each of these subjects was individually matched to a control of the same sex, age +/- 10%, body index +/- 15%, smoking and drinking habits. This produced study groups which did not differ significantly by any of these criteria. Fasting venous blood samples were collected at 06.30 hours following polysomnography, and analysed blind of the subjects respiratory status. The OSA patients were then treated with nasal continuous positive airway pressure. In 10 of these subjects lipid and insulin levels were repeated after more than three months treatment. Lipid and insulin levels were also remeasured in the controls matched to these 10 subjects. The end points were compared with paired t-tests. There was no difference in any of the end points when the untreated OSA patients and the snorers were compared to their matched controls (P > 0.25 for all comparisons), and none of the indices changed when OSA was corrected with nasal continuous positive airway pressure (P > 0.25 for all comparisons). Patients with obstructive sleep apnoea or snoring do not have significant fasting hyperlipidaemia or hyperinsulinaemia when compared to carefully matched controls. These factors are therefore unlikely to be the cause of the excess cardiovascular mortality experienced by this patient group.
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PMID:Plasma insulin and lipid levels in untreated obstructive sleep apnoea and snoring; their comparison with matched controls and response to treatment. 1060 24


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