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Sleep apnoea and metabolic dysfunction

Maria R. Bonsignore, Anne-Laure Borel, Elizabeth Machan, Ron Grunstein
European Respiratory Review 2013 22: 353-364; DOI: 10.1183/09059180.00003413
Maria R. Bonsignore
1Biomedical Dept of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo, Palermo, and 2Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy. 3Endocrinology Dept, University Hospital, Grenoble, 4INSERM U1042, Grenoble, and 5University Grenoble Alpes, HP2, Grenoble, France. 6Centre for Integrated Understanding and Research into Sleep (CIRUS), Woolcock Institute, University of Sydney and Royal Prince Alfred Hospital, Glebe, Australia
1Biomedical Dept of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo, Palermo, and 2Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy. 3Endocrinology Dept, University Hospital, Grenoble, 4INSERM U1042, Grenoble, and 5University Grenoble Alpes, HP2, Grenoble, France. 6Centre for Integrated Understanding and Research into Sleep (CIRUS), Woolcock Institute, University of Sydney and Royal Prince Alfred Hospital, Glebe, Australia
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  • For correspondence: marisa@ibim.cnr.it
Anne-Laure Borel
1Biomedical Dept of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo, Palermo, and 2Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy. 3Endocrinology Dept, University Hospital, Grenoble, 4INSERM U1042, Grenoble, and 5University Grenoble Alpes, HP2, Grenoble, France. 6Centre for Integrated Understanding and Research into Sleep (CIRUS), Woolcock Institute, University of Sydney and Royal Prince Alfred Hospital, Glebe, Australia
1Biomedical Dept of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo, Palermo, and 2Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy. 3Endocrinology Dept, University Hospital, Grenoble, 4INSERM U1042, Grenoble, and 5University Grenoble Alpes, HP2, Grenoble, France. 6Centre for Integrated Understanding and Research into Sleep (CIRUS), Woolcock Institute, University of Sydney and Royal Prince Alfred Hospital, Glebe, Australia
1Biomedical Dept of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo, Palermo, and 2Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy. 3Endocrinology Dept, University Hospital, Grenoble, 4INSERM U1042, Grenoble, and 5University Grenoble Alpes, HP2, Grenoble, France. 6Centre for Integrated Understanding and Research into Sleep (CIRUS), Woolcock Institute, University of Sydney and Royal Prince Alfred Hospital, Glebe, Australia
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Elizabeth Machan
1Biomedical Dept of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo, Palermo, and 2Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy. 3Endocrinology Dept, University Hospital, Grenoble, 4INSERM U1042, Grenoble, and 5University Grenoble Alpes, HP2, Grenoble, France. 6Centre for Integrated Understanding and Research into Sleep (CIRUS), Woolcock Institute, University of Sydney and Royal Prince Alfred Hospital, Glebe, Australia
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Ron Grunstein
1Biomedical Dept of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo, Palermo, and 2Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy. 3Endocrinology Dept, University Hospital, Grenoble, 4INSERM U1042, Grenoble, and 5University Grenoble Alpes, HP2, Grenoble, France. 6Centre for Integrated Understanding and Research into Sleep (CIRUS), Woolcock Institute, University of Sydney and Royal Prince Alfred Hospital, Glebe, Australia
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  • Article
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Figures

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  • Figure 1.
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    Figure 1.

    Prevalence of obstructive sleep apnoea (OSA) (apnoea/hypopnoea index ≥15 events·h−1) in a) males aged 50–69 years and b) females aged 50–69 years with type 2 diabetes compared with estimated prevalence (—) in a general population of the same age range and body mass index (BMI). DT2: type 2 diabetes; SHHS: Sleep Heart Health Study.

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    Figure 2.

    Intermediary mechanisms implicated in the deterioration of insulin sensitivity in obstructive sleep apnoea patients. HPA: hypothamic-pituitary-adrenal.

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    Figure 3.

    Prevalence rates of Metabolic Syndrome (MetS) in obstructive sleep apnoea syndrome (OSAS) patients worldwide.

Tables

  • Figures
  • Table 1. Lifestyle intervention studies in obstructive sleep apnoea (OSA) patients
    InterventionComparison/controlDuration monthsSubjects nBaseline OSAOutcomesAdditional metabolic benefits reported
    Diagnostic procedureSeverityWeight loss interventionWeight loss controlp-value
    Diet + CPAP
        Ballester [71]Conservative treatment + CPAPConservative treatment only3105Partially attended night-time respiratory recordingSevere (AHI 56±20)-1.1 kg-3.1 kg<0.001Nil
    Conservative treatment: sleep hygiene and weight loss programme, home diet prescribed by dietician
        Monasterio [73]Conservative measures + CPAPConservative measures only6125PSGModerate (AHI 20±6)+0.1 kg 6 months-2.7 kg 6 months<0.001Nonsignificant improvement in blood pressure in both control and CPAP group
    Conservative measures: weight loss programme following a home diet, avoidance of sedatives and alcohol consumption, avoidance of supine position during sleep and adequate hours of sleep
        Kajaste [72]Weight reduction strategy + CPAP (individualised CBT + dietary counselling)Weight reduction strategy + CPAP (CBT + dietary counselling)2431 malesPSGModerate (AHI 20±6)-19.1 kg 6 months-19.2 kg 6 months>0.05Nil
    Intensive Lifestyle Intervention (ILI)
        Foster [74]ILI: group weight loss programme based on low calorie diet and physical activity prescription of 175 min·week−1 of moderate, developed specifically for obese T2DM patientsThree group diabetes support education sessions focused on diet, physical activity and social support12264Unattended PSGModerate (AHI 23.2±16.5, ODI 19.4±4.9)10.8 kg post-1-year intervention0.6 kg post-1-year intervention<000.1Significant improvement in waist and neck circumference and HBA1c (p<0.001)
        Tuomilehto [75]Lifestyle intervention: individual tailored counselling and weight reduction programme with emphasis placed on diet, exercise and modification of lifestyle, focusing on eating behaviourOne dietary and exercise counselling session1271EmblettaMild (AHI 9.65±12)10.7 kg post-1-year intervention2.4 kg post-1-year intervention<0.001Significantly improved waist circumference (p<0.001)
    Lifestyle Intervention
        Kemppainen [76]Lifestyle intervention: individual tailored counselling and weight reduction programme with emphasis on diet, exercise and lifestyle modification (focusing on eating behaviour)One dietary and exercise counselling session352EmblettaMild (AHI 10.1±6.3)BMI 5.4 kg·m−2 3 monthsBMI 0.49 kg·m−2 3 months<0.05Nil
        Papandreou [77]ILI: individualised weight reduction programme based on a low calorie Mediterranean diet and physical activity prescription of at least 30 min·day−1, developed specifically for obese OSA patients who underwent CPAP treatmentIndividualised weight reduction programme based on a low calorie prudent diet and physical activity prescription of at least 30 min·day−1, developed specifically for obese OSA patients who underwent CPAP treatment621PSGSevere (AHI 46.2±32.7)Weight
    -8.9 kg
    Waist circumference -8.7 cm
    Body fat
    -4.3%
    Weight
    -7.2 kg
    Waist circumference 5.7 cm
    Body fat
    -2.6%
    0.162
    0.013
    0.032
    Nil
        Kline [78]ILI: group exercise training based on 150 min per week of moderate intensity aerobic activity followed by resistance training twice per weekStretching exercises343PSGModerate (AHI 28.3±5.6)Body fat
    -1.1%
    Body fat
    -0.2%
    <0.01Significant AHI reduction in exercise group and ODI
        Ackel-D'Elia [79]ILI: 2-month supervised aerobic exercise three times per week + CPAP therapyCPAP therapy only232 malesPSGModerate (AHI >15)No significant difference in weight parameters between groups>0.05Subjective sleepiness improved in exercise
    Other
        Sengul [80]Exercise training programme (breathing and aerobic exercise)No treatment620 malesPSGModerate (AHI 16.5±5.94)No significant changes in weight parameters between groups> 0.05Nil
        Stradling [81]Dietary advice and Arm 1: hypnotherapy type 1 (emphasis on ego strengthening centred on stress reduction) versus Arm 2: hypnotherapy type 2 (emphasis on ego strengthening centred on altering attitudes to food using the Spiegal and Spiegal approach)Dietary advice on two occasions only1846Not statedNot assessed3 months no significant difference between groups, 18 months follow-up hypnotherapy + stress reduction mean weight loss 3.8 kg compared to baseline.<0.02Nil
        Johansson [82]Weight loss programme (very low energy diet using a standard 2.3 MJ per day liquid energy intake protocol Cambridge diet)Usual diet2.2563 malesTwo consecutive unattended sleep studies using a 6-channel ambulatory polyography equipmentSevere whole group 37±15 AHI18.7 kg weight loss1.1 kg weight loss<0.001Nil
    • CPAP: continuous positive airway pressure; AHI: apnoea/hyponoea index; PSG: polysomnography; CBT: cognitive behavioural therapy; T2DM: type 2 diabetes mellitus; ODI: oxygen desaturation index; BMI: body mass index.

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Sleep apnoea and metabolic dysfunction
Maria R. Bonsignore, Anne-Laure Borel, Elizabeth Machan, Ron Grunstein
European Respiratory Review Sep 2013, 22 (129) 353-364; DOI: 10.1183/09059180.00003413

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Sleep apnoea and metabolic dysfunction
Maria R. Bonsignore, Anne-Laure Borel, Elizabeth Machan, Ron Grunstein
European Respiratory Review Sep 2013, 22 (129) 353-364; DOI: 10.1183/09059180.00003413
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  • Article
    • Abstract
    • Introduction
    • OSA and type 2 diabetes: an independent relationship?
    • The role of OSA in the metabolic consequences of obesity
    • Lifestyle interventions: metabolic benefits of exercise and weight reduction in OSA
    • Conclusions
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