What is Endocrinology - What impact do androgens have on sleep?
Exogenous testosterone may cause sleep apnea-related alterations or exacerbate OSA that already exists. A high-dose testosterone injection in hypogonadal older men who were otherwise healthy and had undiagnosed sleep apnea reduced total sleep time and made it worse, according to one randomised controlled experiment. Despite the fact that there have been no confirmed reports linking hypogonadism to diminished cognition and impaired driving, it is the prescriber's responsibility to check patients for the risk of undiagnosed OSA.
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What is Endocrinology - Is the testosterone loss seen with ageing linked to alterations in aging-related sleep patterns?
It most likely is. As was previously mentioned, ageing is linked to shorter sleep and SWS durations. LH pulses in older males have a smaller amplitude but a higher frequency. Although it is less pronounced and no longer correlated with the time to the first REM episode, the testosterone surge linked with sleep is still evident. What is Endocrinology - What impact does lack of sleep have on the hunger and satiety hormones, ghrelin and leptin?
Leptin levels drop with sleep deprivation whereas ghrelin levels rise (from the root ghre, which means "to grow"). Leptin levels rise and ghrelin levels fall during extended periods of sleep. Leptin release is known to be reduced in sleep deprived individuals, and during a 6-month period, sleep deprived individuals gain an average of 10 pounds more than do rested individuals. What is Endocrinology - What impact does lack of sleep have on the hunger and satiety hormones, ghrelin and leptin?
Leptin levels drop with sleep deprivation whereas ghrelin levels rise (from the root ghre, which means "to grow"). Leptin levels rise and ghrelin levels fall during extended periods of sleep. Leptin release is known to be reduced in sleep deprived individuals, and during a 6-month period, sleep deprived individuals gain an average of 10 pounds more than do rested individuals. What is Endocrinology - Does weight loss occur in obstructive sleep apnea (OSA) patients who use CPAP effectively?
Yes, it does, and reportedly via two different processes. First, people with sleep apnea who receive treatment typically wake up feeling better rested and more energised. Patients with OSA have even been shown to exercise more after starting treatment. Second, treating sleep apnea causes serum leptin, or "satiety hormone," to return to normal levels. Leptin is derived from the Greek word leptos, which means "thin." Leptin is suppressed by sleep loss and untreated sleep apnea, as covered in the following question. What is Endocrinology - How effectively do healthcare professionals in diabetic clinics screen patients for obstructive sleep apnea (OSA)?
What are effective tools for history- and physical-based screening? 56% of diabetic patients reported snoring, 29% had weariness upon awakening, and 34% reported feeling tired while awake, according to a study that used a validated clinical assessment and questionnaire to estimate OSA risk and drowsiness. 56% of individuals surveyed, according to the study's authors, had a high risk of developing OSA. Given the high prevalence of SDB reported in the diabetic patient population, this finding supports a recommendation for increased vigilance in the screening for OSA in this patient population. To do this, a few screening tools might be useful. The risk of OSA is inversely correlated with BMI; the most delicate physical finding is a neck size more than 17 inches. Patients who have certain craniofacial alterations, such retrognathia, are also at a higher risk. A patient with OSA is frequently ignorant of the neurocognitive changes that have gradually taken place over time, thus unless specifically asked, he or she may not readily provide a history that is consistent with OSA. What is Endocrinology - Does the use of continuous positive airway pressure (CPAP) improve aberrant glucose metabolism parameters with regard to causality?
Yes. Patients without diabetes, diabetics who are not obese, and those with poorly controlled diabetes all exhibit this. Warning: In this body of work, it is up to the reader to determine from the trial if a documented CPAP compliance measure was used. Trials that report CPAP adherence definitions and those that show no change in BMI over the course of the research do demonstrate improvement. After just two days of treatment, CPAP dramatically improved insulin sensitivity in a study of non-diabetic patients with moderate to severe OSA, and the improvement sustained at the 3-month follow-up with no appreciable changes in body weight. The non-obese patients showed the strongest effects of this factor. In contrast, patients with DM2 who were obese did not exhibit any improvement in insulin sensitivity in this research lab. In other studies, patients with DM2 and OSA experienced the greatest postprandial blood glucose level improvements following CPAP therapy. What is Endocrinology - What two primary pathways underlie the emergence of impaired glucose metabolism in sleep apnea patients?
Airflow decrease, which is the defining feature of OSA, is frequently linked to intermittent hypoxemia, fragmented sleep, and SNS stimulation. Independent of SNS activity, intermittent hypoxemia has been demonstrated to alter insulin sensitivity in animal experiments. Additionally, it has been demonstrated that in overweight to mildly obese male non-diabetic subjects, every 4% drop in oxygen saturation is connected to an odds ratio of nearly 2 for deteriorated glucose tolerance. An impaired glucose metabolism has been linked to fragmented sleep. In one study of healthy adults, selective SWS suppression without a reduction in total sleep time was linked to a roughly 25% reduction in insulin sensitivity. This finding implies that the increased frequency of DM2 in elderly and obese people may be related to their low levels of SWS. Mild OSA was linked to a mean HbA1C of 7.22% and severe OSA with a HbA1C of about 9.42% in a study of consecutive people with DM2, aged 41 to 77, with a BMI of 20 to 57 kg/m2. The severity of OSA as measured by the AHI linked with higher mean HbA1C values after controlling for age, gender, race, BMI, number of diabetic medications, degree of exercise, years with diabetes, and total sleep time. What is Endocrinology - . What evidence exists connecting (obstructive sleep apnea) OSA and improper glucose metabolism?
Type 2 diabetes mellitus (DM2) risk has been connected to snoring, lack of sleep, and OSA. Data from a variety of patient demographics indicate that the severity of OSA is a risk factor for the onset of DM2. The data that are currently available do not conclusively demonstrate direct causation. Snoring has been independently linked to faulty oral glucose tolerance tests and higher haemoglobin A1C (HbA1C) percentages in nonobese Asians, particularly those who are obese. The risk of acquiring DM2 and sleep quality have a favourable correlation, according to epidemiological studies. According to observational research, people with less than 6 hours of sleep every night are more likely to have diabetes type 2 and glucose intolerance. It was discovered that the amount of sleep (between six and eight hours each night) was a good indicator of a higher prevalence of DM2. Atypical glucose metabolism is independently linked to OSA, as determined by PSG. Through a thorough analysis of the potential confounders associated with overweight and obesity, another article furthered this independent connection. In this cross-sectional research of 2588 patients, it was demonstrated that OSA is linked (although to varying degrees) with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and occult diabetes in both the normal-weight (BMI,25 kg/m2) and overweight or obese subgroups. This study implies that those with OSA are particularly vulnerable to DM2 and its cardiovascular side effects. What is Endocrinology - How does lack of sleep affect glucose tolerance?
One study found that after 4 hours of sleep every night for a week, post-breakfast insulin resistance increased. When compared to a group that had sleep extension, glucose tolerance is about 40% worse after sleep restriction. It has been discovered that first-phase insulin release has been significantly decreased. There are noticeable increases in glucose and insulin levels when sleep-deprived people enter recovery sleep (sleeping during the day as a result of past sleep deprivation), demonstrating that sleep also modulates glucose regulation independently of the circadian rhythm. |
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