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.
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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. What is Endocrinology -How does sleep apnea caused by GH overproduction vary from sleep apnea caused by thyroid hormone deficiency?
A large percentage of central sleep apnea is linked to GH excess, whereas hypothyroidism is virtually always linked to OSA. PSG tests finally reveal sleep apnea in up to 60% of acromegaly patients. More than 30% of people in one series had central sleep apnea. The lack of occlusive posterior tongue movement during sleep, as demonstrated by endoscopy, rules out macroglossia. This claim is further corroborated by the finding that, when compared to individuals with OSA, these patients exhibit higher ventilatory responsiveness and lower arterial carbon dioxide levels while awake. It is unclear what causes the central sleep apnea in these people. What is Endocrinology - What endocrine conditions are linked to obstructive sleep apnea (OSA)?9/22/2022 What is Endocrinology - What endocrine conditions are linked to obstructive sleep apnea (OSA)?
The most prevalent conditions are polycystic ovarian syndrome, acromegaly, and hypothyroidism (PCOS). Although it was formerly believed that all OSA patients had subclinical hypothyroidism, this has since been disproven. According to the available data, roughly 30% of hypothyroid patients also have OSA. In most of these people, OSA is curable with the right thyroid hormone replacement therapy. 30% of nonobese, middle-aged men and women with newly diagnosed symptomatic hypothyroidism had OSA by PSG at study start, according to one prospective investigation. In 84% of these cases, the OSA was reversed as soon as the TSH level returned to normal. Finally, there is a significant correlation between the likelihood and severity of OSA in PCOS and insulin levels and markers of glucose tolerance. Additionally, insulin levels are considerably greater in PCOS-positive women with normal glucose tolerance who are at high versus low OSA risk, regardless of BMI. It makes sense to evaluate restorative sleep measurements, sleep patterns, and sleep behaviours in all PCOS patients. What is Endocrinology - Does the comorbidity of obstructive sleep apnea (OSA) affect the evaluation of metanephrines and catecholamines while screening for pheochromocytoma in light of the elevated SNS tone in OSA?
Yes. Similar to how acute catecholamine elevations are linked to myocardial infarctions, cerebral vascular accidents, and acute heart failure, OSA causes an appropriate release of catecholamines in response to physiologic stress or disease. In the case of undiagnosed or undertreated OSA, a 24-hour urine collection would probably reveal higher levels of catecholamines and metanephrine. This could incorrectly point to a pheochromocytoma diagnosis. What is Endocrinology - What distinguishes sleep apnea from sleep deprivation?
When one is sleep deprived, they do not sleep yet nevertheless breathe regularly. When someone has OSA, they sleep yet have breathing problems. As long as it is linked to daytime sleepiness, the AASM recognises volitional sleep deprivation as behaviorally produced insufficient sleep syndrome. A standardised instrument like the Epworth Sleepiness Scale can be used to objectively assess excessive daytime sleepiness (EDS) (ESS). In the ESS, the interviewer presents the patient with eight different life scenarios and asks them to rate their own perceived level of sleep pressure in each scenario using a four-point scale (0–3). A score of 0 indicates that the patient feels no sleep pressure in the scenario, while a score of 3 indicates that the patient perceives significant sleep pressure in the scenario. The patient must respond to all eight questions in order for the total score from all 8 life circumstances to be valid for use in clinical practise. A higher than 9 ESS score is consistent with EDS. Patients with acute or chronic sleep shortness fight falling asleep despite having normal gas exchange. In OSA, despite prolonged thoracic and abdominal breathing effort, the upper airway repeatedly collapses, causing apneic and hypopneic episodes. As a result, the diaphragm, chest wall, and upper airway are mechanically loaded. Hypoxia, hypercarbia, and a significant rise in adrenergic tone ensue. Endocrine reactivity and the typical sleep-wake cycle are frequently affected by OSA. Both can be responsible for exhaustion and drowsiness during the day. The patient's sleep continuity is normal if EDS is a result of sleep deprivation, and it is frequently accompanied by a rise in SWS. Remember that daytime recovery sleep has an inhibitory effect on TSH; if nocturnal sleep deprivation is followed by daytime recovery sleep, the inhibitory effect of sleep will lower TSH. What is Endocrinology - Explain what sleep deprivation is. How frequent is it?
Lack of sleep can be sudden or ongoing. Acute sleep loss is defined as not getting any sleep for 24 hours, but chronic sleep deprivation is defined as sleeping less than 6 hours every night for six nights or longer. People in developed countries are sleeping fewer hours. For instance, in the United States, more than 30% of adults under the age of 64 report sleeping fewer than 6 hours each night, a statistic that makes it clear that many patients are developing chronic sleep deprivation. What is Endocrinology - How common is obstructive sleep apnea (OSA) today?
The prevalence varies depending on how OSA is defined. Early epidemiologic studies, mostly on white men, reported that up to 4% of patients had OSA and between 60% and 90% were obese. For individuals aged 30 to 60, the typical prevalence of OSA is 24% for males and 9% for women. Genetic craniofacial traits like retrognathia are linked to OSA in persons who are not fat. The prevalence may become specific to communities or ethnicities as OSA data mature. Body mass index (BMI) and age were positively connected in Asian nonobese male office employees, but weight was less so than in white, non-Asian subjects. In Chinese populations, it is believed that risk factors for OSA other than obesity, such as pharyngeal narrowing, retrognathia or micrognathia, and pharyngeal collapsibility, take higher clinical relevance. What is Endocrinology - What are respiratory events, exactly?
Apneas, hypopneas, and respiratory effort-related arousals are examples of respiratory events (RERAs). An apneic episode is defined as a minimum 90% reduction in airflow from baseline that lasts for at least 10 seconds (try holding your own breath for 10 seconds). According to pulse oximetry, hypopnea is characterised by a 10 second period of at least a 30% drop in airflow that causes a desaturation of at least 4%. In contrast, if an observed event does not satisfy hypopnea or apnea criteria, RERA criteria should be sought. RERA is described as a series of breaths lasting more than 10 seconds, which are linked to increased respiratory effort and awaken the sleeper. Apneas, hypopneas, and RERAs are to be scored in the standard PSG interpretation, according to the AASM, if they are present. The apnea-hypopnea index measures the average number of apneas and hypopneas in a single hour (AHI). The average number of apneas, hypopneas, and RERAs should be determined if RERAs are present, though. The respiratory disturbance index is used to describe this (RDI). Even though the terms are occasionally used interchangeably, the AHI and RDI are not equal—this could lead to mistake. |
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