СРАР therapy for obstructive sleep apnea syndrome in patients with carbohydrate metabolic disturbances and type 2 diabetes mellitus

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The review presents the data of clinical trials assessing the association between type 2 diabetes mellitus (DM) and obstructive sleep apnea syndrome (OSAS). The factors influencing the development of OSAS are analyzed in patients with DM; and disturbed sleep patterns are described in detail in patients with OSAS. The relationship of OSAS, diabetic autonomic neuropathy, and insulin resistance is analyzed. Whether CPAP therapy may be used to correct metabolic disturbances in patients with DM is considered.

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Применение СРАР-терапии при синдроме обструктивного апноэ во сне у больных с нарушениями углеводного обмена и сахарным диабетом 2-го типа. - Аннотация. В обзоре представлены данные клинических исследований, в которых оценивалась взаимосвязь сахарного диабета (СД) 2-го типа и синдрома обструктивного апноэ во сне (СОАС). Приведен анализ факторов, влияющих на развитие СОАС у больных СД, а также подробно описываются нарушения структуры сна у пациентов с СОАС. Анализируется взаимосвязь СОАС, диабетической автономной невропатии и инсулинорезистентности. Рассматривается возможность применения СРАР-терапии для коррекции метаболических нарушений у пациентов с СД.


  1. Mondini S., Guilleminault C. Abnormal breathing patterns during sleep in diabetes. Ann Neurol 1985; 17: 391-395.
  2. Ficker J.H., Dertinger S.H., Siegfried W. et al. Obstructive sleep apnoea and diabetes mellitus: the role of cardiovascular autonomic neuropathy. Eur Respir J 1998; 11: 14-19.
  3. Vgontzas A.N., Legro R.S., Bixler E.O. et al. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metabol 2001; 86 (2): 517-520.
  4. Manzella D., Parillo M., Razzino T. et al. Soluble leptin receptor and insulin resistance as determinant of sleep apnea. Intern J Obes 2002; 26 (3): 370-375.
  5. Page M.M., Watkins P.J. Cardiorespiratory arrest and diabetic autonomic neuropathy. Lancet 1990; i: 14-16.
  6. Bottini P., Dottorini M.L., Cordoni C.M. et al. Sleep-disordered breathing in nonobese diabetic subjects with autonomic neuropathy. ERJ 2003; 22 (4): 654-660.
  7. Neumann C., Martinez D., Schmid H. Nocturnal oxygen desaturation in diabetic patients with severe autonomic neuropathy. Diabetes Res Clin Pract 1995; 28 (2): 97-102.
  8. Keller T., Hader C., Zeeuw D.E., Rasche K. Obstructive sleep apnea syndrome: the effect of diabetes and autonomic neuropathy. J Physiol Pharmacol 2007; 58 (5): 313-318.
  9. Уитлоу Д. Сон и циркадные ритмы - вопросы регуляции. Новая медицина тысячелетия 2008; 5: 9-11.
  10. Cauter van E., Polonsky K.S., Scheen A.J. Roles of circadian rhythmicity and sleep in human glucose regulation. Endocrine Rev 1997; 18 (5): 716-738.
  11. Maquet P. Functional neuroimaging of normal human sleep by positron emission tomography. J Sleep Res 2000; 9 (3): 207-231.
  12. Braun A.R., Balkin T.J., Wesensten N.J. et al. Regional cerebral blood flow throughout the sleep-wake cycle. An H2(15)O PET study. Brain 1997; 120 (7): 1173-1197.
  13. Fehm H.L., Kern W., Peters A. Chapter 7: the selfish brain: competition for energy resources. Progress in Brain Res 2006; 153: 129-140.
  14. Silvani A., Asti V., Berteotti C. et al. Sleep-related brain activation does not increase the permeability of the bloodbrain barrier to glucose. J Cerebral Blood Flow Metabol 2005; 25 (8): 990-997.
  15. Kern W., Offenheuser S., Born J., Fehm H.L. Entrainment of ultradian oscillations in the secretion of insulin and glucagon to the nonrapid eye movement/rapid eye movement sleep rhythm in humans. J Clin Endocrinol Metabol 1996; 81 (4): 1541-1547.
  16. Yee B., Liu P., Philips C., Grunstein R. Neuroendocrine changes in sleep apnea. Cur Opinion Pulmon Med 2004; 10 (6): 475-481.
  17. Weiss H., Spiegler P. The impact of continuous positive airway pressure on insulin resistance in patients with obstructive sleep apnea. Clin Pulmon Med 2004; 11 (3): 196-197.
  18. Yim-Yeh S., Rahangdale S., Nguyen A. et al. Vascular dysfunction in obstructive sleep apnea and type 2 diabetes mellitus. Obesity 2010; 10: 116.
  19. Shiba T., Sato Y., Takahashi M. Relationship Between Diabetic Retinopathy and Sleep-Disordered Breathing. Am J Ophthalmol 2009; 147 (6): 1017-1021.
  20. Shaw J.E., Punjabi N.M., Wilding J.P. et al. Sleep-disordered breathing and type 2 diabetes. A report from the International Diabetes Federation Taskforce on Epidemiology and Prevention Diabetes Res Clin Pract 2008; 81 (1): 2-12.
  21. Malhotra A., Ayas N.T., Epstein L.J. The art and science of continuous positive airway pressure therapy in obstructive sleep apnea. Curr Opin Pulm Med 2000; 6: 490-495.
  22. Giles T.L., Lasserson T.J., Smith B.H. et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006; 3: CD001106.
  23. Gordon P., Sanders M.H. Sleep.7: positive airway pressure therapy for obstructive sleep apnoea/hypopnoea syndrome. Thorax 2005; 60: 68-75.
  24. Weaver T.E., Kribbs N.B., Pack A.I. et al. Night-to-night variability in CPAP use over the first three months of treatment. Sleep 1997; 20: 278-283.
  25. Steiropoulos P., Papanas N., Maltezos E., Bouros D. Is there a metabolic effect of continuous positive airway pressure in sleep apnoea? Adherence should not be underestimated. Eur Respir J 2009; 34: 1209-1210.
  26. Steiropoulos P., Papanas N., Nena E. et al. Continuous positive airway pressure treatment in patients with sleep apnoea: does it really improve glucose metabolism? Curr Diabetes Rev 2010; 6: 156-166.
  27. Steiropoulos P., Papanas N. Continous positive airway pressure to improve insulin resistance and glucose homeostasis in sleep apnea. World J Diabet 2011; 2 (1): 16-18.
  28. Harsch I.A., Schahin S.P., Bruckner K. et al. The effect of continuous positive airway pressure treatment on insulin sensitivity in patients with obstructive sleep apnoea syndrome and type 2 diabetes. Respiration 2004; 71: 252-259.
  29. Saarelainen S., Lahtela J., Kallonen E. Effect of nasal CPAP treatment on inulin sensitivity and plasma leptin. J Sleep Res 1997; 6: 146-147.
  30. Smurra M., Philip P., Taillard J. et al. CPAP treatment does not affect glucose-insulin metabolism in sleep apneic patients. Sleep Med 2001; 2: 207-213.
  31. Dawson A., Abel S.L., Loving R.T. et al. CPAP therapy of obstructive sleep apnea in type 2 diabetics improves glycemic control during sleep. J Clin Sleep Med 2008; 4 (6): 538-543.
  32. Harsch I.A., Schahin S.P., Radespiel-Troger M. et al. Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patients with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2004; 169: 156-162.
  33. Brooks B., Cistulli P.A., Borkman M. et al. Obstructive sleep apnea in obese noninsulin-dependent diabetic patients: effects of continuous positive airway pressure treatment on insulin responsiveness. J Clin Endocrinol Metabol 1994; 79: 1681-1685.
  34. Babu A.R., Herdegen J., Fogelfeld L. et al. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med 2005; 165: 447-452.
  35. Hassaballa H.A., Tulaimat A., Herdegen J.J. et al. The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea. Sleep Breath 2005; 9: 176-180.
  36. Lindberg E., Berne C., Elmasry A. et al. CPAP treatment of a population-based sample: what are the benefits and the treatment compliance? Sleep Med 2006; 7: 553-560.
  37. Sharafkhaneh A., Garcia J., Sharafkhaneh H. et al. Insulin sensitivity in obstructive sleep apnea and effect of CPAP therapy [abstract]. Paper presented at: the American Thoracic Society Meeting; 2006. San Diego, CA.
  38. Fahed G., Boque M., Torres-Palacios A. et al. Effect of continuous positive airway pressure (CPAP) on insulin resistance and aspirin responsiveness [abstract]. Am Thoracic Society 2006; A732.
  39. Pallayova M., Donic D., Donicova V. et al. Effect of continuous positive airway pressure on nocturnal glucose levels in type 2 diabetics with sleep apnea: results of continuous glucose monitoring [abstract]. Sleep Med 2006; 7 (suppl): S50.
  40. Laight D.W., Desai K.M., Gopaul N.K. et al. Pro-oxidant challenge in vivo provokes the onset of NIDDM in the insulin resistant obese Zucker rat. Br J Pharmacol 1999; 128: 269-271.
  41. Coughlin S.R., Mawdsley L., Mugarza J.A. et al. Cardiovascular and metabolic effects of CPAP in obese men with OSA. Eur Respir J 2007; 29: 720-727.
  42. West S.D., Nicoll D.J., Wallace T.M. et al. Obstructive sleep apnea in men with type 2 diabetes: a double blind randomized controlled trial of the effects of CPAP on HbA1c and insulin resistance [abstract]. Paper presented at: the American Thoracic Society Meeting, 2006. San Diego, CA.
  43. Czupryniak L., Loba J., Pawlowski M. et al. Treatment with continuous positive airway pressure may affect blood glucose levels in nondiabetic patients with obstructive sleep apnea syndrome. Sleep 2005; 28 (5): 601-603.
  44. Chin K., Shimizu K., Nakamura T. et al. Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway pressure therapy. Circulation 1999; 100: 706-712.
  45. Vgontzas A.N., Zoumakis E., Bixler E.O. et al. Selective effects of CPAP on sleep apnoea-associated manifestations. Eur J Clinical Investigat 2008; 38 (8): 585-595.
  46. Ip M.S.M. Obstructive sleep apnoea, insulin resistance and sleepiness. Thorax 2008; 63: 939-940.
  47. Barcelo A., Barbe F., de la Pena M. et al. Insulin resistance and daytime sleepiness in patients with sleep apnoea. Thorax 2008; 63 (11): 946-950.

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