Obstructive sleep apnea and type 2 diabetes - Interacting epidemics
Obstructive sleep apnea and type 2 diabetes - Interacting epidemics
复制标题
DOI：
10.1378/chest.07-0828
复制
发表时间：
2008-02-01
期刊：
影响因子：
9.6
通讯作者：
Van Canter, Eve
中科院分区：
文献类型：
--
作者：
Tasali, Esra;Mokhlesi, Babak;Van Canter, Eve
2型糖尿病是一个主要的公共卫生问题，具有高发病率、高死亡率和高保健费用。最近的报道表明，大多数2型糖尿病患者也有阻塞性睡眠呼吸暂停（OSA）。有令人信服的证据表明，阻塞性睡眠呼吸暂停是心血管疾病和死亡率的重要危险因素。从流行病学和临床研究中迅速积累的数据表明，OSA也与葡萄糖代谢的改变独立相关，并使患者患2型糖尿病的风险增加。人类和动物的实验研究表明，睡眠中断导致间歇性缺氧和睡眠时间缩短，如OSA，对葡萄糖代谢产生不利影响。根据目前的证据，临床医生需要解决2型糖尿病患者的OSA风险，反过来，评估OSA患者是否存在2型糖尿病。显然，需要进一步的研究，通过精心设计的研究和长期随访，来充分证明OSA在2型糖尿病的发生和严重程度中的因果作用。特别是，未来的研究在检查OSA与葡萄糖代谢改变之间的联系时，必须仔细考虑中心性肥胖的混杂效应。肥胖症、阻塞性睡眠呼吸暂停和2型糖尿病日益流行之间的相互作用可能是复杂的，涉及多种途径。更好地了解阻塞性睡眠呼吸暂停和2型糖尿病之间的关系可能具有重要的公共卫生意义。
Type 2 diabetes is a major public health concern with high morbidity, mortality, and health-care costs. Recent reports have indicated that the majority of patients with type 2 diabetes also have obstructive sleep apnea (OSA). There is compelling evidence that OSA is a significant risk factor for cardiovascular disease and mortality. Rapidly accumulating data from both epidemiologic and clinical studies suggest that OSA is also independently associated with alterations in glucose metabolism and places patients at an increased risk of the development of type 2 diabetes. Experimental studies in humans and animals have demonstrated that intermittent hypoxia and reduced sleep duration due to sleep fragmentation, as occur in OSA, exert adverse effects on glucose metabolism. Based on the current evidence, clinicians need to address the risk of OSA in patients with type 2 diabetes and, conversely, evaluate the presence of type 2 diabetes in patients with OSA. Clearly, there is a need for further research, using well-designed studies and long-term follow-up, to fully demonstrate a causal role for OSA in the development and severity of type 2 diabetes. In particular, future studies must carefully consider the confounding effects of central obesity in examining the link between OSA and alterations in glucose metabolism. The interactions among the rising epidemics of obesity, OSA, and type 2 diabetes are likely to be complex and involve multiple pathways. A better understanding of the relationship between OSA and type 2 diabetes may have important public health implications.