The Korean journal of internal medicine

  • 제26권3호
  • /
  • Pages.277-284
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  • 2011
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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DOI QR코드

DOI QR Code

Sleep Disorder and Cardiovascular Risk Factors among Patients with Type 2 Diabetes Mellitus

  • Shim, Un-Jin (Department of Internal Medicine, Ewha Womans University School of Medicine) ;
  • Lee, Hye-Jin (Department of Internal Medicine, Ewha Womans University School of Medicine) ;
  • Oh, Jee-Young (Department of Internal Medicine, Ewha Womans University School of Medicine) ;
  • Sung, Yeon-Ah (Department of Internal Medicine, Ewha Womans University School of Medicine)
  • 발행 : 2011.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Sleep disorder (SD) is associated with an increased risk of cardiovascular disease and is more prevalent among individuals with type 2 diabetes mellitus. These health problems not only frequently coexist but also exacerbate each other. We conducted a cross-sectional study to estimate the prevalence of SD among diabetic patients and to investigate the relationship between SD and cardiovascular risk among these patients. Methods: We recruited 784 patients with type 2 diabetes and conducted a self-administered questionnaire. We assessed sleep quality using the Pittsburgh Sleep Quality Index and the risk of obstructive sleep apnea (OSA) using the Berlin Questionnaire. Additional information included blood pressure and metabolic profiles. Results: Of the 784 diabetic patients, 301 (38.4%) patients had poor sleep quality, and 124 (15.8%) were at high risk for OSA. Patients at increased risk for OSA were more obese; they also had higher blood pressure, fasting plasma insulin levels, insulin resistance assessed by homeostasis model assessment (HOMA-IR), and serum triglycerides levels (p < 0.05). The frequency of risk for OSA was higher among obese patients compared with non-obese patients (34.8% vs. 9.4%, p < 0.05). Logistic regression analysis revealed that male sex and bone mass index were independent predictors of risk for OSA. Conclusions: SD was prevalent among type 2 diabetic patients, and OSA could aggravate their risk for cardiovascular disease. Clinical treatment of these patients should include evaluation and intervention for SD.

키워드

참고문헌

  1. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217-1239. https://doi.org/10.1164/rccm.2109080
  2. Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002;165:677-682. https://doi.org/10.1164/ajrccm.165.5.2104087
  3. Vgontzas AN, Bixler EO, Chrousos GP. Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance. J Intern Med 2003;254:32-44. https://doi.org/10.1046/j.1365-2796.2003.01177.x
  4. Punjabi NM, Ahmed MM, Polotsky VY, Beamer BA, O'Donnell CP. Sleep-disordered breathing, glucose intolerance, and insulin resistance. Respir Physiol Neurobiol 2003;136:167-178. https://doi.org/10.1016/S1569-9048(03)00079-X
  5. Choi KM, Lee JS, Park HS, Baik SH, Choi DS, Kim SM. Relationship between sleep duration and the metabolic syndrome: Korean National Health and Nutrition Survey 2001. Int J Obes (Lond) 2008;32:1091-1097. https://doi.org/10.1038/ijo.2008.62
  6. Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 2009;6:e1000132. https://doi.org/10.1371/journal.pmed.1000132
  7. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-1384. https://doi.org/10.1056/NEJM200005113421901
  8. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001;163:19-25. https://doi.org/10.1164/ajrccm.163.1.2001008
  9. Ybarra J, Planas F, Navarro-Lopez F, et al. Association between sleep-disordered breathing, aminoterminal pro-brain natriuretic peptide (NT-proBNP) levels and insulin resistance in morbidly obese young women. Eur J Intern Med 2009;20:174-181. https://doi.org/10.1016/j.ejim.2008.01.019
  10. Elmasry A, Janson C, Lindberg E, Gislason T, Tageldin MA, Boman G. The role of habitual snoring and obesity in the development of diabetes: a 10-year follow-up study in a male population. J Intern Med 2000;248:13-20. https://doi.org/10.1046/j.1365-2796.2000.00683.x
  11. Al-Delaimy WK, Manson JE, Willett WC, Stampfer MJ, Hu FB. Snoring as a risk factor for type II diabetes mellitus: a prospective study. Am J Epidemiol 2002;155:387-393. https://doi.org/10.1093/aje/155.5.387
  12. Meslier N, Gagnadoux F, Giraud P, et al. Impaired glucoseinsulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 2003;22:156-160. https://doi.org/10.1183/09031936.03.00089902
  13. Elmasry A, Lindberg E, Berne C, et al. Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med 2001;249:153-161. https://doi.org/10.1046/j.1365-2796.2001.00787.x
  14. West SD, Nicoll DJ, Stradling JR. Prevalence of obstructive sleep apnoea in men with type 2 diabetes. Thorax 2006;61:945-950. https://doi.org/10.1136/thx.2005.057745
  15. Resnick HE, Redline S, Shahar E, et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care 2003;26:702-709. https://doi.org/10.2337/diacare.26.3.702
  16. Ip MS, Lam B, Lauder IJ, et al. A community study of slee-pdisordered breathing in middle-aged Chinese men in Hong Kong. Chest 2001;119:62-69. https://doi.org/10.1378/chest.119.1.62
  17. Ip MS, Lam B, Tang LC, Lauder IJ, Ip TY, Lam WK. A community study of sleep-disordered breathing in middle-aged Chinese women in Hong Kong: prevalence and gender differences. Chest 2004;125:127-134. https://doi.org/10.1378/chest.125.1.127
  18. Cockram CS. Diabetes mellitus: perspective from the Asia-Pacific region. Diabetes Res Clin Pract 2000;50 Suppl 2:S3-S7. https://doi.org/10.1016/S0168-8227(00)00202-3
  19. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213. https://doi.org/10.1016/0165-1781(89)90047-4
  20. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999;131:485-491.
  21. Ahmadi N, Chung SA, Gibbs A, Shapiro CM. The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance. Sleep Breath 2008;12:39-45. https://doi.org/10.1007/s11325-007-0125-y
  22. Shaw JE, Punjabi NM, Wilding JP, Alberti KG, Zimmet PZ; International Diabetes Federation Taskforce on Epidemiology and Prevention. Sleep-disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Diabetes Res Clin Pract 2008;81:2-12. https://doi.org/10.1016/j.diabres.2008.04.025
  23. Ayas NT, White DP, Al-Delaimy WK, et al. A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care 2003;26:380-384. https://doi.org/10.2337/diacare.26.2.380
  24. Cunha MC, Zanetti ML, Hass VJ. Sleep quality in type 2 diabetics. Rev Lat Am Enfermagem 2008;16:850-855. https://doi.org/10.1590/S0104-11692008000500009
  25. Nonogaki K. New insights into sympathetic regulation of glucose and fat metabolism. Diabetologia 2000;43:533-549. https://doi.org/10.1007/s001250051341
  26. Yaggi HK, Araujo AB, McKinlay JB. Sleep duration as a risk factor for the development of type 2 diabetes. Diabetes Care 2006;29:657-661. https://doi.org/10.2337/diacare.29.03.06.dc05-0879
  27. Chaput JP, Despres JP, Bouchard C, Astrup A, Tremblay A. Sleep duration as a risk factor for the development of type 2 diabetes or impaired glucose tolerance: analyses of the Quebec Family Study. Sleep Med 2009;10:919-924. https://doi.org/10.1016/j.sleep.2008.09.016
  28. Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI. Obstructive sleep apnea and cardiovascular disease: role of the metabolic syndrome and its components. J Clin Sleep Med 2008;4:261-272.
  29. Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI. Obstructive sleep apnea and cardiovascular disease: role of the metabolic syndrome and its components. J Clin Sleep Med 2008;4:261-272.
  30. Reaven G, Abbasi F, McLaughl in T. Obesity, insul in resistance, and cardiovascular disease. Recent Prog Horm Res 2004;59:207-223. https://doi.org/10.1210/rp.59.1.207
  31. Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 2008;31:1079-1085.
  32. Yumino D, Wang H, Floras JS, et al. Relationship between sleep apnoea and mortality in patients with ischaemic heart failure. Heart 2009;95:819-824. https://doi.org/10.1136/hrt.2008.160952
  33. Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008;31:1071-1078.
  34. Kato M, Adachi T, Koshino Y, Somers VK. Obstructive sleep apnea and cardiovascular disease. Circ J 2009;73:1363-1370. https://doi.org/10.1253/circj.CJ-09-0364
  35. Schulz R, Hummel C, Heinemann S, Seeger W, Grimminger F. Serum levels of vascular endothelial growth factor are elevated in patients with obstructive sleep apnea and severe nighttime hypoxia. Am J Respir Crit Care Med 2002;165:67-70. https://doi.org/10.1164/ajrccm.165.1.2101062
  36. Schulz R, Flototto C, Jahn A, et al. Circulating adrenomedullin in obstructive sleep apnoea. J Sleep Res 2006;15:89-95. https://doi.org/10.1111/j.1365-2869.2006.00498.x
  37. Riha RL, Brander P, Vennelle M, et al. Tumour necrosis factoralpha (-308) gene polymorphism in obstructive sleep apnoeahypopnoea syndrome. Eur Respir J 2005;26:673-678. https://doi.org/10.1183/09031936.05.00130804
  38. Shamsuzzaman AS, Winnicki M, Lanfranchi P, et al. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002;105:2462-2464. https://doi.org/10.1161/01.CIR.0000018948.95175.03
  39. Robinson GV, Pepperell JC, Segal HC, Davies RJ, Stradling JR. Circulating cardiovascular risk factors in obstructive sleep apnoea: data from randomized controlled trials. Thorax 2004;59:777-782. https://doi.org/10.1136/thx.2003.018739
  40. Makinodan K, Yoshikawa M, Fukuoka A, et al. Effect of serum leptin levels on hypercapnic ventilator response in obstructive sleep apnea. Respiration 2008;75:257-264. https://doi.org/10.1159/000112471
  41. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 2000;85:1151-1158. https://doi.org/10.1210/jc.85.3.1151
  42. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004;25:735-741. https://doi.org/10.1016/j.ehj.2004.02.021
  43. Hu FB, Willett WC, Colditz GA, et al. Prospective study of snoring and risk of hypertension in women. Am J Epidemiol 1999;150:806-816. https://doi.org/10.1093/oxfordjournals.aje.a010085
  44. Joo S, Lee S, Choi HA, et al. Habitual snoring is associated with elevated hemoglobin A1c levels in non-obese middle-aged adults. J Sleep Res 2006;15:437-444. https://doi.org/10.1111/j.1365-2869.2006.00556.x
  45. Fletcher EC. Sympathetic activity and blood pressure in the sleep apnea syndrome. Respiration 1997;64 Suppl 1:22-28. https://doi.org/10.1159/000196732
  46. Fletcher EC. Sympathetic over activity in the etiology of hypertension of obstructive sleep apnea. Sleep 2003;26:15-19. https://doi.org/10.1093/sleep/26.1.15
  47. Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995;96:1897-1904. https://doi.org/10.1172/JCI118235
  48. Hjalmarsen A, Aasebo U, Birkeland K, Sager G, Jorde R. Impaired glucose tolerance in patients with chronic hypoxic pulmonary disease. Diabetes Metab 1996;22:37-42.
  49. Marshall S, Garvey WT, Traxinger RR. New insights into the metabolic regulation of insulin action and insulin resistance: role of glucose and amino acids. FASEB J 1991;5:3031-3036. https://doi.org/10.1096/fasebj.5.15.1743436
  50. Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med 2002;165:934-939. https://doi.org/10.1164/ajrccm.165.7.2104126
  51. Schulz R, Mahmoudi S, Hattar K, et al. Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea: impact of continuous positive airway pressure therapy. Am J Respir Crit Care Med 2000;162(2 Pt 1):566-570. https://doi.org/10.1164/ajrccm.162.2.9908091
  52. Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science 1993;259:87-91. https://doi.org/10.1126/science.7678183
  53. Stumvoll M, Haring H. Insulin resistance and insulin sensitizers. Horm Res 2001;55 Suppl 2:3-13.
  54. O'Connor C, Thornley KS, Hanly PJ. Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med 2000;161:1465-1472. https://doi.org/10.1164/ajrccm.161.5.9904121
  55. Enright PL, Newman AB, Wahl PW, Manolio TA, Haponik EF, Boyle PJ. Prevalence and correlates of snoring and observed apneas in 5,201 older adults. Sleep 1996;19:531-538. https://doi.org/10.1093/sleep/19.7.531

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