Advertisement

Obesity pp 1-30 | Cite as

Obesity and Obstructive Sleep Apnea Syndrome

  • Ian W. Seetho
  • John P.H. Wilding
Living reference work entry
Part of the Endocrinology book series (ENDOCR)

Abstract

Obstructive sleep apnea (OSA) is a common condition that forms part of the spectrum of sleep disordered breathing (SDB). It may affect between 6 and 17% of all adults, but the risk rises with increasing body weight and it is very common in people with obesity. OSA causes symptoms of daytime sleepiness which can be disabling for patients, and this is currently the main criterion used to determine if treatment should be offered. Although obesity itself is associated with hypertension, hyperlipidaemia and dysglycaemia, emerging evidence shows that those with sleep apnoea are more likely to have all of these abnormalities at any given weight, and subsequently have a higher risk of developing cardiovascular disease. OSA is particularly common in people with type 2 diabetes, affecting at least a quarter of patients, and is associated with a higher risk of developing microvascular complications such as retinopathy. The main treatment used for OSA is continuous positive airway pressure ventilation (CPAP), and this has been shown to reduce daytime sleepiness and lower blood pressure, but no prospective randomised controlled trials have shown reduction in CV risk or improvement in diabetes. Weight loss is also an effective treatment, and some patients can stop CPAP treatment after bariatric surgery.

Keywords

Sleep Apnea Obesity Sleep disordered breathing Type 2 diabetes Cardiovascular disease 

Abbreviations

AHI

Apnea-hypopnea index

BMI

Body mass index

CPAP

Continuous positive airway pressure

HDL

High-density lipoprotein

LDL

Low-density lipoprotein

OSA

Obstructive sleep apnea

SDB

Sleep-disordered breathing

References

  1. Alam I, Lewis K, Stephens JW, Baxter JN. Obesity, metabolic syndrome and sleep apnoea: all pro-inflammatory states. Obes Rev. 2007;8:119–27.PubMedCrossRefGoogle Scholar
  2. Alberti K, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.PubMedCrossRefPubMedCentralGoogle Scholar
  3. Babu AR, Herdegen J, Fogelfeld L, Shott S, Mazzone T. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med. 2005;165:447–52.PubMedCrossRefGoogle Scholar
  4. Ballester E, Badia JR, Hernandez L, et al. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999;159:495–501.PubMedCrossRefGoogle Scholar
  5. Basoglu OK, Sarac F, Sarac S, Uluer H, Yilmaz C. Metabolic syndrome, insulin resistance, fibrinogen, homocysteine, leptin, and C-reactive protein in obese patients with obstructive sleep apnea syndrome. Ann Thorac Med. 2011;6:120–5.PubMedPubMedCentralCrossRefGoogle Scholar
  6. Bastard JP, Maachi M, Van Nhieu JT, et al. Adipose tissue IL-6 content correlates with resistance to insulin activation of glucose uptake both in vivo and in vitro. J Clin Endocrinol Metab. 2002;87:2084–9.PubMedCrossRefGoogle Scholar
  7. Beebe DW, Groesz L, Wells C, Nichols A, Mcgee K. The neuropsychological effects of obstructive sleep apnea: A meta-analysis of norm-referenced and case-controlled data. Sleep. 2003;26:298–307.PubMedCrossRefGoogle Scholar
  8. Bjorntorp P. Metabolic implications of body-fat distribution. Diabetes Care. 1991;14:1132–43.PubMedCrossRefPubMedCentralGoogle Scholar
  9. Blackman A, Foster GD, Zammit G, et al. Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial. Int J Obes. 2016;2016(40):1310–9.PubMedPubMedCentralCrossRefGoogle Scholar
  10. Bonsignore MR, Esquinas C, Barcelo A, et al. Metabolic syndrome, insulin resistance and sleepiness in real-life obstructive sleep apnoea. Eur Resp J. 2012a;39:1136–43.CrossRefGoogle Scholar
  11. Bonsignore MR, Mcnicholas WT, Montserrat JM, Eckel J. Adipose tissue in obesity and obstructive sleep apnoea. Eur Resp J. 2012b;39:746–67.CrossRefGoogle Scholar
  12. Borgel J, Sanner BM, Bittlinsky A, et al. Obstructive sleep apnoea and its therapy influence high-density lipoprotein cholesterol serum levels. Eur Resp J. 2006;27:121–7.CrossRefGoogle Scholar
  13. Botros N, Concato J, Mohsenin V, Selim B, Doctor K, Yaggi HK. Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med. 2009;122:1122–7.PubMedPubMedCentralCrossRefGoogle Scholar
  14. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet. 2009;373:82–93.PubMedCrossRefGoogle Scholar
  15. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta analysis. JAMA. 2004 13;292(14):1724–37.PubMedCrossRefGoogle Scholar
  16. Buckley TM, Schatzberg AFR. On the interactions of the hypothalamic-pituitary-adrenal (HPA) axis and sleep: normal HPA axis activity and circadian rhythm, exemplary sleep disorders. J Clin Endocrinol Metab. 2005;90:3106–14.PubMedCrossRefGoogle Scholar
  17. Buyukaydin B, Akkoyunlu ME, Kazancioglu R, et al. The effect of sleep apnea syndrome on the development of diabetic nephropathy in patients with type 2 diabetes. Diabetes Res Clin Pract. 2012;98:140–3.PubMedCrossRefGoogle Scholar
  18. Calvin AD, Albuquerque FN, Lopez-Jimenez F, Somers VK. Obstructive sleep apnea, inflammation, and the metabolic syndrome. Metab Syndr Relat Disord. 2009;7:271–7.PubMedPubMedCentralCrossRefGoogle Scholar
  19. Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Ann Intern Med. 2005;142:187–97.PubMedCrossRefGoogle Scholar
  20. Ceddia RB, Koistinen HA, Zierath JR, Sweeney G. Analysis of paradoxical observations on the association between leptin and insulin resistance. FASEB J. 2002;16(10):1163–76PubMedCrossRefGoogle Scholar
  21. Chirinos JA, Gurubhagavatula I, Teff K, et al. CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med. 2014;370:2265–75.PubMedPubMedCentralCrossRefGoogle Scholar
  22. Chung F, Elsaid H. Screening for obstructive sleep apnea before surgery: why is it important? Curr Opin Anesthesiol. 2009;22:405–11.CrossRefGoogle Scholar
  23. Comondore VR, Cheema R, Fox J, et al. The Impact of CPAP on cardiovascular biomarkers in minimally symptomatic patients with obstructive sleep apnea: a pilot feasibility randomized crossover trial. Lung. 2009;187:17–22.PubMedCrossRefGoogle Scholar
  24. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PMA, Wilding JPH. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J. 2004;25:735–41.PubMedCrossRefGoogle Scholar
  25. Coughlin SR, Mawdsley L, Mugarza JA, Wilding JPH, Calverley PMA. Cardiovascular and metabolic effects of CPAP in obese males with OSA. Eur Resp J. 2007;29:720–7.CrossRefGoogle Scholar
  26. Dadoun F, Darmon P, Achard V, et al. Effect of sleep apnea syndrome on the circadian profile of cortisol in obese men. Am J Physiol Endocrinol Metab. 2007;293:E466–E74.PubMedCrossRefGoogle Scholar
  27. Dawson A, Abel SL, Loving RT, et al. CPAP therapy of obstructive sleep apnea in type 2 diabetics improves glycemic control during sleep. J Clin Sleep Med. 2008;4:538–42.PubMedPubMedCentralGoogle Scholar
  28. Delarue J, Magnan C. Free fatty acids and insulin resistance. Curr Opin Clin Nutr Metab Care. 2007;10:142–8.PubMedCrossRefGoogle Scholar
  29. Dixon JB, Schachter LM, O’Brien PE, Jones K, Grima M, Lambert G, Brown W, Bailey M, Naughton MT. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial.JAMA. 2012;308(11):1142–9.Google Scholar
  30. Doonan RJ, Scheffler P, Lalli M, et al. Increased arterial stiffness in obstructive sleep apnea: a systematic review. Hypertens Res. 2011;34:23–32.PubMedCrossRefGoogle Scholar
  31. Drager LF, Bortolotto LA, Maki-Nunes C, et al. The incremental role of obstructive sleep apnoea on markers of atherosclerosis in patients with metabolic syndrome. Atherosclerosis. 2010a;208:490–5.PubMedCrossRefGoogle Scholar
  32. Drager LF, Jun J, Polotsky VY. Obstructive sleep apnea and dyslipidemia: implications for atherosclerosis. Curr Opin Endocrinol Diabetes Obes. 2010b;17:161–5.CrossRefGoogle Scholar
  33. Drager LF, Jun JC, Polotsky VY. Metabolic consequences of intermittent hypoxia: relevance to obstructive sleep apnea. Best Pract Res Clin Endocrinol Metab. 2010c;24:843–51.PubMedPubMedCentralCrossRefGoogle Scholar
  34. Drager LF, Lopes HF, Maki-Nunes C, et al. The impact of obstructive sleep apnea on metabolic and inflammatory markers in consecutive patients with metabolic syndrome. PLoS One. 2010d;5  https://doi.org/10.1371/journal.pone.0012065PubMedPubMedCentralCrossRefGoogle Scholar
  35. Drager LF, Li JG, Shin MK, et al. Intermittent hypoxia inhibits clearance of triglyceride-rich lipoproteins and inactivates adipose lipoprotein lipase in a mouse model of sleep apnoea. Eur Heart J. 2012;33:783–90a.PubMedCrossRefGoogle Scholar
  36. Drager LF, Yao QL, Hernandez KL, et al. Chronic intermittent hypoxia induces atherosclerosis via activation of adipose angiopoietin-like 4. Am J Respir Crit Care Med. 2013;188:240–8.PubMedPubMedCentralCrossRefGoogle Scholar
  37. Drager LF, Brunoni AR, Jenner R, Lorenzi-Filho G, Bensenor IM, Lotufo PA. Effects of CPAP on body weight in patients with obstructive sleep apnoea: a meta-analysis of randomised trials. Thorax. 2015;70:258–64.PubMedCrossRefGoogle Scholar
  38. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2005;365:1415–28.PubMedCrossRefGoogle Scholar
  39. Fava C, Dorigoni S, Vedove FD, et al. Effect of CPAP on blood pressure in patients with OSA/hypopnea A systematic review and meta-analysis. Chest. 2014;145:762–71.PubMedCrossRefGoogle Scholar
  40. Flemons WW, Buysse D, Redline S, et al. Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22:667–89.CrossRefGoogle Scholar
  41. Flemons WW, Littner MR, Rowley JA, et al. Home diagnosis of sleep apnea: a systematic review of the literature. An evidence review cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the American Thoracic Society. Chest. 2003;124:1543–79.PubMedCrossRefGoogle Scholar
  42. Fogel RB, Malhotra A, White DP. Sleep 2: Pathophysiology of obstructive sleep apnoea/hypopnoea syndrome. Thorax. 2004;59:159–63.PubMedPubMedCentralCrossRefGoogle Scholar
  43. Foresight Tackling Obesities: Future Choices- Project report. 2nd ed. Government Office for Science; 2007.Google Scholar
  44. Foster GD, Sanders MH, Millman R, et al. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009;32:1017–22.PubMedPubMedCentralCrossRefGoogle Scholar
  45. Furukawa S, Saito I, Yamamoto S, et al. Nocturnal intermittent hypoxia as an associated risk factor for microalbuminuria in Japanese patients with type 2 diabetes mellitus. Eur J Endocrinol. 2013;169:239–46.PubMedCrossRefGoogle Scholar
  46. Gillies CL, Abrams KR, Lambert PC, et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. Br Med J. 2007;334:299–302B.CrossRefGoogle Scholar
  47. Gottlieb DJ, Punjabi NM, Newman AB, et al. Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med. 2005;165:863–8.PubMedCrossRefGoogle Scholar
  48. Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure the sleep heart health study. Circulation. 2010;122:352–60.PubMedPubMedCentralCrossRefGoogle Scholar
  49. Gruber A, Horwood F, Sithole J, Ali NJ, Idris I. Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state. Cardiovasc Diabetol. 2006;1;5:22PubMedPubMedCentralCrossRefGoogle Scholar
  50. Guest JF, Panca M, Sladkevicius E, Taheri S, Stradling J. Clinical outcomes and cost-effectiveness of continuous positive airway pressure to manage obstructive sleep apnea in patients with type 2 diabetes in the U.K. Diabetes Care. 2014;37:1263–71.PubMedCrossRefGoogle Scholar
  51. Haentjens P, Van Meerhaeghe A, Moscariello A, et al. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome – evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med. 2007;167:757–65.PubMedCrossRefGoogle Scholar
  52. Harsch IA, Schahin SP, 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. 2004a;169:156–62.PubMedCrossRefGoogle Scholar
  53. Harsch IA, Wallaschofski H, Koebnick C, et al. Adiponectin in patients with obstructive sleep apnea syndrome: course and physiological relevance. Respiration. 2004b;71:580–6.PubMedCrossRefGoogle Scholar
  54. Health and Social Care Information Centre. Statistics on obesity, physical activity and diet: England 2015. Department of Health; 2015.Google Scholar
  55. Hecht L, Mohler R, Meyer G. Effects of CPAP-respiration on markers of glucose metabolism in patients with obstructive sleep apnoea syndrome: a systematic review and meta-analysis. Ger Med Sci. 2011;9:Doc20-Doc20.Google Scholar
  56. Heffner JE, Rozenfeld Y, Kai M, Stephens EA, Brown LK. Prevalence of diagnosed sleep apnea among patients with type 2 diabetes in primary care. Chest. 2012;141:1414–21.PubMedCrossRefGoogle Scholar
  57. Hoffstein V, Mateika S. Cardiac arrhythmias, snoring, and sleep apnea. Chest. 1994;106:466–71.PubMedCrossRefGoogle Scholar
  58. Hoyos CM, Killick R, Yee BJ, Phillips CL, Grunstein RR, Liu PY. Cardiometabolic changes after continuous positive airway pressure for obstructive sleep apnoea: a randomised sham-controlled study. Thorax. 2012;67:1081–9.PubMedCrossRefGoogle Scholar
  59. Hoyos CM, Sullivan DR, Liu PY. Effect of CPAP on the metabolic syndrome: a randomised sham-controlled study. Thorax. 2013;68:588–9.PubMedCrossRefGoogle Scholar
  60. Iftikhar IH, Blankfield RP. Effect of continuous positive airway pressure on hemoglobin A(1c) in patients with obstructive sleep apnea: a systematic review and meta-analysis. Lung. 2012;190:605–11.PubMedCrossRefGoogle Scholar
  61. Iiyori N, Alonso LC, Li JG, et al. Intermittent hypoxia causes insulin resistance in lean mice independent of autonomic activity. Am J Respir Crit Care Med. 2007;175:851–7.PubMedPubMedCentralCrossRefGoogle Scholar
  62. Imadojemu VA, Mawji Z, Kunselman A, Gray KS, Hogeman CS, Leuenberger UA. Sympathetic chemoreflex responses in obstructive sleep apnea and effects of continuous positive airway pressure therapy. Chest. 2007;131:1406–13.PubMedCrossRefGoogle Scholar
  63. Ip MSM, Lam KSL, Ho CM, Tsang KWT, Lam WK. Serum leptin and vascular risk factors in obstructive sleep apnea. Chest. 2000;118:580–6.PubMedCrossRefGoogle Scholar
  64. Ip MSM, Lam B, Ng MMT, Lam WK, Tsang KWT, Lam KSL. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165:670–6.PubMedCrossRefGoogle Scholar
  65. Isono S. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology. 2012;17:32–42.PubMedCrossRefGoogle Scholar
  66. Jenkinson C, Davies RJO, Mullins R, Stradling JR. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet. 1999;353:2100–5.PubMedCrossRefGoogle Scholar
  67. Jun J, Polotsky VY. Metabolic consequences of sleep-disordered breathing. ILAR J. 2009;50:289–306.PubMedPubMedCentralCrossRefGoogle Scholar
  68. Kajaste S, Brander PE, Telakivi T, Partinen M, Mustajoki P. A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study. Sleep Med. 2004;5:125–31.PubMedCrossRefGoogle Scholar
  69. Kapa S, Kuniyoshi FHS, Somers VK. Sleep apnea and hypertension: interactions and implications for management. Hypertension. 2008;51:605–8.PubMedCrossRefGoogle Scholar
  70. Kendzerska T, Gershon AS, Hawker G, Tomlinson G, Leung RS. Obstructive Sleep Apnea and incident diabetes: a historical cohort study. Am J Respir Crit Care Med. 2014;190:218–25.PubMedCrossRefGoogle Scholar
  71. Kent BD, Grote L, Silke R, et al. Diabetes Mellitus prevalence and control in Sleep Disordered Breathing: the European Sleep Apnea Cohort (ESADA) study. Chest. 2014;146(4):982–990.PubMedCrossRefGoogle Scholar
  72. Kern PA, Ranganathan S, Li CL, Wood L, Ranganathan G. Adipose tissue tumor necrosis factor and interleukin-6 expression in human obesity and insulin resistance. Am J Physiol Endocrinol Metab. 2001;280:E745–E51.PubMedCrossRefGoogle Scholar
  73. Kline CE, Crowley EP, Ewing GB, et al. The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep. 2011;34:1631–40.PubMedPubMedCentralCrossRefGoogle Scholar
  74. Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev. 2007;11:163–78.PubMedPubMedCentralCrossRefGoogle Scholar
  75. Kohler M, Stradling JR. Mechanisms of vascular damage in obstructive sleep apnea. Nat Rev Cardiol. 2010;7:677–85.PubMedCrossRefGoogle Scholar
  76. Kono M, Tatsumi K, Saibara T, et al. Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome. Chest. 2007;131:1387–92.PubMedCrossRefGoogle Scholar
  77. Kritikou I, Basta M, Vgontzas AN, et al. Sleep apnoea, sleepiness, inflammation and insulin resistance in middle-aged males and females. Eur Resp J. 2014;43:145–55.CrossRefGoogle Scholar
  78. Kuna ST, Reboussin DM, Borradaile KE, et al. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep. 2013;36:641–9.PubMedPubMedCentralCrossRefGoogle Scholar
  79. Kylintireas I, Craig S, Nethononda R, et al. Atherosclerosis and arterial stiffness in obstructive sleep apnea-A cardiovascular magnetic resonance study. Atherosclerosis. 2012;222:483–9.PubMedPubMedCentralCrossRefGoogle Scholar
  80. Lam JCM, Lam B, Lam CL, et al. Obstructive sleep apnea and the metabolic syndrome in community-based Chinese adults in Hong Kong. Respir Med. 2006;100:980–7.PubMedCrossRefGoogle Scholar
  81. Lam JCM, Lam B, Yao TJ, et al. A randomised controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea. Eur Resp J. 2010;35:138–45.CrossRefGoogle Scholar
  82. Lam JCM, Mak JCW, Ip MSM. Obesity, obstructive sleep apnoea and metabolic syndrome. Respirology. 2012;17:223–36.PubMedCrossRefGoogle Scholar
  83. Lanfranco F, Gianotti L, Pivetti S, et al. Obese patients with obstructive sleep apnoea syndrome show a peculiar alteration of the corticotroph but not of the thyrotroph and lactotroph function. Clin Endocrinol. 2004;60:41–8.CrossRefGoogle Scholar
  84. Lanfranco F, Motta G, Minetto MA, et al. Neuroendocrine alterations in obese patients with sleep apnea syndrome. Int J Endocrinol. 2010; Article ID 474518,  https://doi.org/10.1155/2010/474518.
  85. Lavie L. Obstructive sleep apnoea syndrome – an oxidative stress disorder. Sleep Med Rev. 2003;7:35–51.PubMedCrossRefGoogle Scholar
  86. Lavie L. Oxidative stress-A unifying paradigm in obstructive sleep apnea and comorbidities. Prog Cardiovasc Dis. 2009;51:303–12.PubMedCrossRefGoogle Scholar
  87. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. Br Med J. 2000;320:479–82.CrossRefGoogle Scholar
  88. Li JG, Grigoryev DN, Ye SQ, et al. Chronic intermittent hypoxia upregulates genes of lipid biosynthesis in obese mice. J Appl Physiol. 2005a;99:1643–8.PubMedCrossRefGoogle Scholar
  89. Li JG, Thorne LN, Punjabi NM, et al. Intermittent hypoxia induces hyperlipidemia in lean mice. Circ Res. 2005b;97:698–706.PubMedCrossRefGoogle Scholar
  90. Liao P, Yegneswaran B, Vairavanathan S, Zilberman P, Chung F. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anaesth-J Can Anesth. 2009;56:819–28.CrossRefGoogle Scholar
  91. Lin QC, Zhang XB, Chen GP, Huang DY, Din HB, Tang AZ. Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome in nonobese adults. Sleep Breath. 2012;16:571–8.PubMedCrossRefGoogle Scholar
  92. Lindberg E, Theorell-Haglow J, Svensson M, Gislason T, Berne C, Janson C. Sleep apnea and glucose metabolism a long-term follow-up in a community-based sample. Chest. 2012;142:935–42.PubMedCrossRefGoogle Scholar
  93. Louis M, Punjabi NM. Effects of acute intermittent hypoxia on glucose metabolism in awake healthy volunteers. J Appl Physiol. 2009;106:1538–44.PubMedPubMedCentralCrossRefGoogle Scholar
  94. Lui MMS, Ip MSM. Disorders of glucose metabolism in sleep-disordered breathing. Clin Chest Med. 2010;31:271–85.PubMedCrossRefGoogle Scholar
  95. Magalang UJ, Cruff JP, Rajappan R, et al. Intermittent hypoxia suppresses adiponectin secretion by adipocytes. Exp Clin Endocrinol Diabet. 2009;117:129–34.CrossRefGoogle Scholar
  96. Malhotra A, White DP. Obstructive sleep apnoea. Lancet. 2002;360:237–45.PubMedCrossRefGoogle Scholar
  97. Marin JM, Carrizo SJ, Vicente E, Agusti AGN. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046–53.PubMedCrossRefGoogle Scholar
  98. Marin JM, Agusti A, Villar I, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA-J Am Med Assoc. 2012;307:2169–76.CrossRefGoogle Scholar
  99. Mason RH, West SD, Kiire CA, et al. High prevalence of sleep disordered breathing in patients with diabetic macular edema. Retina. 2012;32:1791–8.PubMedCrossRefGoogle Scholar
  100. Mehra R, Benjamin EJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing – the Sleep Heart Health Study. Am J Respir Crit Care Med. 2006;173:910–6.PubMedPubMedCentralCrossRefGoogle Scholar
  101. Meslier N, Gagnadoux F, Giraud P, et al. Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Resp J. 2003;22:156–60.CrossRefGoogle Scholar
  102. Meston N, Davies RJO, Mullins R, Jenkinson C, Wass J a H, Stradling JR. Endocrine effects of nasal continuous positive airway pressure in male patients with obstructive sleep apnoea. J Intern Med. 2003;254:447–54.PubMedCrossRefGoogle Scholar
  103. Moller DE. Potential role of TNF-alpha in the pathogenesis of insulin resistance and type 2 diabetes. Trends Endocrinol Metab. 2000;11:212–7.PubMedCrossRefGoogle Scholar
  104. Moller DS, Lind P, Strunge B, Pedersen EB. Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleep apnea. Am J Hypertens. 2003;16:274–80.PubMedCrossRefGoogle Scholar
  105. Monahan K, Redline S. Role of obstructive sleep apnea in cardiovascular disease. Curr Opin Cardiol. 2011;26:541–7.PubMedPubMedCentralCrossRefGoogle Scholar
  106. Morselli L, Leproult R, Balbo M, Spiegel K. Role of sleep duration in the regulation of glucose metabolism and appetite. Best Pract Res Clin Endocrinol Metab. 2010;24:687–702.PubMedPubMedCentralCrossRefGoogle Scholar
  107. Narkiewicz K, Somers VK. Sympathetic nerve activity in obstructive sleep apnoea. Acta Physiol Scand. 2003;177:385–90.PubMedCrossRefGoogle Scholar
  108. National Institute for Health and Care Excellence. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. NICE guidance 139, guidance. 2008. http://nice.org.uk/ta139. Mar 2008.
  109. Newman AB, Nieto FJ, Guidry U, et al. Relation of sleep-disordered breathing to cardiovascular disease risk factors – the Sleep Heart Health Study. Am J Epidemiol. 2001;154:50–9.PubMedCrossRefGoogle Scholar
  110. Nicholl DDM, Hanly PJ, Poulin MJ, et al. Evaluation of continuous positive airway pressure therapy on Renin-Angiotensin system activity in obstructive sleep apnea. Am J Respir Crit Care Med. 2014;190:572–80.PubMedCrossRefGoogle Scholar
  111. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA-J Am Med Assoc. 2000;283:1829–36.CrossRefGoogle Scholar
  112. Nieto FJ, Peppard PE, Young TB. Sleep disordered breathing and metabolic syndrome. WMJ. 2009;108:263–5.PubMedPubMedCentralGoogle Scholar
  113. Oltmanns KM, Gehring H, Rudolf S, et al. Hypoxia causes glucose intolerance in humans. Am J Respir Crit Care Med. 2004;169:1231–7.PubMedCrossRefGoogle Scholar
  114. Onat A, Hergenc G, Uyarel H, et al. Obstructive sleep apnea syndrome is associated with metabolic syndrome rather than insulin resistance. Sleep Breath. 2007;11:23–30.PubMedCrossRefGoogle Scholar
  115. Parati G, Lombardi C, Hedner J, et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J. 2013;41:523–38.PubMedCrossRefGoogle Scholar
  116. Pedrosa RP, Krieger EM, Lorenzi G, Drager LF. Recent advances of the impact of obstructive sleep apnea on systemic hypertension. Arq Bras Cardiol. 2011;97:E40–7.PubMedCrossRefGoogle Scholar
  117. Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Resp J. 2006;28:596–602.CrossRefGoogle Scholar
  118. Peled N, Kassirer M, Shitrit D, et al. The association of OSA with insulin resistance, inflammation and metabolic syndrome. Respir Med. 2007;101:1696–701.PubMedCrossRefGoogle Scholar
  119. Pepin JL, Tamisier R, Levy P. Obstructive sleep apnoea and metabolic syndrome: put CPAP efficacy in a more realistic perspective. Thorax. 2012;67:1025–7.PubMedCrossRefGoogle Scholar
  120. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA-J Am Med Assoc. 2000a;284:3015–21.CrossRefGoogle Scholar
  121. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000b;342:1378–84.PubMedCrossRefGoogle Scholar
  122. Phillips CL, Yee BJ, Marshall NS, Liu PY, Sullivan DR, Grunstein RR. Continuous positive airway pressure reduces postprandial lipidemia in obstructive sleep apnea a randomized, placebo-controlled crossover trial. Am J Respir Crit Care Med. 2011;184:355–61.PubMedCrossRefGoogle Scholar
  123. Polotsky VY, Li JG, Punjabi NM, et al. Intermittent hypoxia increases insulin resistance in genetically obese mice. J Physiol Lond. 2003;552:253–64.PubMedPubMedCentralCrossRefGoogle Scholar
  124. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:136–43.PubMedPubMedCentralCrossRefGoogle Scholar
  125. Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol. 2005;99:1998–2007.PubMedCrossRefGoogle Scholar
  126. 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;165:677–82.PubMedCrossRefGoogle Scholar
  127. Punjabi NM, Shahar E, Redline S, et al. Sleep-disordered breathing, glucose intolerance, and insulin resistance – the Sleep Heart Health Study. Am J Epidemiol. 2004;160:521–30.PubMedCrossRefGoogle Scholar
  128. Qaseem A, Holty JEC, Owens DK, et al. Management of obstructive sleep apnea in adults: a clinical practice guideline from the american college of physicians. Ann Intern Med. 2013;159:471–U94.PubMedCrossRefGoogle Scholar
  129. Reaven GM. Role of insulin resistance in human disease. Diabetes. 1988;37:1595–607.PubMedCrossRefGoogle Scholar
  130. Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes – a population-based study. Am J Respir Crit Care Med. 2005;172:1590–5.PubMedPubMedCentralCrossRefGoogle Scholar
  131. Robinson GV, Pepperell JCT, Segal HC, Davies RJO, Stradling JR. Circulating cardiovascular risk factors in obstructive sleep apnoea: data from randomised controlled trials. Thorax. 2004;59:777–82.PubMedPubMedCentralCrossRefGoogle Scholar
  132. Rosmond R. Stress induced disturbances of the HPA axis: a pathway to Type 2 diabetes? Med Sci Monit: Int Med J Exp Clin Res. 2003;9:RA35–9.Google Scholar
  133. Schmoller A, Eberhardt F, Jauch-Chara K, et al. Continuous positive airway pressure therapy decreases evening cortisol concentrations in patients with severe obstructive sleep apnea. Metab Clin Exp. 2009;58:848–53.PubMedCrossRefGoogle Scholar
  134. Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL. Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc. 2008;5:185–92.PubMedPubMedCentralCrossRefGoogle Scholar
  135. Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev. 2017;34:70–81.PubMedCrossRefGoogle Scholar
  136. Shaw JE, Punjabi NM, Wilding JP, Alberti KGMM, Zimmet PZ. 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.PubMedCrossRefGoogle Scholar
  137. Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96:1897–904.PubMedPubMedCentralCrossRefGoogle Scholar
  138. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354:1435–9.PubMedCrossRefGoogle Scholar
  139. Spiegel K, Tasali E, Leproult R, Van Cauter E. Effects of poor and short sleep on glucose metabolism and obesity risk. Nat Rev Endocrinol. 2009;5:253–61.PubMedPubMedCentralCrossRefGoogle Scholar
  140. Surani S, Subramanian S. Effect of continuous positive airway pressure therapy on glucose control. World J Diabetes. 2012;3:65–70.PubMedPubMedCentralCrossRefGoogle Scholar
  141. Tahrani AA, Ali A, Raymonds NT, et al. Obstructive sleep apnea and diabetic neuropathy a novel association in patients with type 2 diabetes. Am J Respir Crit Care Med. 2012;186:434–41.PubMedPubMedCentralCrossRefGoogle Scholar
  142. Tamura A, Kawano Y, Watanabe T, Kadota J. Obstructive sleep apnea increases hemoglobin A1c levels regardless of glucose tolerance status. Sleep Med. 2012;13:1050–5.PubMedCrossRefGoogle Scholar
  143. Tasali E, Ip MSM. Obstructive sleep apnea and metabolic syndrome: alterations in glucose metabolism and inflammation. Proc Am Thorac Soc. 2008;5:207–17.PubMedCrossRefGoogle Scholar
  144. Tasali E, Mokhlesi B, Van Canter E. Obstructive sleep apnea and type 2 diabetes – interacting epidemics. Chest. 2008;133:496–506.PubMedCrossRefGoogle Scholar
  145. Tchernof A, Despres JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013;93:359–404.PubMedCrossRefGoogle Scholar
  146. Thomasouli MA, Brady EM, Davies MJ, Hall AP, Khunti K, Morris DH, Gray LJ. The impact of diet and lifestyle management strategies for obstructive sleep apnoea in adults: a systematic review and meta-analysis of randomised controlled trials.Sleep Breath. 2013;17(3):925–35.  https://doi.org/10.1007/s11325-013-0806-7.PubMedCrossRefGoogle Scholar
  147. Trujillo ME, Scherer PE. Adiponectin – journey from an adipocyte secretory protein to biomarker of the metabolic syndrome. J Intern Med. 2005;257:167–75.PubMedCrossRefGoogle Scholar
  148. Tuomilehto J. Nonpharmacologic therapy and exercise in the prevention of type 2 diabetes. Diabetes Care. 2009;32:S189–S93.PubMedPubMedCentralCrossRefGoogle Scholar
  149. Tuomilehto HPI, Seppa JM, Partinen MM, et al. Lifestyle intervention with weight reduction first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med. 2009;179:320–7.PubMedCrossRefGoogle Scholar
  150. Tuomilehto H, Seppa J, Uusitupa M, Tuomilehto J, Gylling H, Kuopio Sleep Apnea G. Weight reduction and increased physical activity to prevent the progression of obstructive sleep apnea: a 4-year observational postintervention follow-up of a randomized clinical trial. JAMA Intern Med. 2013;173:930–2.CrossRefGoogle Scholar
  151. Veasey SC, Guilleminault C, Strohl KP, Sanders MH, Ballard RD, Magalang UJ. Medical therapy for obstructive sleep apnea: a review by the medical therapy for obstructive sleep apnea task force of the standards of practice committee of the American academy of sleep medicine. Sleep. 2006;29:1036–44.PubMedCrossRefGoogle Scholar
  152. 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;85:1151–8.PubMedCrossRefGoogle Scholar
  153. Vgontzas AN, Bixier EO, Chrousos GP. Sleep apnea is a manifestation of the metabolic syndrome. Sleep Med Rev. 2005;9:211–24.PubMedCrossRefGoogle Scholar
  154. Vgontzas AN, Pejovic S, Zoumakis E, et al. Hypothalamic-pituitary-adrenal axis activity in obese men with and without sleep apnea: Effects of continuous positive airway pressure therapy. J Clin Endocrinol Metab. 2007;92:4199–207.PubMedCrossRefGoogle Scholar
  155. Weinstock TG, Wang X, Rueschman M, et al. A controlled trial of CPAP therapy on metabolic control in individuals with impaired glucose tolerance and sleep apnea. Sleep. 2012;35:617–25.PubMedPubMedCentralCrossRefGoogle Scholar
  156. West SD, Nicoll DJ, Stradling JR. Prevalence of obstructive sleep apnoea in men with type 2 diabetes. Thorax. 2006;61:945–50.PubMedPubMedCentralCrossRefGoogle Scholar
  157. West SD, Nicoll DJ, Wallace TM, Matthews DR, Stradling JR. Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and type 2 diabetes. Thorax. 2007;62:969–74.PubMedPubMedCentralCrossRefGoogle Scholar
  158. West SD, Groves DC, Lipinski HJ, et al. The prevalence of retinopathy in men with Type 2 diabetes and obstructive sleep apnoea. Diabetic Med. 2010;27:423–30.PubMedCrossRefGoogle Scholar
  159. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.CrossRefGoogle Scholar
  160. Wilcox I, Mcnamara SG, Collins FL, Grunstein RR, Sullivan CE. “Syndrome Z”: the interaction of sleep apnoea, vascular risk factors and heart disease. Thorax. 1998;53:S25–8.PubMedPubMedCentralCrossRefGoogle Scholar
  161. Wolk R, Svatikova A, Nelson CA, et al. Plasma levels of adiponectin, a novel adipocyte-derived hormone, in sleep apnea. Obes Res. 2005;13:186–90.PubMedCrossRefGoogle Scholar
  162. Xu J, Long YS, Gozal D, Epstein PN. beta-cell death and proliferation after intermittent hypoxia: role of oxidative stress. Free Radic Biol Med. 2009;46:783–90.PubMedCrossRefGoogle Scholar
  163. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034–41.PubMedCrossRefGoogle Scholar
  164. Young D, Collop N. Advances in the treatment of obstructive sleep apnea. Curr Treat Options Neurol. 2014;16(8):305.  https://doi.org/10.1007/s11940-014-0305-6
  165. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.PubMedCrossRefGoogle Scholar
  166. Young T, Peppard P, Palta M, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med. 1997;157:1746–52.PubMedCrossRefGoogle Scholar
  167. Zimmet P, Alberti K, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414:782–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Obesity & Endocrinology ResearchInstitute of Ageing and Chronic Disease, Clinical Sciences Centre, University Hospital AintreeLiverpoolUK

Personalised recommendations