Bone mineral density and its determinants in diabetes: the Fremantle Diabetes Study

Aims/hypothesis We assessed the effects of type 1 and type 2 diabetes on bone density and metabolism.Materials and methods We analysed bone mineral density (BMD) measured at the hip, spine and forearm using dual energy X-ray absorptiometry in 34 patients with type 1 and 194 patients with type 2 diabetes. Patients were from the community-based Fremantle Diabetes Study, and findings for them were compared with those from normal age- and sex-matched control subjects from the local community. Biochemical and hormonal markers of bone metabolism were measured in a subset of 70 patients.Results After adjusting for age and BMI, there was a lower BMD at total hip (p<0.001) and femoral neck (p=0.012) in type 1 men vs control subjects, but type 1 women and matched controls had similar BMD at each site. There was a higher BMD at total hip (p=0.006), femoral neck (p=0.026) and forearm (p<0.001) in type 2 women vs control subjects, but diabetes status was not associated with BMD in type 2 men after adjustment for age and BMI. Serum oestradiol, BMI, C-terminal telopeptide of collagen type 1 and male sex were consistently and independently associated with BMD at forearm, hip and femoral neck and explained 61, 55 and 50% of the total variance in BMD, respectively, at these sites. Spine BMD was independently associated with BMI and ln(oestradiol).Conclusions/interpretation Men with type 1 diabetes may be at increased risk of osteoporosis, while type 2 women appear to be protected even after adjusting for BMI. Low serum oestradiol concentrations may predispose to diabetes-associated osteoporosis regardless of sex.     

Upper airway length may be associated with the severity of obstructive sleep apnea syndrome

Objectives  The exact pathophysiology leading to pharyngeal collapse in obstructive sleep apnea syndrome (OSAS) remains incompletely understood. Prior research has shown that normal men have a longer pharyngeal airway than women, and it has been hypothesized that this difference may play a role in the gender-related differences in OSAS. In the current study, we sought to study the potential relationship between the length of the collapsible pharyngeal segment, the upper airway length (UAL), and the severity of OSAS. Study design  The hospital records were searched for all patients who had had polysomnography and also had had a computed tomography of the neck. A total of 24 such patients were identified who participated (15 men and nine women). Measurements and results  The UAL, the distance between the lower posterior part of the hard palate bone to the upper posterior part of the hyoid bone, was measured for all participants in the midsagittal plane. A correlation coefficient (Pearson r) of 0.406 was found between Respiratory Disturbance Index (RDI) and UAL (p = 0.049). When UAL was normalized to body height, a correlation coefficient (r) of 0.423 was found (p = 0.039). A gender-related difference in UAL was also found. Men with OSAS were found to have longer UAL even when normalized to body height (p = 0.003, unpaired t test) as compared with OSAS women. Conclusion  This study provides potential clinical relevance to prior studies in normal subjects, by demonstrating that men with OSAS have longer UAL than women with OSAS, independent of body size. In addition, the significant correlation between UAL and OSAS severity suggests that UAL may play a role in the pathophysiology of OSAS. These findings are consistent with our predictions from computational modeling studies.     

Bone mineral density in patients with obstructive sleep apnea syndrome

Purpose

Obstructive sleep apnea syndrome (OSAS) is a disorder that is characterized by repetitive pauses in breathing during sleep. Airway obstruction episodes can lead to ischemia or hypoxia in tissues. Hypoxia may also have an effect on bone metabolism. In this study, we aim to investigate both the bone metabolic abnormalities and bone mineral density (BMD) in OSAS patients compared to individuals without OSAS.

Methods

Twenty-one male patients with OSAS and 26 control subjects, also male, enrolled in this study. Serum calcium, phosphorus, alkaline phosphatase, and urinary desoxypiridinoline levels were measured in all participants, and BMD was evaluated using DEXA (Hologic QDR 2000). The BMD was measured in the lumbar spine (L1–L4), the femoral neck, and total femur region.

Results

No statistically significant difference was noted between the two groups with respect to demographic data, except for body mass index (BMI). We adjusted the statistical analyses in line with the BMI and noted significant differences between OSAS patients and control subjects with regard to lumbar L1–L4 t score, lumbar L1–L4 BMD, and femoral neck BMD values (p?≤?0.001). We find significant correlations with lumbar L1-L4 BMD (r?=??0.4; p?=?0.023) and lumbar L1–L4 t score values (r?=??0.5; p?=?0.012).

Conclusion

Our study indicates that there is a relationship between OSAS and osteoporosis. However, further controlled studies comprising a greater number of patients are needed to investigate the relationship between osteoporosis and OSAS.     

The Frequency of Monocyte Chemoattractant Protein-1 Gene Polymorphism in Obstructive Sleep Apnea Syndrome

Purpose

In obstructive sleep apnea syndrome (OSAS) many proinflammatory cytokines are released from activated endothelial cells due to repeated decreases in arterial oxygen saturation. Some of these proinflammatory cytokines are involved in the etiology of coronary artery disease (CAD). Although the association between OSAS and CAD is known, risk factors for CAD have not been determined in this patient group. Monocyte chemoattractant protein-1 (MCP-1) is a proinflammatory cytokine that plays a key role in the development of atherosclerosis. In this study, we compared the frequency of MCP1 rs1024610-rs1024611 single-nucleotide polymorphisms (SNPs) in OSAS patients with no comorbidity, OSAS patients with no comorbidity except CAD, and healthy individuals.

Material and Methods

The study included 301 subjects. Two hundred one patients with OSAS (OSAS only and OSAS + CAD groups) and 100 healthy control subjects underwent polysomnography. MCP1 rs1024610 and rs1024611 mutation frequencies were determined.

Results

Body mass index, apnea–hypopnea index, triglyceride levels, and mean oxygen desaturation were significantly higher in the OSAS patients than in the healthy population (p < 0.05). In MCP1 rs1024611 SNP analysis, homozygous mutation was significantly more common in the OSAS + CAD group than in the OSAS and control groups (p < 0.001). MCP1 rs1024610 SNP analysis showed no significant differences among the study groups.

Conclusion

OSAS patients with homozygous MCP1 rs1024611 SNP are at higher risk for CAD. The MCP1 rs1024610 SNP was not associated with incidence of CAD. Patients with OSAS and MCP1 rs1024611 homozygous mutation are more susceptible to CAD and early detection and treatment may significantly reduce mortality and morbidity.

     

Proteomic biomarkers of cognitive impairment in obstructive sleep apnea syndrome

Purpose

There are currently no biomarkers that are associated with cognitive impairment (CI) in patients with obstructive sleep apnea syndrome (OSAS). This pilot study performed an exploratory plasma proteomic analysis to discover potential biomarkers and explore proteomic pathways that differentiate OSAS subjects with and without CI.

Methods

Participants were selected from a cohort of women within 5 years of menopause not on hormone replacement therapy between the ages of 45–60 years. The Berlin questionnaire was used to select OSAS participants who then completed the MCFSI (Mail-In Cognitive Function Screening Instrument) to measure cognition. Six subjects with the highest MCFSI scores (≥?5 denoting CI) were compared to six with normal scores. Proteomic analysis was done by Myriad RBM using a targeted ELISA for 254 serum proteins. Pathway analysis of differentially expressed proteins was performed using STRING (Search Tool for the Retrieval of Interacting Genes/Proteins) software.

Results

Distinct proteomic signatures were seen in OSAS subjects with CI as compared to those without CI. Proteins including insulin, prostasin, angiopoietin-1, plasminogen activator inhibitor 1, and interleukin-1 beta were overexpressed in OSAS subjects with CI. Proteins underexpressed in CI participants included cathepsin B, ceruloplasmin, and adiponectin. Pathway analysis revealed prominence of insulin-regulated vascular disease biomarkers.

Conclusions

Proteomic biomarkers in participants with cognitive impairment suggest roles for insulin, and vascular signaling pathways, some of which are similar to findings in Alzheimer’s disease. A better understanding of the pathogenic mechanisms of CI in OSAS will help focus clinical trials needed in this patient population.

     

Reduced bone mineral density in the first year after total pancreatectomy with islet autotransplantation (TPIAT)

Background/objectivesThe effect of total pancreatectomy with islet autotransplantation (TPIAT) on bone mineral density (BMD) in patients with CP is unknown. We aimed to assess bone health in patients with CP after TPIAT.MethodsWe measured BMD, BMD Z-score, and bone mineral content (BMC) for total body, lumbar spine, right and left hip in 78 patients before and after TPIAT using dual-energy X-ray absorptiometry (DXA, n = 78 pre-TPIAT, n = 65 paired pre- and 12 months post-TPIAT, n = 33 paired 12 and 18 months post-TPIAT), and tested for association with clinical history including age, smoking status, and medications using paired and two-sample t-tests, linear regression, and Fisher's exact test. Laboratory measures related to bone health were also assessed.ResultsIn the patients with pre-TPIAT DXA, 12% had low BMD (Z-score ≤ −2). BMD, BMD Z-score, and BMC all decreased from pre-to 12 months post-TPIAT. BMD declined by 1.7%–4.1% with the greatest change at the hips. Adjusted for change in lean and fat body mass, DXA changes remained significant for total body and hip. Serum carboxy-terminal collagen crosslinks telopeptide and alkaline phosphatase increased at 12 months post-TPIAT, suggesting possible increased bone remodeling. BMD, BMD Z-score, and BMC did not change between 12 months and 18 months in any of the four regions (p > 0.6).ConclusionsTPIAT is associated with decreases in BMD in the body, lumbar, and hip regions of patients with CP in the first year after TPIAT but these appear to stabilize between 12 and 18 months after TPIAT.     

Lack of association between obstructive sleep apnea syndrome and specular microscopic features of the corneal endothelium

Background

Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of hypoxemia and hypercapnia during sleep. The aim of this study was to determine whether OSAS causes significant changes in corneal endothelium detectable by specular microscopy.

Methods

This prospective, cross-sectional study compared the specular microscopic features of the corneal endothelium of patients with OSAS and age-and gender-matched controls. Patients diagnosed with OSAS by polysomnography in the sleep unit were classified using apnea-hypopnea indexes into two groups as mild-moderate OSAS group and severe OSAS group. All participants were divided into three age groups: 30–45, 46–60, and >?60 years. Corneal endothelial cell density (ECD), percentage of hexagonal cells (Hex), and coefficient of variation of cell area (CV) were obtained using a non-contact specular microscope. The measurements of each group were compared statistically.

Results

A total of 66 patients (51.1?±?9.4 years) and 88 controls (49.2?±?10.5 years) were examined. The mild-moderate OSAS group and the severe OSAS group had no significant differences in measures of specular microscopy compared with the controls (ECD, p?=?0.84; Hex, p?= 0.18; CV, p?=?0.41). The mean values of ECD, Hex, and CV were 2552.56?±?302.49 cells/mm², 54.13?±?8.13%, and 36.41?±?5.92, respectively, in the mild-moderate OSAS group; 2510.52?±?377.12 cells/mm², 54.85?±?8.68%, and 34.77?±?5.02, respectively, in the severe OSAS group; 2543.37?±?286.94 cells/mm², 51.89?±?9.09%, and 36.03?±?5.32, respectively, in the control group.

Conclusions

There were no significant differences in corneal endothelial features between patients and controls. Although OSAS causes systemic hypoxia, its effects do not appear to result in corneal endothelial alterations detectable by specular microscopy.

     

Metformin treatment is associated with an increase in bone mineral density in type 2 diabetes mellitus patients in China: A retrospective single center study

AimsTo investigate the association between metformin and bone mineral density (BMD) in a large cohort of Chinese patients with type 2 diabetes mellitus (T2DM).MethodsA total of 11,458 T2DM patients aged ≥40 years were included. Information on demographic, anthropometric and clinical characteristics was collected from medical records. BMD at lumbar spine (LS), femoral neck (FN), and total hip(TH) was assessed by dual-energy X-ray absorptiometry.ResultsOverall prevalence of osteopenia and osteoporosis was 37.4% and 10.3%, and was lower in patients on metformin (34.6% vs 38.3% and 7.1% vs 11.3%, both p < 0.001). Patients who had a lower BMI, older age, and lower estimated glomerular filtration rate (eGFR), had more osteoporosis, lower BMD (osteoporosis or osteopenia), and a lower T-score at LS, FN and TH. Metformin use and male sex was associated with a higher BMD. Metformin treatment was also independently associated with higher T-score at LS, FN and TH (β values of 0.120, 0.082 and 0.108; all p <0.001), and lower odds ratio of osteoporosis (OR = 0.779, 95%CI: 0.648–0.937, p = 0.008) or low BMD (OR = 0.834, 95%CI: 0.752 - 0.925, p = 0.001). However, when analyzed by sex, this association of a lower odds ratio for osteoporosis with metformin was only significant in women (OR= 0.775, 95% CI: 0.633–0.948; p = 0.013).ConclusionsMetformin treatment was associated with a higher T-score and a lower odds ratio of osteopenia and osteoporosis, especially in the female population, independent of age, BMI, and eGFR.     

Impaired skeletal health in patients with chronic atrophic gastritis

Objective: In chronic atrophic gastritis (CAG), destruction of gastric parietal cells causes anacidity and hypergastrinemia. Use of proton pump inhibitors, which also induces gastric anacidity, is associated with increased fracture rates. Our objectives were to study possible differences in bone mineral density (BMD) and bone quality in patients with CAG compared to controls.

Material and methods: We performed a cross-sectional study on 17 CAG patients aged 54?±?13 years and 41 sex- and age-matched controls. Lumbar and femoral BMD and bone quality assessed by lumbar trabecular bone score (TBS) were measured by DXA, and bone material strength (BMS) by microindentation of the tibia. Serum bone markers (CTX, P1NP, sclerostin, osteocalcin, OPG, RANKL) were analyzed.

Results: We found lower lumbar BMD Z-score (?0.324?±?1.096 versus 0.456?±?1.262, p?=?0.030), as well as a higher frequency of osteoporosis at the lumbar spine (p?=?0.046) and osteopenia at total hip (p?=?0.019) in patients compared to controls. In a post hoc subgroup analysis, we observed that the differences were confined to the male patients. TBS also tended to be lower in male patients (p?=?0.059), while BMS did not differ between the groups. Osteocalcin, sclerostin, OPG, and OPG/RANKL ratio were lower in patients compared to controls, while CTX and P1NP did not differ between the groups.

Conclusions: We observed lower lumbar BMD, increased frequency of osteopenia and osteoporosis in male, but not female patients with CAG. Bone markers suggest a decrease in bone formation and increased bone resorption in CAG patients compared to controls.     

Gender differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2827 patients

Purpose

Obstructive sleep apnea (OSA) is underdiagnosed in females due to different clinical presentation. We aimed to determine the effect of gender on clinical and polysomnographic features and identify predictors of OSA in women.

Methods

Differences in demographic, clinical, and polysomnographic parameters between 2052 male and 775 female OSA patients were compared.

Results

In female OSA patients, age (56.1 ± 9.7 vs. 50.4 ± 11.6 years, p < 0.0001) and body mass index (36.3 ± 8.6 vs. 31.8 ± 5.9 kg/m², p < 0.0001) were increased, whereas men had higher waist-to-hip ratio and neck circumference (p < 0.0001). Hypertension, diabetes mellitus, thyroid disease, and asthma were more common in females (p < 0.0001). Men reported more witnessed apnea (p < 0.0001), but nocturnal choking, morning headache, fatigue, insomnia symptoms, impaired memory, mood disturbance, reflux, nocturia, and enuresis were more frequent in women (p < 0.0001).

The indicators of OSA severity including apnea-hypopnea index (AHI) (p < 0.0001) and oxygen desaturation index (p = 0.007) were lower in women. REM AHI (p < 0.0001) was higher, and supine AHI (p < 0.0001) was lower in females. Besides, women had decreased total sleep time (p = 0.028) and sleep efficiency (p = 0.003) and increased sleep latency (p < 0.0001). In multivariate logistic regression analysis, increased REM AHI, N3 sleep, obesity, age, morning headache, and lower supine AHI were independently associated with female gender.

Conclusions

These data suggest that frequency and severity of sleep apnea is lower in female OSA patients, and they are presenting with female-specific symptoms and increased medical comorbidities. Therefore, female-specific questionnaires should be developed and used for preventing underdiagnosis of OSA.

     

Obstructive sleep apnea and craniofacial appearance in MPS type I-Hurler children after hematopoietic stem cell transplantation

Objectives

Mucopolysaccharidosis type I (MPS I) is an inherited lysosomal storage disorder characterized by severe multi-systemic organ manifestations including obstructive sleep apnea syndrome (OSAS). Hematopoietic stem cell transplantation (HSCT) is the treatment of choice in severe MPS I (MPS IH, Hurler syndrome). However, the effect of HSCT on OSAS in MPS IH still remains unclear. The purpose of this study was to analyze respiratory patterns during sleep following HSCT in MPS IH children and to relate these findings to craniofacial abnormalities.

Methods

Overnight polysomnographies of nine MPS IH children (mean age: 8.2 years) previously treated with HSCT were retrospectively analyzed. Magnetic resonance images of the head were assessed with regard to soft and hard tissue abnormalities of the upper respiratory tract.

Results

The mean apnea hypopnea index (AHI) was 5.3 events/h (range, 0.3–12.2), and the majority of apnea/hypopneas were obstructive. Whereas two patients had severe OSAS (AHI?>?10) and two moderate OSAS (5?>?AHI?<?10), five patients had no evidence of OSAS (AHI?<?2.0). Donor cell chimerism was significantly lower in MPS IH patients with OSAS as compared to patients without OSAS (p?<?0.001). The upper airway space and the maxilla were significantly smaller and the adenoids larger in MPS IH patients with OSAS as compared to those of non-OSAS patients.

Conclusion

OSAS was only observed in MPS IH patients with graft failure or low donor cell chimerism. Conversely, successful HSCT seems to ameliorate adenoid hyperplasia and maxillary constriction in MPS IH patients and thereby minimizes the risk of OSAS at least at younger ages.

     

Long-term efficacy of expansion sphincter pharyngoplasty in obstructive sleep apnea syndrome

Purpose

The aim of this study was to analyze both short-term and long-term results of the expansion sphincter pharyngoplasty surgery, which is commonly used in obstructive sleep apnea syndrome (OSAS) and to compare it with objective and subjective methods.

Methods

Patients who underwent expansion sphincter pharyngoplasty were included in the study. Polysomnography at postoperative sixth-month, Epworth Sleepiness Scale, and visual analog score of snoring (VAS) were used to assess short-term results. Epworth Sleepiness Scale (ESS) and visual analog score of snoring (VAS) at postoperative third-year were used for long-term results. Sixth-month and third-year data before and after the surgery were compared. Possible complications and morbidity rates related to surgery were evaluated.

Results

Of 39 patients, OSAS was assessed as mild in 16 (41%), moderate in 14 (36%), and severe in 9 (23%). Mean age of patients was 43.2 ± 7.5, and 21 were men (54%). According to postoperative six-month PSG data, the apnea hypopnea index (AHI) values decreased significantly from 25.2 ± 8.3 to 11.6 ± 6.9/h, p=0.012. There were decreases in ESS from baseline to 6-month and 3-years from 10.4, to 4.4, and 4.4, and VAS scores changed from 8.6 to 1.6 and 1.9, p<0.05. No serious complications were observed in patients in the early and late postoperative period.

Conclusion

The expansion sphincter pharyngoplasty procedure is an important option for OSAS surgery with long-term effective results and low morbidity and complication rates.

     

The effect of high evening blood pressure on obstructive sleep apnea–related morning blood pressure elevation: does sex modify this interaction effect?

Purpose

Obstructive sleep apnea (OSA) can lead to increased morning blood pressure (BP). We hypothesized that high evening BP may aggravate OSA-related morning BP elevation. Additionally, this interactional effect may be modified by sex.

Methods

This retrospective, cross-sectional study included newly diagnosed OSA patients with an apnea-hypopnea index (AHI) ≥?5 per hour on a full-night polysomnography. An analysis of covariance (ANCOVA) was used to determine whether severe OSA (AHI?≥?30) was associated with higher morning BP than mild-to-moderate OSA (5?≤?AHI?<?30) and whether there was an interaction between apnea severity and evening BP on morning BP. To identify the sex effects, analyses were performed separately in each sex group.

Results

A total of 1445 patients with an average age of 51.9 years (SD 11.7) (male 77.9% vs. female 22.1%; high evening BP group 22.4% vs. normal evening BP group 59.6%) were included in the study. Based on the ANCOVA, patients with severe OSA had significantly higher morning systolic BP (SBP) (p?=?0.003), diastolic BP (DBP) (p?<?0.001), and mean BP (MBP) (p?<?0.001) than the mild-to-moderate group in male subjects. A significant interaction between apnea severity and evening BP was identified on morning DBP and MBP in male subjects. However, there were no differences in morning BP between severe and mild-to-moderate OSA groups in female subjects.

Conclusions

In male subjects, severe OSA contributed to higher morning BP than mild-to-moderate OSA. OSA-associated morning BP elevation was more prominent in the high evening BP group than in the normal BP group. Such relations were not found in female subjects.

     

Obstructive sleep apnea is the triggering factor for massive hemoptysis

Purpose

The purpose of this study was to investigate the prevalence of obstructive sleep apnea (OSA) in patients with hemoptysis.

Methods

Files of patients who had undergone bronchial arterial embolization due to hemoptysis between 1 December 2009 and 2015 were evaluated and interviews of patients were conducted until 1 June 2016. Pittsburgh Sleep Quality Index (PSQI), STOP and STOP-BANG surveys were administered. OSA risk was determined with Berlin Questionnaire.

Results

Study group consisted of 53 patients and 58 control subjects. Mean age was 46.94 ± 14.36 and 41.97 ± 12.92 in patient and control group, respectively. Of these patients, seven had re-embolization procedure because of recurrence of hemoptysis. High OSA risk was more common among patients with hemoptysis (24.5%, n = 13) than the control group (8.6%, n = 5) (p = 0.023). Percentage of high risk OSA patients with massive hemoptysis, nonmassive hemoptysis, and control subjects was 29.7% (n = 11), 12.5% (n = 2), and 8.6% (n = 5), respectively (p = 0.022). There were more high OSA risk subjects among patients with idiopathic hemoptysis 44.4% (four out of nine), while 20.5% (nine out of 53) patients with a known etiology had high risk (p = 0.127). The number of patients with high OSA risk was also higher in patients who required a second embolization procedure (four out of seven, 57.1%), while 19.6% of patients without need for re-embolization had high risk (p = 0.031).

Conclusions

OSA is found to be a risk factor for hemoptysis and also may provoke massive hemoptysis. It seems reasonable to consider OSA as an underlying condition in idiopathic hemoptysis. OSA may contribute to embolization failure.

     

Endothelial dysfunction and inflammatory reactions of elderly and middle-aged men with obstructive sleep apnea syndrome

Introduction  Obstructive sleep apnea syndrome (OSAS) is considered to be associated with cardiovascular complications, and atherosclerosis could mediate this relationship. Cardiovascular risk factors of OSAS still need to be elucidated in elderly patients, since studies about the association between OSAS and cardiovascular diseases have been done mainly in middle-aged adults. To investigate whether endothelial dysfunction, as an early marker of atherosclerosis, and inflammatory responses in OSAS were affected by age, we studied flow-mediated dilatation (FMD) and C-reactive protein (CRP) in elderly and middle-aged patients with OSAS. Materials and methods  This study enrolled 161 male subjects of 117 middle-aged (35–59 years old) and 44 elderly (≥60 years old) patients with OSAS. After they finished nocturnal polysomnography (NPSG), FMD was measured on the brachial artery and blood samples were obtained to determine serum CRP levels. Results and discussion  FMD was significantly lower in the elderly patients (p = 0.04), but no difference was observed between two age groups in body mass index (BMI), neck circumference, waist-to-hip ratio, apnea hypopnea index (AHI), serum CRP level, or NPSG findings related with nocturnal hypoxemia such as average O₂ saturation, percentage of time below 90% O₂ saturation, and oxygen desaturation index (ODI). From the results of stepwise multiple linear regression analysis, the lowest oxygen saturation was a significant determinant of FMD (β = 0.25, p < 0.01, adjusted R ² = 6%), and BMI (β = 0.22, p < 0.05) and waist-to-hip ratio (β = 0.21, p < 0.05) were significant variables to explain CRP (adjusted R ² = 11%, p < 0.01) in the middle aged patients. In the elderly patients, no variable was significant for predicting FMD, but AHI was significant determinant of CRP (β = 0.46, p < 0.01, adjusted R ² = 19%, p < 0.01). In predicting cardiovascular risks of OSAS, both hypoxia and obesity should be considered in the middle-aged group, whereas nocturnal respiratory disturbances are important in the elderly group.     

Prevalence and predictors of osteopenia and osteoporosis in adults with Type 1 diabetes

Aims To determine the prevalence and biochemical/hormonal determinants of osteopenia and osteoporosis in adults with Type 1 diabetes. Methods One hundred and two patients (52 female, 50 male) with Type 1 diabetes aged 20–71 years underwent cross‐sectional assessment of biochemical/hormonal markers of bone metabolism, and bone mineral density (BMD) measurement at forearm, hip and spine using dual energy x‐ray absorptiometry. BMD data were available for 102 age‐ and gender‐matched population‐based control subjects. Results After adjusting for age and body mass index (BMI), osteopenia and osteoporosis were more common at the spine in males with Type 1 diabetes than in control subjects (P = 0.030). In Type 1 males, after adjustment for age and BMI, BMD, T‐ and Z‐scores at the hip, femoral neck and spine were lower compared with age‐matched control subjects (P ≤ 0.048). Female Type 1 patients and control subjects had similar BMDs and T‐ and Z‐scores at all sites. On multiple linear regression analysis, which adjusted for the natural logarithm of the sex hormone binding globulin concentration, smoking status and alcohol consumption, and (for women) menopausal status, each of BMI, serum ionized calcium and serum alkaline phosphatase (negatively) were independently associated with BMD at the hip and femoral neck in Type 1 diabetic subjects. Conclusions Adult males with Type 1 diabetes have reduced bone density at the hip, femoral neck and spine when compared with age‐matched control subjects. Impaired bone formation may occur in Type 1 diabetes.     

Circulating vaspin and its relationship with insulin sensitivity,adiponectin, and liver histology in subjects with non-alcoholic steatohepatitis

Abstract

Objective. Non-alcoholic steatohepatitis (NASH) is closely associated with components of metabolic syndrome. Vaspin is a novel adipocytokine that may link obesity, insulin resistance (IR), and type 2 diabetes mellitus. We aimed to investigate circulating vaspin levels in subjects with NASH and also to search for the association of vaspin with IR, adiponectin, and histological findings. Material and methods. A total of 50 male patients with NASH and 30 healthy male controls were enrolled. Vaspin and adiponectin were measured with ELISA method. Insulin sensitivity determined by homeostasis model assessment (HOMA-IR) index. Results. Plasma vaspin levels were higher and adiponectin levels were lower in NASH group compared with controls (p < 0.01 and p < 0.001, respectively). However, in multivariate analysis adjusted for glucose and lipid parameters, and HOMA-IR indexes, the difference in vaspin concentrations was disappeared. Nonetheless, the difference regarding the adiponectin levels remained significant between groups (p = 0.03). Vaspin was negatively correlated with low-density lipoprotein cholesterol (r = -0.32, p = 0.03) in subjects with NASH. Conclusions. This study indicates that circulating vaspin levels are not altered in male subjects with NASH. These results suggest that in the absence of metabolic risk factors, vaspin per se may not be involved in the pathogenesis of NASH.     

Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing?

Purpose

Data in the literature suggest that myofunctional therapy (MT) may be able to play a role in the treatment of children with sleep-disordered breathing (SDB). Our study investigated the effectiveness of MT in reducing respiratory symptoms in children with SDB by modifying tongue tone.

Methods

Polysomnographic recordings were performed at baseline to assess obstructive sleep apnea (OSA) severity in 54 children (mean age 7.1 ± 2.5 years, 29 male) with SDB. Patients were randomly assigned to either the MT or no-MT group. Myofunctional evaluation tests, an assessment of tongue strength, tongue peak pressure, and endurance using the Iowa Oral Performance Instrument (IOPI), and nocturnal pulse oximetry were performed before (T0) and after (T1) 2 months of treatment.

Results

MT reduced oral breathing (83.3 vs 16.6%, p < 0.0002) and lip hypotonia (78 vs 33.3%, p < 0.003), restored normal tongue resting position (5.6 vs 33.4%, p < 0.04), and significantly increased mean tongue strength (31.9 ± 10.8 vs 38.8 ± 8.3, p = 0.000), tongue peak pressure (34.2 ± 10.2 vs 38.1 ± 7.0, p = 0.000), and endurance (28.1 ± 8.9 vs 33.1 ± 8.7, p = 0.01) in children with SDB. Moreover, mean oxygen saturation increased (96.4 ± 0.6 vs 97.4 ± 0.7, p = 0.000) and the oxygen desaturation index decreased (5.9 ± 2.3 vs 3.6 ± 1.8, p = 0.001) after MT.

Conclusions

Oropharyngeal exercises appear to effectively modify tongue tone, reduce SDB symptoms and oral breathing, and increase oxygen saturation, and may thus play a role in the treatment of SDB.

     

A novel intermittent negative air pressure device ameliorates obstructive sleep apnea syndrome in adults

Purpose

Patients with obstructive sleep apnea syndrome (OSAS) have difficulties in compliance with continuous positive airway pressure (CPAP) and the treatment outcome is heterogeneous. We proposed a proof-of-concept study of a novel intermittent negative air pressure (iNAP®) device for physicians to apply on patients who have failed or refused to use CPAP.

Methods

The iNAP® device retains the tongue and the soft palate in a forward position to decrease airway obstruction. A full nightly usage with the device was evaluated with polysomnography. Subgrouping by baseline apnea–hypopnea index (AHI) and body mass index (BMI) with different treatment response criteria was applied to characterize the responder group of this novel device.

Results

Thirty-five patients were enrolled: age 41.9?±?12.2 years (mean?±?standard deviation), BMI 26.6?±?4.3 kg/m², AHI 41.4?±?24.3 events/h, and oxygen desaturation index (ODI) 40.9?±?24.4 events/h at baseline. AHI and ODI were significantly decreased (p?<?0.001) by the device. Patients with moderate OSAS, with baseline AHI between 15 to 30 events/h, achieved 64% response rate; and non-obese patients, with BMI below 25 kg/m², achieved 57% response rate, with response rate defined as 50% reduction in AHI from baseline and treated AHI lower than 20. There were minimal side effects reported.

Conclusions

In a proof-of-concept study, the device attained response to treatment as defined, in more than half of the moderate and non-obese OSAS patients, with minimal side effects.