Prevalence of sleep abnormalities and their association with metabolic syndrome among Asian Indians: Chennai Urban Rural Epidemiology Study (CURES-67)

Objective

To estimate the prevalence of sleep abnormalities and their association with glucose intolerance and metabolic syndrome (MS) in the normal-weight urban South Indian population.

Methods

This population-based, cross-sectional study was carried out in 358 subjects aged 20–76 years randomly selected from the Chennai Urban Rural Epidemiology Study in South India. A validated questionnaire assessing various sleep abnormalities (snoring, daytime sleepiness, lack of refreshing sleep, and number of hours of sleep) was administered. All subjects underwent an oral glucose tolerance test, and anthropometric biochemical measurements were obtained to assess cardiometabolic risk factors including glucose intolerance. Diabetes risk was assessed using a previously validated Indian Diabetes Risk Score (IDRS).

Results

The overall prevalence of snoring and daytime sleepiness was 40% and 59%, respectively. Snorers were more male, older, smokers, and had higher levels of cardiometabolic risk factors. Subjects with daytime sleepiness had higher body mass index (BMI) and abdominal obesity. Both snoring (50.9% vs 30.2%, p < 0.001) and daytime sleepiness (68% vs 49.7%, p < 0.001) were more prevalent among subjects with impaired glucose metabolism compared to those with normal glucose metabolism. Both sleep measures were associated with higher diabetes risk scores, as assessed by the IDRS (snoring: trend χ², 11.14, p = 0.001; daytime sleepiness: trend χ², 5.12, p = 0.024). Metabolic syndrome was significantly associated with snoring even after adjusting for age, sex, family history of diabetes, physical activity, smoking, and alcohol.

Conclusion

The prevalence of snoring and daytime sleepiness is high among urban South Indians and these two sleep measures are associated with glucose intolerance, MS, and higher diabetes risk scores.     

Polymorphisms in Mn-SOD and EC-SOD gene and risk of nephropathy in Western Indian Type 2 diabetic patients

Single-nucleotide polymorphisms in genes related to oxidative stress are a risk factor for the development of diabetes and its complications. The allele and genotype frequencies of missense polymorphism Ala-9Val and Val16Ala in Mn-SOD and Arg213Gly in EC-SOD genes were studied in (a) patients with Type 2 diabetes mellitus (T2DM) without any complication (T2DM), (b) diabetic nephropathy (DN), (c) non-diabetic nephropathy (NDN) and (d) control healthy subjects from Western region of India. The PCR products were digested with BshTI, BsaWI and Eco52I restriction enzymes to detect Ala-9Val, Val16Ala and Arg213Gly polymorphisms respectively. The frequency of Val allele of Ala-9Val (P?=?0.568 and P?=?0.571) and Ala allele of Val16Ala (P?=?0.993 and P?=?0.152) polymorphisms of Mn-SOD gene did not show a significant difference in patient with T2DM and NDN compared to control subjects respectively. Frequency of Val allele of Ala-9Val (42.8 % vs. 61.5 %, P?<?0.001) and Ala allele of Val16Ala (39.0 % vs. 53.5 %, P?=?0.005) polymorphisms of Mn-SOD gene was significantly higher in patients with DN than that of patient with T2DM. For Arg213Gly polymorphism of EC-SOD gene, the Gly allele frequency in T2DM and NDN group did not significantly (P?=?0.993 and P?=?0.152 respectively) differ from control subjects as well as non-significantly higher in DN compared to T2DM. These results suggests that Ala-9Val and Val16Ala polymorphism in Mn-SOD is not involved in development of diabetes but may play a crucial role in determining genetic susceptibility to diabetic nephropathy in Western Indian Type 2 diabetic patients. Our data found a lack of association of EC-SOD (Arg213Gly) polymorphism with development of diabetes and diabetic nephropathy.     

Burning mouth syndrome and peripheral neuropathy in patients with type 1 diabetes mellitus

ObjectiveBurning mouth syndrome (BMS) has been attributed secondarily to diabetes, poor glycemic control, and diabetic neuropathy. The prevalence and predictor factors of BMS were compared in type 1 diabetes mellitus (T1DM) and nondiabetic subjects.Study designAn assessment of 371 adult T1DM subjects and 261 control subjects participating in a cross-sectional epidemiological study of oral health complications of diabetes was performed. Subjects were participants of the Pittsburgh Epidemiology of Diabetes Complications study. Prevalence of BMS was determined by response to the following questions: “Do you now or in the last month had any persistent uncomfortable sensations in your mouth or tongue? If yes, would you describe the feeling as tingling, burning, sore, numb, or other?”ResultsBurning mouth syndrome symptoms were reported by 28 T1DM and control subjects (4.6%). Eleven had oral pathologies that might explain the BMS, including atrophy of the tongue papillae, fissured tongue, denture stomatitis, and candidiasis. The prevalence of BMS within the two groups with no pathologies was similar; 12/371 (3.2%) vs. 5/233 (2.1%). Multivariate analyses of the 12 T1DM subjects with BMS found significant associations for female gender (P=.042) and a diagnosis of diabetic peripheral neuropathy (P=.024).ConclusionsIn this T1DM population, BMS or related discomforts occurred slightly more frequently than in the control group. Symptomatic T1DM subjects were more likely to be female who had also developed peripheral neuropathy. These findings and other similarities between BMS and diabetic peripheral neuropathy suggest that a neuropathic process may be an underlying source of BMS in some patients who have no apparent oral abnormality.     

The prevalence and associated risk factors of sleep disorder-related symptoms in pregnant women in China

Purpose

The sleep disorder in pregnant women remains unfamiliar to perinatal care providers, resulting in lack of appropriate care. This study was designed to investigate the prevalence of sleep disorder-related symptoms in pregnant women and to identify the associated risk factors.

Methods

Married pregnant women were enrolled from their first trimester and followed up until delivery. Nonpregnant married healthy women were selected as controls. A survey questionnaire was administered to each of them.

Results

We successfully performed a survey to 1,993 pregnant women and 598 nonpregnant women. The overall prevalence of sleep disorder-related symptoms in pregnant women was significantly higher than the controls (56.1 vs. 29.9 %, P?<?0.05). There was higher prevalence of snoring (30.2 %), observed sleep apnea (1.1 %), mouth breathing (23.7 %), nocturnal arousal (46.5 %), insomnia (35.1 %), and daytime sleepiness (52.6 %) in pregnant women. There were no significant differences of the prevalence of bruxism (7.0 vs. 6.7 %), sleep talking (8.1 vs. 7.2 %), and sleep walking (0.4 vs. 0.2 %) between the two groups (P?>?0.05). Nocturnal sleep time (8.0?±?1.3 h) was less in the third trimester compared with the nonpregnant women (8.2?±?1.1 h) (P?<?0.05). Smoking (OR?=?3.39), drinking (OR?=?2.40), allergic rhinitis/asthma (OR?=?1.71), an obvious difference in neck circumference (OR?=?1.11), and waistline (OR?=?1.07) changes between the first and third trimesters were the risk factors for sleep disorder-related problems.

Conclusions

There is a high prevalence of sleep disorder-related symptoms in pregnant women. Our data may provide a baseline for prevention and treatment of sleep disturbances in pregnant women.     

Correlation of daytime sleepiness with urine metabolites in patients with obstructive sleep apnea

Purpose

The apnea–hypopnea index (AHI) is closely related with the severity of daytime sleepiness, but excessive daytime sleepiness (EDS) is not presented on all patients with obstructive sleep apnea (OSA). It is unclear why daytime sleepiness is not always present in OSA patients even if their sleep is disrupted from the perspective of polysomnographic findings. This study aimed to analyze the correlation between sleepiness and urine metabolites of neurotransmitters involved in the arousal system.

Methods

On the basis of AHI in polysomnography, 49 consecutive OSA patients were included. According to their Epworth sleepiness scale (ESS), 23 non-sleepy patients (ESS <11) and 26 sleepy patients (ESS ≥11) were included. Urine samples were collected before and after polysomnography and analyzed by gas chromatography–mass spectrometry with selective ion monitoring. Six metabolites of dopamine, norepinephrine and serotonin were analyzed.

Results

The dopamine metabolites, homovanillic acid (r?=?0.366, P?=?0.017) and 3,4-dihydroxyphenylacetic acid (DOPAC; r?=?0.584, P?P?=?0.032).

Conclusion

Urine dopamine metabolites may identify sleepy patients with OSA. In particular, the overnight change of urine DOPAC may indicate OSA patients with EDS.     

Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea

The prevalence of obstructive sleep apnea (OSA) defined at an apnea-hypopnea index (AHI) ≥5 was a mean of 22% (range, 9-37%) in men and 17% (range, 4-50%) in women in eleven published epidemiological studies published between 1993 and 2013. OSA with excessive daytime sleepiness occurred in 6% (range, 3-18%) of men and in 4% (range, 1-17%) of women. The prevalence increased with time and OSA was reported in 37% of men and in 50% of women in studies from 2008 and 2013 respectively. OSA is more prevalent in men than in women and increases with age and obesity. Smoking and alcohol consumption are also suggested as risk factors, but the results are conflicting. Excessive daytime sleepiness is suggested as the most important symptom of OSA, but only a fraction of subjects with AHI >5 report daytime sleepiness and one study did not find any relationship between daytime sleepiness and sleep apnea in women. Stroke and hypertension and coronary artery disease are associated with sleep apnea. Cross-sectional studies indicate an association between OSA and diabetes mellitus. Patients younger than 70 years run an increased risk of early death if they suffer from OSA. It is concluded that OSA is highly prevalent in the population. It is related to age and obesity. Only a part of subjects with OSA in the population have symptoms of daytime sleepiness. The prevalence of OSA has increased in epidemiological studies over time. Differences and the increase in prevalence of sleep apnea are probably due to different diagnostic equipment, definitions, study design and characteristics of included subjects including effects of the obesity epidemic. Cardiovascular disease, especially stroke is related to OSA, and subjects under the age of 70 run an increased risk of early death if they suffer from OSA.     

Personality profiles in patients with obstructive sleep apnea

Objective

The Minnesota Multiphasic Personality Inventory (MMPI) responses between snorers and obstructive sleep apnea (OSA) may be different. Thus, we compared the MMPI responses between snorers and OSA.

Design

A clinical-based cross-sectional survey.

Participants

This is a survey of 94 treatment-naive sleep-disordered breathing (SDB) subjects.

Method

Clinical information, body mass index (BMI), 36-item Short Form Health Survey, the Turkish version of the MMPI, Epworth sleepiness scale (ESS), fatigue scale, attention-deficit scale, and polysomnography were collected. All patients with OSA and snorers was accepted as individuals with SDB (AHI?>?0 events/h). The threshold of five apnea and hypopnea per hour of sleep was chosen to define both OSA and snorers. Disability profile is consisting of four or more MMPI clinical scale elevations.

Results

OSA patients compared to snorers have significantly higher absolute scores on hypochondriasis (Hs) (65.0?±?12.0 vs 58.4?±?7.9, p?=?0.01, respectively). OSA patients compared to snorers have significantly higher rate of clinical elevation on both psychopathic deviance (13.0 vs 0?%, p?=?0.03, respectively) and Hs (26.1 vs 3.3?%, p?=?0.01, respectively). People with disability profile has lower the quality of life, a higher score for inattention, a higher fatigue scores, and higher sleepiness scores. The quality of life and attention deficit and daytime sleepiness scores were associated with total MMPI absolute score in individuals with SDB in bivariate analyses.

Conclusion

Present study indicated that patients with OSAS compared to snorers displayed significantly more hyopchondriasis and psychopathic deviance personality characteristics. The daytime functions in individuals with sleep-disordered breathing may be influenced by the severity of psychopathology.     

Sleepiness and sleep-disordered breathing in truck drivers

Background

Portugal has one of the highest road traffic fatality rates in Europe. A clear association between sleep-disordered breathing (SDB) and traffic accidents has been previously demonstrated. This study aimed to determine prevalence of excessive daytime sleepiness (EDS) and other sleep disorder symptoms among truck drivers and to identify which individual traits and work habits are associated to increased sleepiness and accident risk.

Methods

We evaluated a sample of 714 truck drivers using a questionnaire (244 face-to-face interviews, 470 self-administered) that included sociodemographic data, personal habits, previous accidents, Epworth Sleepiness Scale (ESS), and the Berlin questionnaire (BQ).

Results

Twenty percent of drivers had EDS and 29 % were at high risk for having obstructive sleep apnea syndrome (OSAS). Two hundred sixty-one drivers (36.6 %) reported near-miss accidents (42.5 % sleep related) and 264 (37.0 %), a driving accident (16.3 % sleep related). ESS score ≥11 was a risk factor for both near-miss accidents (odds ratio (OR)?=?3.84, p?<?0.01) and accidents (OR?=?2.25, p?<?0.01). Antidepressant use was related to accidents (OR?=?3.30, p?=?0.03). We found an association between high Mallampati score (III–IV) and near misses (OR?=?1.89, p?=?0.04).

Conclusion

In this sample of Portuguese truck drivers, we observed a high prevalence of EDS and other sleep disorder symptoms. Accident risk was related to sleepiness and antidepressant use. Identifying drivers at risk for OSAS should be a major priority of medical assessment centers, as a public safety policy.     

Sleep-wake cycle irregularities in type 2 diabetics

Background

The incidence of type 2 diabetes mellitus (T2DM) has been increasing in recent years. Sleep loss and circadian rhythm abnormalities are thought to be one of the underlying causes of adverse metabolic health. However, little is known about sleep-wake cycle irregularities in T2DM. The present study compared the bedtime, waking time, and estimated sleep duration between T2DM and non-T2DM subjects.

Methods

The study subjects were 106 consecutive outpatients with lifestyle-related diseases (males/females?=?56/50), who answered a questionnaire on sleep status. Subjects were divided into two groups; non-T2DM (n?=?32) and T2DM (n?=?74) subjects.

Results

T2DM subjects retired to bed on weekdays and holidays significantly later than non-T2DM subjects (23:43 versus 22:52, p?=?0.0032; 23:45 versus 22:53, p?=?0.0038, respectively), and woke up significantly later on weekdays and holidays, compared with non-T2DM subjects (06:39 versus 06:08, p?=?0.0325; 06:58 versus 06:24, p?=?0.0450, respectively). There was no significant difference in the estimated sleep duration between the two groups. Daytime sleepiness was reported significantly more commonly by T2DM subjects than non-T2DM subjects (p?=?0.0195).

Conclusions

Sleep-wake cycle irregularities are more common in T2DM subjects than non-T2DM. Confirmation that such irregularity plays a role in the metabolic abnormalities of T2DM requires further investigation in the future.

Trial registration

UMIN 000002998     

Acute phase proteins and diabetes microvascular complications

The association of serum high-sensitivity C-reactive protein and ferritin with diabetes microvascular complications has not been examined concurrently in people with type 2 diabetes. So, we carried out this study in order to investigate this association in a group of type 2 diabetic patients. In a prospective cross-sectional study, 242 people with type 2 diabetes were enrolled. All of the participants were evaluated for diabetes microvascular complications. Retinal status was evaluated by retinal color photography and indirect ophthalmoscopy exam with dilated pupils. Michigan neuropathy screening instrument was used for detection of peripheral neuropathy, and albumin/creatinine ratio in a spot urine sample was considered to diagnose diabetic nephropathy. High-sensitivity C-reactive protein and ferritin were measured as indicators of acute phase proteins. The mean for high-sensitivity C-reactive protein was 5.3?±?13.02 mg/L, and for ferritin was 126.9?±?114.4 ng/mL. Statistically significant difference was found between the high-sensitivity C-reactive protein levels and diabetic nephropathy. Spearman’s correlation coefficients test revealed that high-sensitivity C-reactive protein was positively correlated with diabetic nephropathy (P?=?0.05, r?=?0.14). However, such a correlation was not found for diabetic neuropathy and retinopathy. Using binary logistic regression analysis, a significant odds ratio was defined for nephropathy and high-sensitivity C-reactive protein level (OR?=?2.62; CI?=?1.13–6.06; P?=?0.025). Our findings suggest that low-grade inflammation is an independent predictor of diabetic nephropathy and measurement of high-sensitivity C-reactive protein can be useful for early detection of high-risk individuals.     

Insulin autoantibody could help to screen latent autoimmune diabetes in adults in phenotypic type 2 diabetes mellitus in Chinese

Latent autoimmune diabetes in adults (LADA) is characterized by a relatively mild diabetes onset, autoantibody positivity, and eventual requirement for insulin therapy. Glutamic acid decarboxylase autoantibodies (GADA) or cytoplasmic islet cell autoantibodies (ICA) play a key role in distinguishing LADA from type 2 diabetes mellitus (T2DM) in clinical practice. The aim of our research was to determine whether insulin autoantibody (IAA) has some additional value in diagnosing LADA. We analyzed IAA, GADA, and IA-2A (antibodies to insulinoma-associated antigen-2) in 1,003 newly diagnosed phenotypic T2DM patients, 110 type 1 diabetes mellitus (T1DM) patients, and 317 normal controls to survey the prevalence of IAA in phenotypic T2DM patients and the overlapping positivity of IAA with other autoantibodies. Sera were drawn within 7?days from the start of insulin therapy. Results showed that 3.39% of the newly diagnosed phenotypic T2DM, 0.95% of normal control (χ²?=?5.3, P?<?0.05), and 21.82% of T1DM (χ²?=?68.2, P?<?0.001) were positive for IAA at diagnosis. The combination frequency of three antibodies was 10.47%, which was higher than any single antibody testing. Combination testing of IAA with GADA and IA-2A could improve LADA diagnose rate by 2.39% than that of GADA and IA-2A. IAA-positive subjects had diabetes family history more common compared to its matched group (67.6% vs. 14.7%, P?=?0.000). Postprandial C-peptide in IAA-positive group tended to be lower, but the difference was not statistically significant (P?=?0.084). We concluded that IAA can be used to screen LADA in phenotypic T2DM in the Chinese population.     

The interaction between hypertension and obstructive sleep apnea on subjective daytime sleepiness

Hypertension is one of the most common chronic cardiovascular diseases in adults while obstructive sleep apnea (OSA) is the most common type of sleep apnea. It was recently reported that the mean Epworth Sleepiness Scale (ESS) score, measuring subjective daytime sleepiness, was significantly higher in non‐hypertensive subjects than the hypertensive counterparts with moderate to severe obstructive sleep apnea. In the current study, the authors investigated the interaction between hypertension and OSA on daytime sleepiness among 280 subjects recruited from a sleep study. OSA was evaluated with the Apnea‐Hypopnea Index (AHI), and daytime sleepiness was measured with the ESS. Significantly higher mean ESS scores were found for subjects without than those with hypertension (11.3 vs 9.4, P = 0.003) but only a marginally significant difference was discerned for the ESS scores between subjects with AHI ≥15/h and AHI <15/h (P = 0.075). A significant interaction between hypertension and OSA status on daytime sleepiness was observed from the analysis of variance (P = 0.02). The adjusted mean ESS score for the group of normotensive subjects with moderate to severe OSA (13.11) was significantly higher than the other three groups, namely, normotensive subjects with mild OSA (9.35), hypertensive subjects with mild OSA (9.70), and hypertensive subjects with moderate to severe OSA to (9.43). In conclusion, subjective daytime sleepiness of normotensive subjects with moderate to severe OSA was significantly more severe than other subjects.     

Prevalence of diabetic complications in fibrocalculous pancreatic diabetic patients and type 2 diabetic patients: a cross-sectional comparative study

OBJECTIVE: To determine the prevalence of diabetes-related complications in subjects with fibrocalculous pancreatic diabetes (FCPD) and compare them with subjects with type 2 diabetes mellitus matched for age, sex, and duration of diabetes. METHODS: The study group comprised of 277 FCPD patients and 277 age, sex, and duration of diabetes-matched type 2 diabetic patients. All the study subjects underwent a detailed clinical examination, and fasting blood samples were obtained for biochemical studies. Peripheral Doppler was used for diagnosis of peripheral vascular disease (PVD). Vibratory perception threshold (VPT) was determined using biothesiometry for diagnosis of neuropathy. Diagnosis of coronary artery disease (CAD) was based on medical history and 12-lead resting ECG. Retinal photographs were used for diagnosis of retinopathy using a modified version of Early Treatment Diabetic Retinopathy Study (ETDRS) grading system. RESULTS: FCPD patients had lower body mass index (BMI) (P<.001), systolic blood pressure (P<.0001), diastolic blood pressure (P<.001), serum cholesterol (P<.001), serum triglyceride (P<.001), and serum creatinine (P<.01) but higher glycosylated hemoglobin (P<.001) levels compared to patients with type 2 diabetes. Prevalence of CAD was significantly higher among type 2 diabetic patients (11.9%) compared to FCPD patients (5.1%), P<.003. There was no significant difference in the prevalence of other diabetic complications between the two study groups (type 2 diabetes vs. FCPD: retinopathy-37.2% vs. 30.1%, PVD-4.3% vs. 4.7%, Neuropathy-25.3% vs. 20.9%, Nephropathy-15.0% vs. 10.1%). Multiple logistic regression analysis revealed the following risk factors for diabetes complications among type 2 diabetic subjects-retinopathy: BMI (P=.028), duration of diabetes (P<.001), and glycosylated hemoglobin (P=.026); nephropathy: diastolic blood pressure (P=.016) and glycosylated hemoglobin (P=.040); neuropathy: age (P<.001), duration of diabetes (P=.003), and glycosylated hemoglobin (P=.001). Among subjects with FCPD, systolic blood pressure (P=.013), glycosylated hemoglobin (P=.021), and duration of diabetes (P<.001) were associated with retinopathy; BMI (P=.057), glycosylated hemoglobin (P=.010), and duration of diabetes (P=.024) with nephropathy and age (P=.011) and BMI (P=.010) with neuropathy. Conclusion: The prevalence of retinopathy, nephropathy, neuropathy, and PVD was similar among FCPD patients and type 2 diabetic patients, but the prevalence of CAD was lower among FCPD patients.     

Angiotensin converting enzyme (ACE) gene polymorphism increases the susceptibility of diabetic nephropathy in Western Indian Type 2 diabetic patients

Angiotensin-converting enzyme (ACE) gene has been associated with the pathogenesis and progression of chronic kidney diseases. Diabetic nephropathy has become leading cause of renal end stage disease (ESRD). An I/D polymorphism of angiotensin-converting enzyme (ACE) gene has been suggested as one of the risk factors for the progression of diabetic nephropathy. We analyzed the genotype and allele frequency distribution of ACE gene in 166 Type 2 diabetic patients without any complication (T2DM), 61 with diabetic nephropathy (DN), 50 with non-diabetic nephropathy (NDN) and 50 healthy individuals from western Indian population. ACE genotype was analyzed by PCR method. The D allele distribution for the ACE I/D polymorphisms was not significantly different between control group and patients with T2DM without any complication (41.0% vs. 45.2%, P?=?0.461) and between control subjects and patients with non-diabetic nephropathy (NDN) (41.0% vs. 44.0%, P?=?0.668). Frequency of the D allele (63.9% vs. 45.2%, P?<?0.001) and DD genotype (I allele noncarrier) (44.3% vs. 25.3%, P?=?0.006) of ACE gene was significantly higher in patients with diabetic nephropathy (DN) than in patients with T2DM without any complication. Results of the present study indicate that ACE gene polymorphism does not have significant influence on development of diabetes mellitus and nondiabetic nephropathy, whereas, the DD polymorphism in ACE gene has been associated with the development of diabetic nephropathy in the Western Indian population.     

Subjective sleepiness and daytime functioning in bariatric patients with obstructive sleep apnea

Purpose

The purpose of this study was to evaluate associations between obstructive sleep apnea (OSA) severity and self-reported sleepiness and daytime functioning in patients considering bariatric surgery for treatment of obesity.

Methods

Using a retrospective cohort design, we identified 342 patients who had sleep evaluations prior to bariatric surgery. Our final sample included 269 patients (78.6 % of the original cohort, 239 females; mean age?=?42.0?±?9.5 years; body mass index?=?50.2?±?7.7 kg/m²) who had overnight polysomnography and completed the Epworth Sleepiness Scale (ESS) and the Functional Outcomes of Sleep Questionnaire (FOSQ). Patients' OSA was classified as none/mild (apnea–hypopnea index (AHI)?<?15, n?=?112), moderate (15?≤?AHI?<?30, n?=?77), or severe (AHI?≥?30, n?=?80). We calculated the proportion of unique variance (PUV) for the five FOSQ subscales. ANOVA was used to determine if ESS and FOSQ were associated with OSA severity. Unpaired t tests compared ESS and FOSQ scores in our sample with published data.

Results

The average AHI was 29.5?±?31.5 events per hour (range?=?0–175.8). The mean ESS score was 6.3?±?4.8, and the mean global FOSQ score was 100.3?±?18.2. PUVs for FOSQ subscales showed moderate-to-high unique contributions to FOSQ variance. ESS and global FOSQ score did not differ by AHI group. Only the FOSQ vigilance subscale differed by OSA severity with the severe group reporting more impairment than the moderate and none/mild groups. Our sample reported less sleepiness and daytime impairment than previously reported means in patients and controls.

Conclusions

Subjective sleepiness and functional impairment were not associated significantly with OSA severity in our sample of patients considering surgery for obesity. Further research is needed to understand individual differences in sleepiness in patients with OSA. If bariatric patients underreport symptoms, self-report measures are not an adequate substitute for objective assessment and clinical judgment when evaluating bariatric patients for OSA. Patients with severe obesity need evaluation for OSA even in the absence of subjective complaints.     

Association between EPCs count and rate of coronary revascularization in asymptomatic type 2 diabetic patients

Coronary arterial disease (CAD) is common in diabetic patients, and endothelial progenitor cells (EPCs) are considered a surrogate marker for CAD, but controversies regarding this issue still remain. We investigated the potential clinical role of EPCs during coronary screening in asymptomatic type 2 diabetic patients screened with cardiovascular magnetic resonance (CMR). A total of 100 asymptomatic type 2 diabetic subjects (51 men and 49 women) were enrolled. Clinical and laboratory parameters, including EPCs (CD34⁺/CD133⁺/VEGFR-2⁺) count, were evaluated and CMR was performed. A total of 51 patients [silent myocardial infarction (n?=?3), inducible ischemia (n?=?11), suspected CAD (n?=?37)] had abnormal finding on CMR. Of the 20 patients who later underwent invasive coronary angiography, 8 were treated with revascularization. Fifty-one subjects with abnormal finding on CMR were divided into two groups [subjects with revascularization (group I, n?=?8) vs. without revascularization (group II, n?=?43)]. Group I had a significantly increased EPCs level than group II (833 vs. 415, P?=?0.027). Multivariate logistic regression analysis revealed that an increased EPCs level (OR?=?1.003, P?=?0.024) and a high body-mass index (OR?=?1.907, P?=?0.028) were independently correlated with revascularization. In our study, increased EPCs count is associated with performing revascularization in asymptomatic type 2 diabetic patients, and that increased EPCs count can provide clinically important information while performing intervention.     

The association between diabetes mellitus and Helicobacter pylori infection

Helicobacter pylori is a major cause of duodenal and gastric diseases. The aim of this study was to estimate the prevalence of H. pylori infection in patients with diabetes mellitus, and to investigate the association between H. pylori infection and upper gastrointestinal symptoms. In this case-control study, 79 diabetic patients and 84 control subjects with upper gastrointestinal symptoms were included. Upper gastrointestinal endoscopy was performed and gastric mucosa biopsied. H. pylori was identified by rapid urease test and by histology. A serum sample was obtained to measure H. pylori antibodies. The adjusted odds ratio estimates of H. pylori infection among pre-diabetic and diabetic subjects compared to non-diabetic subjects were 0.51 (95 % CI: 0.16, 1.63) and 1.33 (95 % CI: 0.64, 1.79) respectively. No association was found between H. pylori infection and upper gastrointestinal symptoms among three groups. The serology test for H. pylori was positive in 54.4 % (43) of diabetics and 61.4 % (43) of non-diabetic patients (P?=?0.689, non-significant). There was significant difference in rapid urease test between diabetes mellitus patients and non-diabetes patients (70.9 % versus 48.6 %, P?=?0.002). There was no association between upper gastrointestinal symptoms among diabetes mellitus, pre-diabetic and non-diabetic patients. We found no association between H. pylori infection and diabetes mellitus.     

High prevalence of obstructive sleep apnea in patients with resistant paroxysmal atrial fibrillation after pulmonary vein isolation

Objectives

To address the question whether obstructive sleep apnea (OSA) is associated with the recurrence of paroxysmal atrial fibrillation (AF) in patients treated with ≥2 pulmonary vein isolation procedures.

Patients and Methods

In this study, we included adults with therapy-resistant symptomatic paroxysmal AF, defined as AF recurring after ≥2 PV-isolation procedures (n?=?23). For comparison, we selected another cohort of patients being successfully treated by one PV isolation without AF recurrence within 6 months (n?=?23). PV isolation was performed by radiofrequency with an open irrigated tip catheter. Each of the 46 participants completed an overnight polygraphic study. The two groups were matched for age, gender, and ejection fraction. Patients were late middle-aged (65?±?7 vs 63?±?10 years, P?=?0.23), white (100%), and overweight (BMI 27.3?±?3.6 vs. 27.2?±?4.6 kg/m², P?=?0.97).

Results

The prevalence of sleep apnea, defined as an apnea–hypopnea index (AHI) of >5 per hour of sleep, was 87% in patients with therapy-resistant AF compared to 48% in the control cohort (P?=?0.005). In addition, OSA was more severe in the resistant AF group indicated by a significantly higher AHI (27?±?22 vs 12?±?16, P?=?0.01).

Conclusion

The extraordinarily high prevalence of sleep apnea in patients with recurrent paroxysmal AF supports its presumable role in the pathogenesis of AF and demands further controlled prospective trials. Moreover, OSA should inherently be considered in patients with therapy-resistant AF.     

Prevalence and predictors of severe autonomic failure in patients with insulin-dependent type 2 diabetes mellitus and coronary artery disease: pilot study

Background

Presence of severe autonomic failure (SAF), defined as coincidence of abnormal heart rate turbulence and abnormal deceleration capacity, identifies a group of patients with very poor prognosis among post-infarction patients with diabetes mellitus. However, factors contributing to development of SAF are entirely unknown. Here, we aimed to identify clinical, biochemical, and hemodynamic factors predicting SAF in a consecutive cohort of diabetic patients with coronary artery disease (CAD).

Methods

Between January 2010 and July 2011, we prospectively enrolled 97 patients with insulin-dependent type 2 diabetes mellitus and stable CAD in sinus rhythm. Heart rate turbulence (as marker of autonomic reflex activity) and deceleration capacity (as marker of autonomic tonic activity) were calculated from 24-hour Holter recordings. Uni- and multivariable logistic regression analysis included duration of diabetes mellitus, diabetic neuropathy, retinopathy, nephropathy, level of HbA_1c, left ventricular ejection fraction (LVEF), brain natriuretic peptide, presence of multivessel disease, and history of myocardial infarction.

Results

Ten (10.3%) of the 97 patients exhibited signs of SAF. Patients with SAF were characterized by longer duration of diabetes (25 years vs 15 years), higher prevalence of diabetic neuropathy (70% vs. 36%), retinopathy (80% vs 45%) and nephropathy (90% vs 55%), significantly higher levels of HbA_1c (9.0% vs 7.4%; P = .002) and a lower LVEF (30% vs.55%; P = .001). On multivariable analysis, LVEF ≤ 35% and HbA_1c > 8% were the only factors which were independently associated with SAF (odds ratios of 23.1 [95% CI, 1.8-287.0]; P = .015 and 6.6 [1.1-40.1]; P = .043).

Discussion

In patients with insulin-dependent type 2 diabetes mellitus and CAD, presence of SAF correlates with both glycemic control and diabetic complications. Impaired LVEF and increased level of HbA_1c were independently associated with SAF.