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01.08.2013 | Original Article

Preliminary evidence that obese patients with obstructive sleep apnea/hypopnea syndrome are refractory to the acute beneficial metabolic effects of a very low calorie diet

verfasst von: Ilaria Giordani, Ilaria Malandrucco, Fabiana Picconi, Susanna Longo, Alessandra Di Flaviani, Laura Chioma, Barbara Moscatelli, Silvia Donno, Simona Frontoni

Erschienen in: Acta Diabetologica | Ausgabe 4/2013

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Abstract

Since obesity seems to play a causal role in both obstructive sleep apnea/hypopnea syndrome (OSAHS) and type 2 diabetes, the question arises whether diet-induced weight loss is equally efficacious in type 2 diabetic patients with and without OSAHS. The present study was aimed to investigate the effect of 1 week very low calorie diet (VLCD) on oxygen desaturation index (ODI) and on glucose regulation in OSAHS versus non-OSAHS patients. Fourteen patients with type 2 diabetes mellitus and morbid obesity were enrolled. According to ODI, patients were divided into 2 groups (with and without OSAHS) and evaluated by a hyperglycemic clamp study, before and after a 7 day-VLCD. After a VLCD, a significant reduction of anthropometric parameters, in the overall group and in subgroups, was observed. M-value and acute insulin response increased significantly only in patients without obstructive sleep apnea (990.10 ± 170.19 vs. 1,205.22 ± 145.73 μmol min⁻¹ m⁻², p = 0.046; −1.05 ± 8.40 vs. 48.26 ± 11. 90 pmol/L, p = 0.028, respectively). The average 24-h heart rate (24-h HR) fell significantly (p = 0.05), primarily because of a decrease during daytime (p = 0.041), in the whole group. In conclusion, we observed that morbidly obese patients with type 2 diabetes and OSAHS are specifically resistant to the acute beneficial effects of VLCD on metabolic parameters. Our preliminary observation deserves further investigation to clarify the pathogenetic mechanisms involved.

Rusu A, Todea D, Rosca L, Nita C, Bala C (2012) The development of a sleep apnea screening program in Romanian type 2 diabetic patients: a pilot study. Acta Diabetol 49(2):105–109PubMedCrossRef

Foster GD, Sanders MH, Millman R et al (2009) Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 32:1017–1019PubMedCrossRef

Laaban JP, Daenen S, Léger D et al (2009) Prevalence and predictive factors of sleep apnoea syndrome in type 2 diabetic patients. Diabetes Metab 35:372–377PubMedCrossRef

Resnick HE, Redline S, Shahar E et al (2003) Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care 26:702–709PubMedCrossRef

Lindberg E, Theorell-Haglöw J, Svensson M, Gislason T, Berne C, Janson C (2012) Sleep apnea and glucose metabolism: a long-term follow-up in a community-based sample. Chest 142(4):935–942PubMedCrossRef

Oda E (2012) Metabolic syndrome: its history, mechanisms, and limitations. Acta Diabetol 49(2):89–95PubMedCrossRef

Wright J, Johns R, Watt I, Melville A, Sheldon T (1997) Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence. Br Med J 314:851–860CrossRef

Young T, Finn L, Peppard PE et al (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31:1071–1078PubMed

Hecht L, Moehler R, Meyer G (2011) Effect of CPAP-respiration on markers of glucose metabolism in patients with obstructive sleep apnoea syndrome: a systematic review and meta-analysis. Ger Med Sci 9:1–13

10.

O’Donnell CP (2007) Metabolic consequences of intermittent hypoxia. Adv Exp Med Biol 618:41–49PubMedCrossRef

11.

Ip MSM, Lam B, Ng MM, Lam WK, Tsang KWT, Lam KSL (2002) Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 165:670–676PubMedCrossRef

12.

Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL (2002) Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 165:677–682PubMedCrossRef

13.

Meslier N, Gagnadoux F, Giraud P et al (2003) Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 22:156–160PubMedCrossRef

14.

Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE (2004) Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol 160:521–530PubMedCrossRef

15.

Tiihonen M, Partinen M, Narvanen S (1993) The severity of obstructive sleep apnoea is associated with insulin resistance. J Sleep Res 2:56–61PubMedCrossRef

16.

Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T (2005) Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med 165:2408–2413PubMedCrossRef

17.

Foster GD, Borradaile KE, Sanders MH, For the Sleep AHEAD Research Group of the Look AHEAD Research Group et al (2009) The sleep ahead study a randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes. Arch Intern Med 169(17):1619–1626PubMedCrossRef

18.

Tuomilehto HP, Seppa JM, Partinen MM et al (2009) Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 179:320–327PubMedCrossRef

19.

Johansson K, Neovius M, Lagerros YT et al (2009) Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomized controlled trial. BMJ 339:b4609PubMedCrossRef

20.

Dixon J, Schachter L, O’Brien P, Jones K et al (2012) Surgical versus conventional therapy for weight loss treatment of obstructive sleep apnea. JAMA 308(11):1142–1149PubMedCrossRef

21.

Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R (2011) Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 54:2506–2514PubMedCrossRef

22.

Malandrucco I, Pasqualetti P, Giordani I et al (2012) Very-low-calorie diet: a quick therapeutic tool to improve β cell function in morbidly obese patients with type 2 diabetes. Am J Clin Nutr 95:609–613PubMedCrossRef

23.

American Diabetes Association (2010) Diagnosis and classification of diabetes mellitus. Diabetes Care 33(suppl 1):S62–S69CrossRef

24.

Netzer N, Eliasson AH, Netzer C, Kristo DA (2001) Overnight pulse oximetry for sleep-disordered breathing in adults. Chest 120:625–633PubMedCrossRef

25.

DeFronzo RA, Tobin JD, Andres R (1979) Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 237(suppl 3):E214–E223PubMed

26.

Mari A, Ahre′n B, Pacini G (2005) Assessment of insulin secretion in relation to insulin resistance. Curr Opin Clin Nutr Metab Care 8:529–533PubMedCrossRef

27.

Pontiroli AE, Merlotti C, Veronelli A, Lombardi F (2013). Effect of weight loss on sympatho-vagal balance in subjects with grade-3 obesity: restrictive surgery versus hypocaloric diet. Acta Diabetol. doi:10.1007/s00592-013-0454-1

28.

Frontoni S, Bracaglia D, Gigli F (2005) Relationship between autonomic dysfunction, insulin resistance and hypertension, in diabetes. Nutr Metab Cardiovasc Dis 15(6):441–449PubMedCrossRef

29.

Ota H, Tamaki S, Itaya-Hironaka A et al (2012) Attenuation of glucose-induced insulin secretion by intermittent hypoxia via down-regulation of CD38. Life Sci 90(5–6):206–211PubMedCrossRef

30.

Antonelli A, Ferrannini E (2004) CD38 autoimmunity: recent advances and relevance to human diabetes. J Endocrinol Invest 27(7):243–252

31.

Yokoe T, Alonso LC, Romano LC et al (2008) Intermittent hypoxia reverses the diurnal glucose rhythm and causes pancreatic beta-cell replication in mice. J Physiol 586(3):899–911PubMedCrossRef

32.

Xu J, Long YS, Gozal D, Epstein PN (2009) Beta-cell death and proliferation after intermittent hypoxia: role of oxidative stress. Free Radic Biol Med 46(6):783–790PubMedCrossRef

33.

Cnop M, Hughes SJ, Igoillo-Esteve M et al (2009) The long lifespan and low turnover of human islet beta cells estimated by mathematical modelling of lipofuscin accumulation. Diabetologia 53(2):321–330PubMedCrossRef

34.

Perl S, Kushner JA, Buchholz BA et al (2010) Significant human beta-cell turnover is limited to the first three decades of life as determined by in vivo thymidine analog incorporation and radiocarbon dating. Am J Physiol 95(10):E234–E239

Titel: Preliminary evidence that obese patients with obstructive sleep apnea/hypopnea syndrome are refractory to the acute beneficial metabolic effects of a very low calorie diet
verfasst von: Ilaria Giordani
Ilaria Malandrucco
Fabiana Picconi
Susanna Longo
Alessandra Di Flaviani
Laura Chioma
Barbara Moscatelli
Silvia Donno
Simona Frontoni
Publikationsdatum: 01.08.2013
Verlag: Springer Milan
Erschienen in: Acta Diabetologica / Ausgabe 4/2013
Print ISSN: 0940-5429
Elektronische ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-013-0487-5

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