Top

Sleep and Breathing

Published in:

11-08-2021 | Sleep Apnea | Sleep Breathing Physiology and Disorders • Original Article

Blood glucose dynamics during sleep in patients with obstructive sleep apnea and normal glucose tolerance: effects of CPAP therapy

Authors: Kimimasa Saito, Yosuke Okada, Keiichi Torimoto, Yoko Takamatsu, Yoshiya Tanaka

Published in: Sleep and Breathing | Issue 2/2022

Abstract

Purpose

Glycemic variability (GV) and hypoglycemia during nighttime are presumed to be associated with fatal bradycardia. The aim of this prospective study was to evaluate blood glucose dynamics during sleep in patients with obstructive sleep apnea syndrome (OSA) and normal glucose tolerance.

Methods

Patients with OSA and no diabetes who underwent type 1 overnight polysomnography from December 2018 to May 2020 participated in this study. GV was evaluated in all participants for 14 days using a flash glucose monitoring device. Correlations were examined between GV indexes and indexes related to sleep breathing disorders, the effects of treatment with continuous positive airway pressure (CPAP) on these GV indexes, and the characteristics of glucose dynamics in different OSA subtypes classified by sleep stage.

Results

Among 42 patients with OSA and no diabetes, the standard deviation of GV during sleep correlated significantly with sleep time spent with oxygen saturation <90% (r=0.591, p=0.008). High blood glucose index during sleep correlated significantly with stage N1% (r=0.491, p=0.032) and negatively with stage N2% (r=−0.479, p=0.038). High blood glucose index correlated significantly with sleep time spent with oxygen saturation <90% (r=0.640, p=0.003). The rapid eye movement–related OSA group had a higher incidence of hypoglycemia. One-week with CPAP treatment significantly improved GV during sleep, standard deviation of GV (from 12.1 to 9.0 mg/dL, p<0.001), and high blood glucose index (from 0.7 to 0.4, p=0.006).

Conclusions

To evaluate GV during sleep in patients with OSA may be useful for clinical risk management. CPAP treatment for 1 week may have an improving GV and high blood glucose index.

Clinical trial registration

UMIN000038489 2019/11/04, UMIN 000025433 2016/12/27

Available only for authorised users

Arnardottir ES, Mackiewicz M, Gislason T, Teff KL, Pack AI (2009) Molecular signatures of obstructive sleep apnea in adults: a review and perspective. Sleep 32(4):447–470CrossRef

Yoshihisa A, Owada T, Hoshino Y et al (2010) Flow-mediated dilatation identifies impaired endothelial function in patients with sleep apnea syndrome. Fukushima J Med Sci 56(2):115–120CrossRef

Iguchi A, Yamakage H, Tochiya M, Muranaka K, Sasaki Y, Kono S, Shimatsu A, Satoh-Asahara N (2013) Effects of weight reduction therapy on obstructive sleep apnea syndrome and arterial stiffness in patients with obesity and metabolic syndrome. J Atheroscler Thromb 20(11):807–820CrossRef

Hirakawa Y, Arima H, Zoungas S, Ninomiya T, Cooper M, Hamet P, Mancia G, Poulter N, Harrap S, Woodward M, Chalmers J (2014) Impact of visit-to-visit glycemic variability on the risks of macrovascular and microvascular events and all-cause mortality in type 2 diabetes: the ADVANCE trial. Diabetes Care 37(8):2359–2365CrossRef

Su G, Mi SH, Tao H, Li Z, Yang HX, Zheng H, Zhou Y, Tian L (2013) Impact of admission glycemic variability, glucose, and glycosylated hemoglobin on major adverse cardiac events after acute myocardial infarction. Diabetes Care 36(4):1026–1032CrossRef

Hanefeld M, Fischer S, Julius U, Schulze J, Schwanebeck U, Schmechel H, Ziegelasch HJ, Lindner J (1996) Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up. Diabetologia 39(12):1577–1583CrossRef

Cavalot F, Petrelli A, Traversa M, Bonomo K, Fiora E, Conti M, Anfossi G, Costa G, Trovati M (2006) Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study. J Clin Endocrinol Metab 91(3):813–819CrossRef

Ceriello A (2000) The post-prandial state and cardiovascular disease: relevance to diabetes mellitus. Diabetes Metab Res Rev 16(2):125–132CrossRef

Bonds DE, Miller ME, Bergenstal RM, Buse JB, Byington RP, Cutler JA, Dudl RJ, Ismail-Beigi F, Kimel AR, Hoogwerf B, Horowitz KR, Savage PJ, Seaquist ER, Simmons DL, Sivitz WI, Speril-Hillen JM, Sweeney ME (2010) The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ 340:b4909. https://doi.org/10.1136/bmj.b4909CrossRefPubMedPubMedCentral

10.

Khunti K, Davies M, Majeed A, Thorsted BL, Wolden ML, Paul SK (2015) Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care 38(2):316–322CrossRef

11.

Torimoto K, Okada Y, Tanaka Y (2019) Hypoglycemia abrogates the vascular endothelial protective effect of exenatide in type 2 diabetes mellitus. Diabetes Ther 10(3):1127–1132CrossRef

12.

Gami AS, Howard DE, Olson EJ, Somers VK (2005) Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med 352(12):1206–1214CrossRef

13.

Chow E, Bernjak A, Williams S, Fawdry RA, Hibbert S, Freeman J, Sheridan PJ, Heller SR (2014) Risk of cardiac arrhythmias during hypoglycemia in patients with type 2 diabetes and cardiovascular risk. Diabetes 63(5):1738–1747CrossRef

14.

Gill GV, Woodward A, Casson IF, Weston PJ (2009) Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes--the ‘dead in bed’ syndrome revisited. Diabetologia 52(1):42–45CrossRef

15.

Özlek B, Özlek E, Doğan V, Başaran Ö, Çil C, Çelik O, Biteker M, Bilge AR (2020) Implications of continuous positive airway pressure on heart rate variability in patients with obstructive sleep apnea: does gender matter? Turk Kardiyol Dern Ars 48(1):26–35PubMed

16.

Bergenstal RM, Beck RW, Close KL, Grunberger G, Sacks DB, Kowalski A, Brown AS, Heinemann L, Aleppo G, Ryan DB, Riddlesworth TD, Cefalu WT (2018) Glucose management indicator (GMI): a new term for estimating A1C from continuous glucose monitoring. Diabetes Care 41(11):2275–2280CrossRef

17.

Molnar GD, Taylor WF, Ho MM (1972) Day-to-day variation of continuously monitored glycaemia: a further measure of diabetic instability. Diabetologia 8(5):342–348CrossRef

18.

Kovatchev BP, Cox DJ, Gonder-Frederick LA, Clarke W (1997) Symmetrization of the blood glucose measurement scale and its applications. Diabetes Care 20(11):1655–1658CrossRef

19.

Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, Troester MT, Vaughn BV (2017) AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med 13(5):665–666CrossRef

20.

Hoshino T, Sasanabe R, Tanigawa T, Murotani K, Arimoto M, Ueda H, Shiomi T (2018) Effect of rapid eye movement-related obstructive sleep apnea on adherence to continuous positive airway pressure. J Int Med Res 46(6):2238–2248CrossRef

21.

Peng CS, Cao YA, Tian YH, Zhang WL, Xia J, Yang L (2017) Features of continuous glycemic profile and glycemic variability in patients with obstructive sleep apnea syndrome. Diabetes Res Clin Pract 134:106–112CrossRef

22.

Nakata K, Miki T, Tanno M, Ohnishi H, Yano T, Muranaka A, Sato T, Oshima H, Tatekoshi Y, Mizuno M, Abe K, Miura T (2017) Distinct impacts of sleep-disordered breathing on glycemic variability in patients with and without diabetes mellitus. PLoS One 12(12):e0188689. https://doi.org/10.1371/journal.pone.0188689CrossRefPubMedPubMedCentral

23.

Kurosawa H, Saisho Y, Fukunaga K, Haraguchi M, Yamasawa W, Kurihara I, Betsuyaku T, Itoh H (2018) Association between severity of obstructive sleep apnea and glycated hemoglobin level in Japanese individuals with and without diabetes. Endocr J 65(1):121–127CrossRef

24.

Khaire SS, Gada JV, Utpat KV, Shah N, Varthakavi PK, Bhagwat NM (2020) A study of glycemic variability in patients with type 2 diabetes mellitus with obstructive sleep apnea syndrome using a continuous glucose monitoring system. Clin Diabetes Endocrinol 6:10. https://doi.org/10.1186/s40842-020-00098-0CrossRefPubMedPubMedCentral

25.

Hui P, Zhao L, Xie Y, Wei X, Ma W, Wang J, Hou Y, Ning J, Zhou L, Guo Q, Zhou S (2016) Nocturnal hypoxemia causes hyperglycemia in patients with obstructive sleep apnea and type 2 diabetes mellitus. Am J Med Sci 351(2):160–168CrossRef

26.

Sun JL, Zhao LL, Wu H, Liu Q, Liao L, Luo J, Lian WQ, Cui C, Jin L, Ma JD, Li MZ, Yang S (2020) Acute hypoxia changes the mode of glucose and lipid utilization in the liver of the largemouth bass (Micropterus salmoides). Sci Total Environ 713:135157. https://doi.org/10.1016/j.scitotenv.2019.135157CrossRefPubMed

27.

Morariu EM, Chasens ER, Strollo PJ Jr, Korytkowski M (2017) Effect of continuous positive airway pressure (CPAP) on glycemic control and variability in type 2 diabetes. Sleep Breath 21(1):145–147CrossRef

28.

Mokhlesi B, Grimaldi D, Beccuti G, Van Cauter E (2017) Effect of one week of CPAP treatment of obstructive sleep apnoea on 24-hour profiles of glucose, insulin and counter-regulatory hormones in type 2 diabetes. Diabetes Obes Metab 19(3):452–456CrossRef

29.

Guo LX, Zhao X, Pan Q, Sun X, Li H, Wang XX, Zhang LN, Wang Y (2015) Effect of continuous positive airway pressure therapy on glycemic excursions and insulin sensitivity in patients with obstructive sleep apnea-hypopnea syndrome and type 2 diabetes. Chin Med J (in English) 128(17):2301–2306CrossRef

30.

Van Cauter E, Kerkhofs M, Caufriez A, Van Onderbergen A, Thorner MO, Copinschi G (1992) A quantitative estimation of growth hormone secretion in normal man: reproducibility and relation to sleep and time of day. J Clin Endocrinol Metab 74(6):1441–1450PubMed

31.

Jones TW, Porter P, Sherwin RS, Davis EA, O'Leary P, Frazer F, Byrne G, Stick S, Tamborlane WV (1998) Decreased epinephrine responses to hypoglycemia during sleep. N Engl J Med 338(23):1657–1662CrossRef

32.

Bialasiewicz P, Czupryniak L, Pawlowski M, Nowak D (2011) Sleep disordered breathing in REM sleep reverses the downward trend in glucose concentration. Sleep Med. 12(1):76–82CrossRef

Title: Blood glucose dynamics during sleep in patients with obstructive sleep apnea and normal glucose tolerance: effects of CPAP therapy
Authors: Kimimasa Saito
Yosuke Okada
Keiichi Torimoto
Yoko Takamatsu
Yoshiya Tanaka
Publication date: 11-08-2021
Publisher: Springer International Publishing
Keywords: Sleep Apnea
Polysomnography
Hypoglycemia
Published in: Sleep and Breathing / Issue 2/2022
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02442-9

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Blood glucose dynamics during sleep in patients with obstructive sleep apnea and normal glucose tolerance: effects of CPAP therapy

Abstract

Purpose

Methods

Results

Conclusions

Clinical trial registration

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Clinical trial registration

Please log in to get access to this content

Other articles of this Issue 2/2022

Lower 24-h urinary potassium excretion is negatively associated with excessive daytime sleepiness in the general population

Automatic sleep staging by cardiorespiratory signals: a systematic review

Comments on “Increase in the circulating levels of malondialdehyde in patients with obstructive sleep apnea: a systematic review and meta-analysis”

Gender-related sleep duration perception in a Brazilian sleep clinic cohort

Risk factors for non-positional obstructive sleep apnea–hypopnea syndrome

Breathing irregularities before sleep onset on polysomnography in patients with heart diseases

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page