叙述性综述:肥胖、2型糖尿病和阻塞性睡眠呼吸暂停——共同的同床共枕

IF 2.4 Q3 ENDOCRINOLOGY & METABOLISM Diabetology Pub Date : 2022-08-08 DOI:10.3390/diabetology3030033
D. Sajkov, Bliegh Mupunga, J. Bowden, Christopher Langton, N. Petrovsky
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引用次数: 0

摘要

阻塞性睡眠呼吸暂停(OSA)和2型糖尿病(T2DM)都是肥胖的主要危险因素。此外,这些疾病有重叠的机制,包括炎症、自主神经系统的激活和缺氧相关的内分泌病。因此,这两种疾病的发病机制可能比以前认识到的更密切相关。这就提出了OSA治疗是否有助于解决肥胖和/或T2DM的问题。在此,我们对文献进行叙述性回顾,以确定阻塞性睡眠呼吸暂停与T2DM控制之间关系的临床和科学数据。我们发现缺乏足够有力、控制良好的临床试验来直接检验因果关系。考虑到超重/肥胖人群中睡眠呼吸障碍的高发性,目前尚不能对所有T2DM患者进行多导睡眠图常规筛查,因此所有T2DM患者至少应该对潜在的阻塞性睡眠呼吸暂停风险进行临床评估,并将其作为常规临床护理的一部分。特别是,筛选问卷可用于识别阻塞性睡眠呼吸暂停风险较高的T2DM受试者,以考虑正式的多导睡眠图研究。由于病态肥胖是T2DM和OSA的共同特征,应考虑将多导睡眠图作为这类高危人群的筛查工具。
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Narrative Review: Obesity, Type 2 DM and Obstructive Sleep Apnoea—Common Bedfellows
Obstructive sleep apnoea (OSA) and type 2 DM mellitus (T2DM) share obesity as a major risk factor. Furthermore, these conditions share overlapping mechanisms including inflammation, activation of the autonomic nervous system, and hypoxia-linked endocrinopathy. Hence, the pathogenesis of the two conditions may be more closely related than previously recognised. This raises the question of whether treatment of OSA might assist resolution of obesity and/or T2DM. Here, we present a narrative review of the literature to identify clinical and scientific data on the relationship between obstructive sleep apnoea and T2DM control. We found there is a paucity of adequately powered well-controlled clinical trials to directly test for a causal association. While routine screening of all T2DM patients with polysomnography cannot currently be justified, given the high prevalence of sleep disordered breathing in the overweight/obese population, all T2DM patients should at a minimum have a clinical assessment of potential obstructive sleep apnoea risk as part of their routine clinical care. In particular, screening questionnaires can be used to identify T2DM subjects at higher risk of OSA for consideration of formal polysomnography studies. Due to morbid obesity being a common feature in both T2DM and OSA, polysomnography should be considered as a screening tool in such high-risk individuals.
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