Obstructive Sleep Apnea Dynamically Increases Nocturnal Plasma Free Fatty Acids, Glucose, and Cortisol During Sleep

ContextObstructive sleep apnea (OSA) is associated with diabetes and cardiovascular disease. This association may be related to metabolic changes that transpire during sleep in OSA.ObjectiveTo examine the impact of OSA, elicited by cessation of continuous positive airway pressure (CPAP), on frequent...

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Vydáno v:The journal of clinical endocrinology and metabolism Ročník 102; číslo 9; s. 3172 - 3181
Hlavní autoři: Chopra, Swati, Rathore, Aman, Younas, Haris, Pham, Luu V, Gu, Chenjuan, Beselman, Aleksandra, Kim, Il-Young, Wolfe, Robert R, Perin, Jamie, Polotsky, Vsevolod Y, Jun, Jonathan C
Médium: Journal Article
Jazyk:angličtina
Vydáno: Washington, DC Endocrine Society 01.09.2017
Copyright Oxford University Press
Oxford University Press
Témata:
Adult
Aged
Apnea
Biomarkers - blood
Blood Glucose - analysis
Blood pressure
C-reactive protein
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - prevention & control
Cholesterol
Circadian Rhythm
Clinical s
Continuous positive airway pressure
Continuous Positive Airway Pressure - methods
Cortisol
Cross-Over Studies
Diabetes
Diabetes mellitus
Fatty acids
Fatty Acids, Nonesterified - blood
Female
Follow-Up Studies
Glucose
Glucose tolerance
Heart rate
Hormones
Humans
Hydrocortisone - blood
Hypoxemia
Insulin
Lactic acid
Male
Mechanical ventilation
Metabolic rate
Metabolism
Middle Aged
Oxygen Consumption - physiology
Polysomnography
Predictive Value of Tests
Reference Values
Respiratory tract
Respiratory tract diseases
Risk Assessment
Severity of Illness Index
Sleep
Sleep - physiology
Sleep apnea
Sleep Apnea, Obstructive - blood
Sleep Apnea, Obstructive - diagnosis
Sleep Apnea, Obstructive - therapy
Sleep disorders
Treatment Outcome
Triglycerides
Withholding Treatment
ISSN:0021-972X, 1945-7197, 1945-7197
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Shrnutí:ContextObstructive sleep apnea (OSA) is associated with diabetes and cardiovascular disease. This association may be related to metabolic changes that transpire during sleep in OSA.ObjectiveTo examine the impact of OSA, elicited by cessation of continuous positive airway pressure (CPAP), on frequently sampled nocturnal metabolic markers including plasma free fatty acids (FFAs), glucose, insulin, triglycerides (TGs), cortisol, and lactate, as well as glucose production, oral glucose tolerance, blood pressure (BP), endothelial function, cholesterol, and high-sensitivity C-reactive protein (hsCRP).Design and SettingRandomized crossover trial of CPAP vs CPAP withdrawal.PatientsThirty-one patients with moderate to severe OSA acclimated to CPAP.InterventionPatients underwent attended polysomnography while sleeping with therapeutic CPAP, or after CPAP withdrawal, in random order. Venous blood was sampled at ∼20-minute intervals on both nights. In 11 patients, we assessed glucose kinetics with an infusion of 6,6-[2H2]glucose.ResultsCPAP withdrawal caused recurrence of OSA associated with hypoxemia, sleep disruption, and heart rate (HR) elevation. CPAP withdrawal dynamically increased nocturnal FFA (P = 0.007), glucose (P = 0.028), and cortisol (P = 0.037), in proportion to respiratory event frequency, HR elevation, or sleep fragmentation. Diabetes predisposed to glucose elevation. CPAP withdrawal also increased systolic BP (P = 0.017) and augmentation index (P = 0.008), but did not affect insulin, TGs, glucose production, oral glucose tolerance, cholesterol, or hsCRP.ConclusionOSA recurrence during CPAP withdrawal increases FFA and glucose during sleep, associated with sympathetic and adrenocortical activation. Recurring exposure to these metabolic changes may foster diabetes and cardiovascular disease.We studied the overnight metabolic profile of patients during sleep, in the presence or absence of sleep apnea. Sleep apnea caused dynamic elevations of plasma FFA and glucose.
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ISSN:0021-972X
1945-7197
1945-7197
DOI:10.1210/jc.2017-00619