January 21, 2022

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Diabetes patients should pay attention to snoring

Diabetes patients should pay attention to snoring

 

Diabetes patients should pay attention to snoring. Snoring, which is easily overlooked by diabetic patients, should be paid attention to.


Obstructive sleep apnea (OSA) is caused by snoring during sleep, with apneas associated with snoring, and decreased sleep quality. Therefore, there are more sleepiness and lethargy during the day, and neurological symptoms such as inattention and memory Decline, irritability, anxiety or depression, etc.
Almost one-third of everyone’s life is spent in sleep, and sleep-related health problems have also received widespread attention. Among them, insomnia is the most concerned. Today I want to talk about snoring, although snoring is very It is common, but sometimes snoring is caused by obstructive sleep apnea (OSA), which needs attention.

 

What is OSA

Obstructive sleep apnea (OSA) is a type of sleep breathing disease with sleep snoring accompanied by apnea and daytime sleepiness as the main clinical manifestations. The prevalence rate is 2% to 4%, because OSA can cause intermittent hypoxia and hyperoxia. Capnia and sleep structure disorders are therefore related to multi-organ and multi-system damage such as hypertension, coronary heart disease, arrhythmia, cerebrovascular disease, cognitive dysfunction, and type 2 diabetes. What is the relationship between diabetes and OSA?

 

Clinical manifestations of OSA

Obstructive sleep apnea (OSA) is caused by snoring during sleep, with apneas associated with snoring, and decreased sleep quality. Therefore, there are more sleepiness and lethargy during the day, and neurological symptoms such as inattention and memory Decline, irritability, anxiety or depression, etc.

The influence of “snoring” is so wide?

Because of the persistence of hypoxia and other conditions in patients with OSA, it has adverse effects on multiple systems. The following figure lists the possible range of effects.

1. Endocrine system: It can lead to insulin resistance, abnormal glucose metabolism, and even diabetes; abnormal lipid metabolism; metabolic syndrome.

2. Cardiovascular system: In hypertensive patients, refractory hypertension and abnormal circadian rhythms of blood pressure may occur, which are non-dipper or even reverse dipper; for coronary heart disease patients, nocturnal angina pectoris may occur.

3. Nervous and mental system: Because of hypoxia in the brain, cognitive function can be impaired, and patients will also have emotional disorders.

4. Oral cranio-maxillofacial: Because of snoring, the patient’s facial appearance may be changed. Adult OSA is more common with long face, enlarged mandibular angle, mandibular retraction, posterior inferior position of the hyoid bone, long and thick tongue and soft palate.

5. Otolaryngology: can cause hearing loss; rhinitis, pharyngitis and OSA may be causal to each other.

 

OSA and type 2 diabetes

Enhance insulin resistance: Compared with healthy people, OSA patients are more likely to develop hyperglycemia, insulin resistance and type 2 diabetes. The decrease in oxygen saturation during sleep is related to fasting blood glucose and blood glucose 2 hours after OGTT, which means that insulin resistance is positively related to the severity of OSA. More importantly, for non-obese people, the correlation between the two is the same.

Affect blood sugar control: OSA causes hypoxemia not only to lead to insulin resistance, but also to affect the synthesis of pancreatic β cells and intracellular ATP, thereby inhibiting insulin secretion. On the other hand, hypoxemia promotes sympathetic nerve excitement, can lead to increased blood sugar, and impaired glucose tolerance by increasing liver glycogenolysis and gluconeogenesis. Moreover, due to sleep disorders in patients with OSAS, daytime sleepiness is caused, which will prolong total sleep time, reduce activity and energy expenditure, increase body weight and fat deposits, and increase ectopic fat deposits and obesity symptoms, which will further increase the incidence of insulin resistance and high blood sugar. .

Therefore, although OSA seems to be a disease of the respiratory system, it also affects the endocrine system, causing or aggravating obesity and diabetes and other related diseases. A recent Meta analysis also showed that the AHI index (referring to the apnea-hypopnea index, used to assess the severity of OSA) is an independent risk factor for insulin resistance and type 2 diabetes. Based on the binary Meta analysis of 16 cohort studies, the aggregate relative risk of OSA combined with type 2 diabetes is 1.4 (95% CI, 1.32-1.48). With AHI as the parameter, the relative risk of more than 5 apneas per hour The risk was 1.08 (95% CI, 1.01-1.14), and OSA was positively linearly correlated with the risk of type 2 diabetes.

 

What to do with diabetes and sleep apnea?

OSA is a serious hazard to our health. On the occasion of World Sleep Day, we appeal to everyone to pay attention to this disease. What should be done if diabetic patients merge with OSA?

Weight loss: First of all, obesity and sleep apnea affect each other. It is very important to control weight through exercise and diet adjustment. The relatively light OSA can be relieved under the intervention of lifestyle.

Changing sleep position: Many OSAs are position-dependent, and are most likely to occur in the supine position. Therefore, we should try to sleep on the side to reduce the time of supine sleep.

Continuous Positive Airway Pressure (CPAP): Non-invasive auxiliary ventilation devices commonly used clinically improve the ventilation of OSA patients. These devices include ordinary fixed pressure CPAP, intelligent CPAP ventilation and bi-level positive airway pressure (BiPAP) ventilation. CPAP is the most commonly used. If carbon dioxide retention is significant, BiPAP is recommended.

A prospective study showed that CPAP therapy can significantly improve insulin resistance in patients with type 2 diabetes, significantly reduce fasting and postprandial blood sugar, and reduce glycosylated hemoglobin, especially for patients with initial glycosylated hemoglobin> 9%.

 

(source:internet, reference only)


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