+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Sleep apnea is a manifestation of the metabolic syndrome

, : Sleep apnea is a manifestation of the metabolic syndrome. Sleep Medicine Reviews 9(3): 211-224

Obstructive sleep apnea (OSA) is a prevalent disorder particularly among middle-aged, obese men, although its existence in women as well as in lean individuals is increasingly recognized. Despite the early recognition of the strong association between OSA and obesity, and OSA and cardiovascular problems, sleep apnea has been treated as a 'local abnormality' of the respiratory track rather than as a 'systemic illness.' In 1997, we first reported that the pro-inflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNFalpha) were elevated in patients with disorders of excessive daytime sleepiness (EDS) and proposed that these cytokines were mediators of daytime sleepiness. Also, we reported a positive correlation between IL-6 or TNFalpha plasma levels and the body-mass-index (BMI). In subsequent studies, we showed that IL-6, TNFalpha, and insulin levels were elevated in sleep apnea independently of obesity and that visceral fat, was the primary parameter linked with sleep apnea. Furthermore, our findings that women with the polycystic ovary syndrome (PCOS) (a condition associated with hyperandrogenism and insulin resistance) were much more likely than controls to have sleep disordered breathing (SDB) and daytime sleepiness, suggests a pathogenetic role of insulin resistance in OSA. Other findings that support the view that sleep apnea and sleepiness in obese patients may be manifestations of the Metabolic Syndrome, include: obesity without sleep apnea is associated with daytime sleepiness; PCOS and diabetes type 2 are independently associated with EDS after controlling for SDB, obesity, and age; increased prevalence of sleep apnea in post-menopausal women, with hormonal replacement therapy associated with a significantly reduced risk for OSA; lack of effect of continuous positive airway pressure (CPAP) in obese patients with apnea on hypercytokinemia and insulin resistance indices; and that the prevalence of the metabolic syndrome in the US population from the Third National Health and Nutrition Examination Survey (1988-1994) parallels the prevalence of symptomatic sleep apnea in general random samples. Finally, the beneficial effect of a cytokine antagonist on EDS in obese, male apneics and that of exercise on SDB in a general random sample, supports the hypothesis that cytokines and insulin resistance are mediators of EDS and sleep apnea in humans. In conclusion, accumulating evidence provides support to our model of the bi-directional, feed forward, pernicious association between sleep apnea, sleepiness, inflammation, and insulin resistance, all promoting atherosclerosis and cardiovascular disease.


PMID: 15893251

DOI: 10.1016/j.smrv.2005.01.006

Other references

Hanus V.; Vanek J., 1979: Systems of subduction in the South-West Pacific. Pages 35-40 1979

Semerikov, V.L.; Shurkhal, A.V.; Podogas, A.V.; Rakitskaya, T.A., 1991: Protein electrophoretic variability of scotch pine pinus sylvestris l. needles. The results of isozyme analysis protein of Scotch Pine needles are presented. The method of polyacrylamide gel electrophoresis has been applied. The method allowed to determine individual genotypes for 12 polymorphic loci.

Fasten, N., 1922: Fish Parasitism In Its Relation To Biological Problems Of The Northwest. Science 55(1431): 583-584

Pawlinski, R.; Tencati, M.; Hampton, C.R.; Shishido, T.; Bullard, T.A.; Casey, L.M.; Andrade-Gordon, P.; Kotzsch, M.; Spring, D.; Luther, T.; Abe, J-ichi.; Pohlman, T.H.; Verrier, E.D.; Blaxall, B.C.; Mackman, N., 2007: Protease-activated receptor-1 contributes to cardiac remodeling and hypertrophy. Background-Protease- activated receptor- 1 ( PAR- 1) is the high- affinity receptor for the coagulation protease thrombin. It is expressed by a variety of cell types in the heart, including cardiomyocytes and cardiac fibroblasts. We have shown tha...

Ewert John W., 1987: Sulfur in the Frenchman Springs Member of the Wanapum Basalt in Washington and Oregon. Abstracts with Programs - Geological Society of America 19(6): 376

Belman S.; Block E.; Barany G., 1986: Onion and garlic components inhibit soybean lipoxygenase. Proceedings of the American Association for Cancer Research Annual Meeting 27: 140

Hermes, R.; Goeritz, F.; Blottner, S.; Walzer, C.; Goeltenboth, R.; Schwarzenberger, F.; Rudolph, M.; Hildebrandt, TB., 2001: Evaluation of fertility in captive male white rhinoceros (Ceratotherium simum) - semen assessment and preservation. Erkrankungen der Zootiere, 40: 173-176

Massariol, A.A.; Ramiro, Z.A.; Oliveira, D.A., 1978: Evaluation of some insecticides for the control of Plusia oo (Cramer, 1782) on soyabean. In field and laboratory tests in Sao Paulo, Brazil, to evaluate various insecticides for the control of larvae of Pseudoplusia oo (Cram.) (Plusia oo), third-instar larvae were confirmed on soyabean leaves that had been sprayed in the field; mortal...

Schofield, N.; Sugavanam, A.; Henley, M.; Thompson, K.; Riddell, A.; Mallett, S.V., 2016: An in vitro study comparing two dose regimes of fresh frozen plasma on conventional and thromboelastographic tests of coagulation after major hepatic resection. After hepatic resection, post-operative increases in international normalised ratio (INR) are frequent, but rarely associated with bleeding complication. Coagulation as assessed by thrombin generation may be normal, despite the increased INR. This...

Lu, T.; Wang, X.; Yi, D., 2003: The history of Sparganium stoloniferum processing. Through the study on medical literatures about Sparganium stoloniferum processing from Tang Dynasty to Qing Dynasty and Pharmacopoeias of China and the standards of herbal processing practised in defferent localities in China, the author summed th...