OSA and DIABETES MELLITUS Richard S. Goodstein DO, FCCP Haggin - - PowerPoint PPT Presentation

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OSA and DIABETES MELLITUS Richard S. Goodstein DO, FCCP Haggin - - PowerPoint PPT Presentation

Apr 03, 2023 403 likes •825 views

OSA and DIABETES MELLITUS Richard S. Goodstein DO, FCCP Haggin Pulmonary & Sleep Medicine OSA is independently associated with Insulin Resistance AJRCCM : 2002 ; 165.670 Mary Ip et al ADIPOCYTES New Understanding of Adipocytes

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OSA and DIABETES MELLITUS

Richard S. Goodstein DO, FCCP Haggin Pulmonary & Sleep Medicine

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“ OSA is independently associated with Insulin Resistance”

AJRCCM : 2002 ; 165.670 Mary Ip et al

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ADIPOCYTES

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New Understanding of Adipocytes

  • Adipokines
  • Regulatory role in Insulin

sensitivity/ resistance

  • Regulatory role in systemic

inflammatory process

  • Immunologically active
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Changing concept of an inert adipocyte to that of an active participant in metabolism is key to our discussion !

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ADIPOKINES

  • Leptin…pro-inflammatory
  • Adiponectin…anti-

inflammatory

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LEPTIN

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ADIPOCYTES

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OBESITY IS PRO-INFLAMMATORY

STIMULATES LEPTIN STIMULATES TGF- beta INCREASES TNF/ IL-6 REDUCES Ob- R OBESITY

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Obesity as Pro-Inflammatory State

  • In obesity as adipocytes hypertrophy
  • Increase in “ activated (Th-1) “

macrophages

  • Increase in pro-inflammatory cytokines
  • Increase FFA
  • DM II / Fatty Liver/ Asthma / MetS
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OBESITY IS SELF-PERPETUATING

OBESITY REDUCES Ob-R INCREASES INSULIN

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INSULIN RESISTANCE

INHIBITS GH REDUCES IGF-1 INSULIN RESISTANCE OBESITY

FURTHER INHIBITED BY OSA

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ROLE OF INSULIN RESISTANCE

Insulin Resistance Increased TG + FFA Pro-inflammatory

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INSULIN AND OBESITY

Pro- inflammatory Insulin Insensitivity

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INSULIN SENSITIVITY FBS/ INSULIN DOSE

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Metabolic Syndrome (MetS)

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Metabolic Syndrome

  • Central Obesity
  • Insulin Resistance
  • Lipid Abnormalities
  • Hypertension
  • OSA
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MetS : The Usual Suspects

  • Insulin Growth

Factor-1

  • GHRH-GH-

Somatostatin

  • Leptin
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INSULIN GROWTH FACTOR -1

  • Protein hormone
  • Similar to Insulin
  • Helps cell growth
  • Inhibits apotosis
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IGF-1 DEFICENCY

  • Decreased peripheral utilization of

glucose

  • Increased Insulin resistance
  • Increased hepatic gluconeogenesis
  • Increased adipose uptake
  • Central adiposity
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Human Growth Hormone (HGH)

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Leptin

  • Increased adiposity
  • Down regulates T regulator cells (Treg)
  • Increases Th-1 pro-inflammatory state
  • Increases Reactive Oxygen Species

(ROS)

  • Increases TGF-beta which increases ASM

and BHR . Increases Vascular SM and PAH.

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ALTERED GENOMICS and DIABETES

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TELOMERES

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TELOMERES

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TELOMERES and OSA

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Uh..OK so what does this have to do with Sleep Apnea ?

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OBESITY and OSA

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AUTONOMIC NEUROPATHY IN DM

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ALTERED GENOMICS and DIABETES

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INDUCIBLE CELL DEATH (APOTOSIS)

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OSA INHIBITS GH

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OSA and IR

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TREATMENT MAKES A DIFFERENCE

IS CPAP AN ADJUNCT THERAPY IN IDDM ??

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CPAP in DM

  • Increases IGF-1
  • Increases GH
  • Reduces Ghrelin
  • Reduces Leptin
  • Normalizes Circadian Counter-

regulatory hormones

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THUS ….?????

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Adipose Deposition and Metabolic Syndrome

Increased risk

  • f Met

Syndrome and Asthma

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HOMEOSTATIC METABOLIC ASESSMENT (HOMA)

  • AHI>5.
  • Low SpO2
  • CT90 (Time in which SpO2 < 90%)

THESE MARKERS WERE INDEPENDENT OF BMI AGE , GENDER , SMOKING AND ETOH CONSUMPTION.

Theorell-Haglow et al. Eur Respir J. 2008:31;1054-1060.

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GLUCOSE INTOLERANCE

  • Total Sleep Time < 7-8 hours
  • Sleep fragmentation
  • Decreased or absence of REM Sleep
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I’M DONE !!