Abstract
Background: The global pandemic of metabolic disease is worsening. The metabolic theory of obesity proposes that hormonal changes, especially hyperinsulinaemia, precede metabolic disease development. Although quality sleep is recognised as a key factor for good health, less is known about disrupted sleep as a risk factor for hyperinsulinaemia. Aim: To explore the relationship between sleep, especially sleep architecture and the nasal cycle, on insulin secretion in obstructive sleep apnoea (OSA) with comorbid metabolic disease. This review includes a discussion of the potential role of Rest-Activity-Cycler positive airway pressure (RACer-PAP), a novel non-pharmacological OSA treatment strategy. Methods: A narrative review of all the relevant papers known to the authors was conducted. This review also included results from a polysomnographic sleep clinic pilot study (n = 3) comparing sleep efficiency of RACer-PAP to nasal continuous positive airways pressure (n-CPAP) in OSA patients. Results: Metabolic disease is strongly associated with disturbed sleep. Sleep architecture influences cerebral hormonal secretion, lateral shifts in the autonomic nervous system and nasal airflow dominance. Disturbed sleep shortens short-wave sleep periods, decreasing insulin sensitivity and glucose tolerance. Improvements to metabolic function during n-CPAP treatment are inconsistent. If RACer-PAP demonstrates superior effects on sleep architecture and autonomic function, it may offer advantages in OSA patients with comorbid metabolic disease. Conclusion: Improving sleep architecture by maintaining the nasal cycle proposes a novel non-pharmacological treatment paradigm for treating OSA with comorbid metabolic disease. Research is required to demonstrate if RACer-PAP therapy influences whole night sleep architecture, sympathovagal balance and markers of metabolic disease.
Highlights
The pandemic of metabolic disease, especially type 2 diabetes, cardiovascular disease, cancers, morbid obesity and dementias, is a global public health crisis carrying a significant economic burden
The metabolic theory of obesity[1] suggests that hormonal changes within the body preferentially partition circulating metabolic fuels into adipose tissues, increasing hunger and decreasing energy expenditure, prior to the development of obesity. This metabolic theory of obesity is strengthened by the recognition of impaired insulin homeostasis and hyperinsulinaemia being a recognised risk factor for metabolic disease.[2]
The literature was reviewed under the broad headings of noncommunicable disease, insulin and metabolic disease, type 2 diabetes, sleep staging and architecture, and the effect of sleep deprivation, targeting full-test English language studies
Summary
The pandemic of metabolic disease, especially type 2 diabetes, cardiovascular disease, cancers, morbid obesity and dementias, is a global public health crisis carrying a significant economic burden. The metabolic theory of obesity[1] suggests that hormonal changes within the body preferentially partition circulating metabolic fuels into adipose tissues, increasing hunger and decreasing energy expenditure, prior to the development of obesity. This metabolic theory of obesity is strengthened by the recognition of impaired insulin homeostasis and hyperinsulinaemia being a recognised risk factor for metabolic disease.[2] Emerging research suggests that hyperinsulinaemia precedes the development of both obesity and insulin resistance.[1,3,4] understanding the causes, and management, of hyperinsulinaemia may elicit novel ways of managing metabolic disease. Quality sleep is recognised as a key factor for good health, less is known about disrupted sleep as a risk factor for hyperinsulinaemia
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