Abstract
Introduction: Many studies on the impact of type 2 diabetes mellitus (T2DM) on sleep breathing have shown a higher prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) in those with T2DM. Moreover, an increased activity of the sympathetic nervous system has been described in both pathologies. This cross-sectional study aimed to assess sympathetic activity in patients with T2DM, and to investigate the relationship between sympathetic activity and polysomnographic parameters.Materials and Methods: Thirty-six patients with T2DM without known clinical macrovascular nor pulmonary disease and 11 controls underwent respiratory polygraphy, and their cardiac variability and 24-h urine total metanephrines were measured.Results: SAHS was highly prevalent with a mean apnea-hypopnea index (AHI) in the range of moderate SAHS. In patients with T2DM, the nocturnal concentration of total metanephrines in urine were higher than diurnal levels [247.0 (120.0–1375.0) vs. 210.0 (92.0–670.0), p = 0.039]. The nocturnal total metanephrine concentration was positively and significantly associatedwith the percentage of sleeping time spent with oxygen saturation <90%(CT90). In the entire population and in subjects with T2DM, the multivariate regression analysis showed a direct interaction between the nocturnal concentration of urine metanephrines and the CT90.Conclusion: These findings suggest that the increase in sympathetic activity previously described in patients with T2DM could be mediated through nocturnal breathing disturbances. The diagnosis and treatment of SAHS may influence sympathetic activity disorders and may contribute to an improvement in T2DM and cardiovascular risk.
Highlights
Many studies on the impact of type 2 diabetes mellitus (T2DM) on sleep breathing have shown a higher prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) in those with T2DM
Since the origin of sympathetic hyperactivation in patients with T2DM is not precisely known, we propose to analyse the relation between the presence of breathing disorders that characterize their sleep with data related with sympathetic activity
The main findings in this study were that a subgroup of patients with T2DM exhibited an increase in urine metanephrines at night associated with nocturnal hypoxia and with a decrease in serum glucagon concentrations, for the parasympathetic tone
Summary
Many studies on the impact of type 2 diabetes mellitus (T2DM) on sleep breathing have shown a higher prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) in those with T2DM. A wealth of clinical and cross-sectional studies showed a higher prevalence of sleep apnoea-hypopnea syndrome (SAHS) in patients with type 2 diabetes (T2DM). Changes in sleep architecture are associated with increased sympathetic activity, leading to endothelial dysfunction and decreased nitric oxide concentration [21,22,23]. In this way, episodes of nocturnal hypoxia activate the sympathetic system, promoting alterations in cardiac variability and probably endothelial damage, which contributes to increased cardiovascular risk [24,25,26,27]. Even genetic polymorphisms have been identified the sympathetic nervous system of humans and animals and seem to contribute to the development of obesity and T2DM in certain populations [31,32,33]
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