The molecular mechanisms linking obstructive sleep apnea (OSA) with type 2 diabetes mellitus (T2DM) remain unclear. This study investigated the effect of OSA on skeletal muscle lipid oxidation in nondiabetic controls and in type 2 diabetes (T2DM) patients. Forty-four participants matched for age and adiposity were enrolled: nondiabetic controls (control, n = 14), nondiabetic patients with severe OSA (OSA, n = 9), T2DM patients with no OSA (T2DM, n = 10), and T2DM patients with severe OSA (T2DM + OSA, n = 11). A skeletal muscle biopsy was performed; gene and protein expressions were determined and lipid oxidation was analyzed. An intravenous glucose tolerance test was performed to investigate glucose homeostasis. No differences in lipid oxidation (178.2 ± 57.1, 161.7 ± 22.4, 169.3 ± 50.9, and 140.0 ± 24.1 pmol/min/mg for control, OSA, T2DM, and T2DM+OSA, respectively; p > 0.05) or gene and protein expressions were observed between the groups. The disposition index, acute insulin response to glucose, insulin resistance, plasma insulin, glucose, and HBA1C progressively worsened in the following order: control, OSA, T2DM, and T2DM + OSA (p for trend <0.05). No association was observed between the muscle lipid oxidation and the glucose metabolism variables. We conclude that severe OSA is not associated with reduced muscle lipid oxidation and that metabolic derangements in OSA are not mediated through impaired muscle lipid oxidation.
- MeSH
- diabetes mellitus 2. typu * komplikace metabolismus MeSH
- glukosa metabolismus MeSH
- inzulinová rezistence * MeSH
- inzuliny * MeSH
- lidé MeSH
- lipidy MeSH
- obstrukční spánková apnoe * metabolismus MeSH
- polysomnografie MeSH
- svaly metabolismus MeSH
- zdraví dobrovolníci pro lékařské studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Obstructive sleep apnoea (OSA) is associated with type 2 diabetes mellitus (T2DM). However, mechanisms mediating association between these two conditions remain unclear. This study investigated, whether the OSA-associated changes in adipose tissue lipolysis might contribute to impaired glucose homeostasis in patient with T2DM. Thirty-five matched subjects were recruited into three groups: T2DM + severe OSA (T2DM + OSA, n = 11), T2DM with mild/no OSA (T2DM, n = 10) and healthy controls (n = 14). Subcutaneous abdominal adipose tissue microdialysis assessed spontaneous, epinephrine- and isoprenaline-stimulated lipolysis. Glucose metabolism was assessed by intravenous glucose tolerance test. Spontaneous lipolysis was higher in the T2DM + OSA compared with the T2DM (60.34 ± 23.40 vs. 42.53 ± 10.16 μmol/L, p = 0.013), as well as epinephrine-stimulated lipolysis (236.84 ± 103.90 vs. 167.39 ± 52.17 µmol/L, p < 0.001). Isoprenaline-stimulated lipolysis was unaffected by the presence of OSA (p = 0.750). The α2 anti-lipolytic effect was decreased in T2DM + OSA by 59% and 315% compared with T2DM and controls (p = 0.045 and p = 0.007, respectively). The severity of OSA (AHI) was positively associated with spontaneous (p = 0.037) and epinephrine-stimulated (p = 0.026) lipolysis. The α2-adrenergic anti-lipolytic effect (p = 0.043) decreased with increasing AHI. Spontaneous lipolysis was positively associated with Insulin resistance (r = 0.50, p = 0.002). Epinephrine-stimulated lipolysis was negatively associated with the Disposition index (r = - 0.34, p = 0.048). AHI was positively associated with Insulin resistance (p = 0.017) and negatively with the Disposition index (p = 0.038). Severe OSA in patients with T2DM increased adipose tissue lipolysis, probably due to inhibition of the α2-adrenergic anti-lipolytic effect. We suggest that dysregulated lipolysis might contribute to OSA-associated impairments in insulin secretion and sensitivity.
- MeSH
- adrenalin aplikace a dávkování MeSH
- diabetes mellitus 2. typu komplikace epidemiologie metabolismus patologie MeSH
- glukosa metabolismus MeSH
- homeostáza fyziologie MeSH
- inzulin metabolismus MeSH
- inzulinová rezistence fyziologie MeSH
- isoprenalin aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- lipolýza účinky léků genetika MeSH
- obstrukční spánková apnoe komplikace epidemiologie metabolismus patologie MeSH
- senioři MeSH
- tuková tkáň účinky léků metabolismus MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Epidemiologické studie ukazují, že jak abnormální doba spánku, tak také jedna z nejčastějších poruch spánku – obstrukční spánková apnoe (OSA) jsou nezávisle asociovány se zvýšeným rizikem rozvoje metabolických onemocnění – především obezity a diabetu mellitu 2. typu (T2DM). OSA je i nezávislým rizikovým faktorem kardiovaskulární mortality, nejčastější příčiny smrti pacientů s T2DM. Vzhledem k vysoké prevalenci OSA u pacientů s T2DM je proto vhodné provádět v této populaci screening OSA. K němu jsou doporučovány dotazníky a domácí monitorování dýchání ve spánku, diagnóza OSA se poté verifikuje polygrafickým či polysomnografickým vyšetřením. V terapii střední a těžké OSA je metodou první volby léčba přetlakem v dýchacích cestách (PAP). Svými účinky zabraňuje hypoxii a fragmentaci spánku, eliminuje tím nadměrnou spavost a snižuje riziko rozvoje kardiovaskulárních onemocnění. Studie efektu PAP na kompenzaci diabetu a glukózový metabolismus u pacientů s T2DM zatím nepřinesly jednoznačné výsledky. U prediabetiků prokazují pozitivní efekt léčby PAP jak na inzulinovou rezistenci, tak na glukózovou toleranci. Zlepšení kompenzace již rozvinutého diabetu ovšem prokázáno nebylo. Stejně jako u pacientů s T2DM se i u pacientů s centrální obezitou v léčbě OSA uplatňuje terapie PAP, snížení tíže OSA přinášejí bariatrické operace.
Epidemiologic studies show that both atypical sleep time and obstructive sleep apnea (OSA) are independently associated with higher risk of metabolic disease development, particularly obesity and type 2 diabetes mellitus (T2DM). OSA is an independent risk factor for cardiovascular mortality, which is amongst the most common causes of death in T2DM. It is advisable to screen patients for OSA due to the high prevalence of the disease in T2DM patients. For screening are recommended questionnaires and home sleep monitoring. OSA diagnosis is then verified by home sleep apnea testing (using polygraphy) or by polysomnography. Positive airway pressure (PAP) is a gold standard in the treatment of moderate and severe OSA. PAP prevents hypoxia and sleep fragmentation, eliminating excessive daytime sleepiness and decreasing the risk of cardiovascular diseases. Studies have not yet shown an effect of PAP treatment on T2DM compensation and glucose metabolism. Despite this a positive effect of PAP on insulin resistance and glucose tolerance has been proven in patients with prediabetes. PAP therapy is advised in obese patients of the central type with OSA, bariatric surgery has been proven to decrease the severity of OSA.
- MeSH
- komorbidita MeSH
- lidé MeSH
- metabolické nemoci * metabolismus patofyziologie MeSH
- obstrukční spánková apnoe * diagnóza terapie MeSH
- spánek fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Insomnie patří mezi nejčastější symptomy, se kterými se setkáváme v klinické praxi. Je definována jako nespokojenost s kvalitou nebo kvantitou spánku spojenou s obtížností iniciovat a/nebo udržet spánek a/nebo s časným ranním probouzením provázenými denními symptomy. Kognitivně behaviorální terapie je metodou první volby v léčbě insomnie. Jedná se o multimodální, propracovaný přístup s nejvyšší efektivitou, při léčbě lze však využít i jednotlivé komponenty samostatně. Portfolio hypnotik bylo nedávno rozšířeno o orexinového antagonistu. U hypnotik jsou v poslední době zdůrazňovány některé nežádoucí účinky, jako je rozvoj infekcí nebo otázka jejich role v nádorovém bujení.
Insomnia is highly prevalent. The diagnosis of insomnia is based on subjective complaints of difficulty falling asleep and/or staying asleep, and/or early morning awaking, and/or non-restorative sleep associated with a significant daytime impairment. Cognitive behavioral therapy (CBT) is the first-line treatment for chronic insomnia. CBT has the strongest evidence for efficacy, however single component therapies might be used too. Orexin receptor antagonists are a new class of hypnotic substances. New information appears about risks and side effects of hypnotics, including severe infections and the association with increased cancer.
- Klíčová slova
- zolpidem, zopiklon, melatonin, midazolam, cinolazepam,
- MeSH
- hypnotika a sedativa aplikace a dávkování farmakologie škodlivé účinky MeSH
- infekční nemoci epidemiologie chemicky indukované MeSH
- kognitivně behaviorální terapie metody MeSH
- léková rezistence MeSH
- lidé MeSH
- nádory epidemiologie chemicky indukované patologie MeSH
- pokus o sebevraždu statistika a číselné údaje MeSH
- polysomnografie metody MeSH
- poruchy iniciace a udržování spánku * diagnostické zobrazování farmakoterapie MeSH
- relaxační terapie metody MeSH
- zpráva o sobě MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Obstructive sleep apnea (OSA) is highly prevalent in patients with Type 2 diabetes mellitus representing an additional risk factor for already increased cardiovascular mortality. As cardiovascular diseases are the main cause of death in this population, there is a need to identify patients with moderate to severe OSA indicated for treatment. We aimed to evaluate the performance of the Berlin, STOP, and STOP-Bang screening questionnaires in a population of patients with Type 2 diabetes mellitus. METHODS: 294 consecutive patients with Type 2 diabetes mellitus filled in the questionnaires and underwent overnight home sleep monitoring using a type IV sleep monitor. RESULTS: Severe, moderate, and mild OSA was found in 31 (10%), 61 (21%), and 121 (41%) patients, respectively. The questionnaires showed a similar sensitivity and specificity for AHI ≥ 15: 0.69 and 0.50 for Berlin, 0.65 and 0.49 for STOP, and 0.59 and 0.68 for STOP-Bang. However, the performance of the STOP-Bang questionnaire was different in men vs. women, sensitivity being 0.74 vs. 0.29 (p < 0.05) and specificity 0.56 vs. 0.82 (p < 0.05). CONCLUSIONS: Even the best-performing Berlin questionnaire failed to identify 31% of patients with moderate to severe OSA as being at high risk of OSA, thus preventing them from receiving a correct diagnosis and treatment. Considering that patients with Type 2 diabetes mellitus are at high risk of cardiovascular mortality and also have a high prevalence of moderate to severe OSA, we find screening based on the questionnaires suboptimal and suggest that OSA screening should be performed using home sleep monitoring devices.
- MeSH
- analýza rozptylu MeSH
- diabetes mellitus 2. typu * komplikace mortalita MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- obstrukční spánková apnoe klasifikace komplikace diagnóza MeSH
- plošný screening metody MeSH
- polysomnografie metody MeSH
- prospektivní studie MeSH
- průzkumy a dotazníky normy MeSH
- rizikové faktory MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- sexuální faktory MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
Narcolepsy with cataplexy is caused by a deficiency in the production of hypocretin/orexin, which regulates sleep and wakefulness, and also influences appetite, neuroendocrine functions and metabolism. In this case-control study, 11 patients with narcolepsy with cataplexy and 11 healthy adults underwent an oral glucose tolerance test, and dexamethasone suppression/corticotropin-releasing hormone stimulation test. The average age of patients and controls was 35.1 ± 13.2 and 41.0 ± 2.9 years, respectively, body mass index was 28.1 ± 6.6 and 25.5 ± 4.7 kg m(-2) . We did not find evidence of a significantly increased prevalence of disturbed glucose tolerance in patients with narcolepsy. After hypothalamo-pituitary-adrenal axis suppression, the number of non-suppressors did not differ between the groups, indicating normal negative feedback sensitivity. The level of cortisol after dexamethasone suppression was significantly lower in patients with narcolepsy, suggesting a slight basal downregulation and/or a slightly increased negative feedback sensitivity of the major endocrine stress system in narcolepsy. Following corticotropin-releasing hormone stimulation, there were no significant differences in levels of adrenocorticotropic hormone or cortisol, and in adrenocortical responsivity to adrenocorticotropic hormone. Finally, patients with narcolepsy displayed significantly higher plasma levels of tumour necrosis factor alpha, soluble tumour necrosis factor receptor p55, soluble tumour necrosis factor receptor p75 and interleukin 6 after adjustment for body mass index. The present study confirms that narcolepsy by itself is not associated with disturbances of glucose metabolism, but goes along with a subtle dysregulation of inflammatory cytokine production. We also found that dynamic hypothalamo-pituitary-adrenal system response is not altered, whereas negative feedback to dexamethasone might be slightly enhanced.
- MeSH
- adrenokortikotropní hormon krev MeSH
- dexamethason farmakologie MeSH
- dospělí MeSH
- glukózový toleranční test MeSH
- hormon uvolňující kortikotropin farmakologie MeSH
- hydrokortison krev MeSH
- index tělesné hmotnosti MeSH
- interleukin-6 metabolismus MeSH
- kataplexie krev komplikace metabolismus MeSH
- krevní glukóza metabolismus MeSH
- lidé MeSH
- narkolepsie krev komplikace metabolismus MeSH
- studie případů a kontrol MeSH
- systém hypofýza - nadledviny účinky léků metabolismus MeSH
- systém hypotalamus-hypofýza účinky léků metabolismus MeSH
- TNF-alfa krev MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- benzodiazepiny škodlivé účinky terapeutické užití MeSH
- hypnotika a sedativa terapeutické užití MeSH
- lidé MeSH
- melatonin terapeutické užití MeSH
- neurodegenerativní nemoci MeSH
- obstrukční spánková apnoe patofyziologie terapie MeSH
- periodické pohyby končetinami ve spánku etiologie MeSH
- poruchy iniciace a udržování spánku diagnóza etiologie terapie MeSH
- poruchy spánku a bdění * diagnóza terapie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- spánek fyziologie účinky léků MeSH
- stadia spánku fyziologie účinky léků MeSH
- stárnutí MeSH
- syndrom neklidných nohou patofyziologie terapie MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
Political, economic and cultural transformations in the Czech Republic after 1989 were reflected in a number of demographic indicators, including those that characterize family behaviour. The main features of these changes are declining birth and marriage rates, postponement of first marriage and first birth ages, and a growing proportion of children born outside of marriage. These changes are comparable to those that have taken place in western Europe since the 1960s; however, some of them are abrupt and cause rapid shift in the family structure. Over the last two decades, significant changes have also occurred in the organization of family therapy. Earlier less coordinated activities underwent institutionalization, and guidelines for training and supervision were established. Family therapy in the Czech Republic is covered by a national organization, the Society of Family Therapy (SOFT). Standards of training and supervision correspond to European standards. The problem remains the lack of support for family therapy from state institutions, especially in the health service. There are only a few healthcare facilities providing family therapy for the treatment of psychiatric disorders or chronic somatic diseases. The capacity of these centres is substantially inadequate.
- MeSH
- charakteristiky rodiny MeSH
- lidé MeSH
- manželství psychologie statistika a číselné údaje MeSH
- rodina psychologie MeSH
- rodinná terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
