STUDY OBJECTIVES: Sleep-disordered breathing and diabetes mellitus (DM) are often concomitant; however, data on the impact of sleep-disordered breathing on mortality in the population with diabetes remain scarce. METHODS: The population from the Sleep Heart Health Study, a multicenter prospective observational study representing 5,780 patients with polysomnography and mortality data, including 453 patients with DM, was analyzed to assess the impact of sleep-disordered breathing variables and the presence of DM on all-cause, cardiovascular disease, and noncardiovascular disease associated mortality. Survival analysis and proportional hazard regression models were used to calculate the adjusted hazard ratios (aHRs) for mortality. RESULTS: Patients with DM and the average oxygen saturation > 91.4% had significantly lower all-cause (aHR 0.52, confidence interval [CI] 0.34-0.80) and cardiovascular disease mortality risk (aHR 0.44, CI 0.22-0.87) as compared with patients with oxygen saturation below this value. Apnea-hypopnea index > 31 (aHR 1.58, CI 1.10-2.28) and oxygen desaturation index > 13.3 (aHR 1.58, CI 1.10-2.25) were associated with increased all-cause mortality in participants with DM on treatment. Sleep efficiency and proportion of rapid eye movement sleep did not have any impact on mortality in patients with DM and thus differed significantly from individuals without DM, where increased all-cause mortality was observed in those with sleep efficiency < 81.4% (aHR 0.77, CI 0.68-0.87) or rapid eye movement sleep < 14.9% (aHR 0.78, CI 0.68-0.89). CONCLUSIONS: Patients with diabetes on treatment and moderate to severe sleep-disordered breathing experience increased all-cause mortality. Reduced average oxygen saturation predicted both all-cause and cardiovascular death in the population with diabetes. CITATION: Vichova T, Petras M, Waldauf P, Westlake K, Vimmerova-Lattova Z, Polak J. Sleep-disordered breathing increases mortality in patients with diabetes. J Clin Sleep Med. 2025;21(1):89-99.

• MeSH
• diabetes mellitus * mortalita   epidemiologie   MeSH
• kardiovaskulární nemoci mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• polysomnografie * statistika a číselné údaje   MeSH
• prospektivní studie MeSH
• senioři MeSH
• syndromy spánkové apnoe * mortalita   komplikace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH

Poruchy spánku predstavujú častú komorbiditu u pacientov s cievnou mozgovou príhodou (CMP). Vzájomné vzťahy medzi poruchami spánku a CMP sú komplexné a obojsmerné. Poruchy spánku môžu jednak predstavovať rizikový faktor vzniku CMP, na druhej strane môže lézia centrálneho nervového systému navodiť narušenie spánku. Spánkové poruchy a ich liečba môžu vo výraznej miere modifikovať proces rekonvalescencie pacienta a ovplyvňovať aj riziko recidívy CMP. V nasledujúcom texte približujeme uvedenú problematiku. Pozornosť venujeme nielen detailne preskúmanému spánkovému apnoe, ale objasňujeme aj úlohu porúch hybnosti viazaných na spánok a insomnie. Interakcie CMP s hypersomniami, poruchami cirkadiánnej rytmicity a parasomniami budú musieť detailnejšie odhaliť až budúce prospektívne štúdie.

Sleep disorders represent a common comorbidity in patients with stroke. Their relationships are complex and bidirectional. Sleep disorders can act as a risk factor for the development of stroke. On the other hand, lesions in the central nervous system can lead to sleep disturbances. Sleep disorders and their treatment can significantly modify the recovery process of the patient and also affect the risk of stroke recurrence. In the following text, we present the mentioned topic. We focus not only on the well-studied sleep apnea but also explain the role of sleep-related movement disorders and insomnia. The interactions of stroke with hypersomnias, circadian rhythm disorders, and parasomnias will need to be more thoroughly investigated by future prospective studies.

• MeSH
• cévní mozková příhoda * diagnóza   etiologie   klasifikace   prevence a kontrola   MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• poruchy cirkadiánního rytmu (spánek) diagnóza   klasifikace   komplikace   MeSH
• poruchy iniciace a udržování spánku diagnóza   klasifikace   komplikace   MeSH
• poruchy spánku a bdění * diagnóza   etiologie   klasifikace   komplikace   MeSH
• poruchy spánku z vnitřních příčin diagnóza   klasifikace   komplikace   MeSH
• syndromy spánkové apnoe diagnóza   klasifikace   komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

We recruited 5,970 hypertensive patients with obstructive sleep apnea (OSA) on current antihypertensive treatment from the European Sleep Apnea Database (ESADA) cohort. The group was subdivided into those receiving monotherapy (n = 3,594) and those receiving dual combined therapy (n = 2,376). We studied how major OSA confounders like age, gender, and body mass index as well as the degree of sleep apnea modified office systolic and diastolic blood pressure. Beta-blockers alone or in combination with a diuretic were compared with other antihypertensive drug classes. Monotherapy with beta-blocker was associated with lower systolic blood pressure, particularly in non-obese middle-aged males with hypertension. Conversely, the combination of a beta-blocker and a diuretic was associated with lower systolic and diastolic blood pressure in hypertensive patients with moderate-severe OSA. Systolic blood pressure was better controlled in female patients using this combined treatment. Our cross-sectional data suggest that specific clinical characteristics and type of antihypertensive medication influence the degree of blood pressure control in hypertensive OSA patients. Controlled trials are warranted.

• MeSH
• antihypertenziva terapeutické užití   farmakologie   MeSH
• diuretika farmakologie   terapeutické užití   MeSH
• hypertenze * komplikace   farmakoterapie   MeSH
• individualizovaná medicína MeSH
• krevní tlak MeSH
• lidé středního věku MeSH
• lidé MeSH
• obstrukční spánková apnoe * komplikace   terapie   MeSH
• polysomnografie MeSH
• průřezové studie MeSH
• syndromy spánkové apnoe * komplikace   terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: Blood bicarbonate concentration plays an important role for obstructive sleep apnea (OSA) patients to maintain acid-base balance. We investigated the association between arterial standard bicarbonate ([HCO3-]) and nocturnal hypoxia as well as comorbid hypertension in OSA. METHODS: A cross-sectional analysis of 3329 patients in the European Sleep Apnea Database (ESADA) was performed. Arterial blood gas analysis and lung function test were performed in conjunction with polysomnographic sleep studies. The 4% oxygen desaturation index (ODI), mean and minimum oxygen saturation (SpO2), and percentage of time with SpO2 below 90% (T90%) were used to reflect nocturnal hypoxic burden. Arterial hypertension was defined as a physician diagnosis of hypertension with ongoing antihypertensive medication. Hypertensive patients with SBP/DBP below or above 140/90 mmHg were classified as controlled-, uncontrolled hypertension, respectively. RESULTS: The [HCO3-] level was normal in most patients (average 24.0 ± 2.5 mmol/L). ODI, T90% increased whereas mean and minimum SpO2 decreased across [HCO3-] tertiles (ANOVA, p = 0.030, <0.001, <0.001, and <0.001, respectively). [HCO3-] was independently associated with ODI, mean SpO2, minimum SpO2, and T90% after adjusting for confounders (β value [95%CI]: 1.21 [0.88-1.54], -0.16 [-0.20 to -0.11], -0.51 [-0.64 to -0.37], 1.76 [1.48-2.04], respectively, all p < 0.001). 1 mmol/L elevation of [HCO3-] was associated with a 4% increased odds of uncontrolled hypertension (OR: 1.04 [1.01-1.08], p = 0.013). CONCLUSION: We first demonstrated an independent association between [HCO3-] and nocturnal hypoxic burden as well as uncontrolled hypertension in OSA patients. Bicarbonate levels as an adjunctive measure provide insight into the pathophysiology of hypertension in OSA.

• MeSH
• hydrogenuhličitany MeSH
• hypertenze * epidemiologie   komplikace   MeSH
• hypoxie komplikace   MeSH
• kyslík MeSH
• lidé MeSH
• obstrukční spánková apnoe * MeSH
• průřezové studie MeSH
• syndromy spánkové apnoe * komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• kardiovaskulární nemoci etiologie   prevence a kontrola   MeSH
• lidé MeSH
• obstrukční spánková apnoe * diagnóza   komplikace   patofyziologie   terapie   MeSH
• polysomnografie metody   MeSH
• řízení motorových vozidel MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• syndromy spánkové apnoe diagnóza   komplikace   patofyziologie   MeSH
• ventilace umělá s výdechovým přetlakem metody   MeSH
• Check Tag
• lidé MeSH

• MeSH
• kardiovaskulární nemoci prevence a kontrola   MeSH
• lidé MeSH
• sběr dat statistika a číselné údaje   MeSH
• spánek * imunologie   MeSH
• spánková deprivace komplikace   MeSH
• spánková hygiena MeSH
• syndromy spánkové apnoe komplikace   MeSH
• Check Tag
• lidé MeSH

• MeSH
• dítě MeSH
• hyperurikemie diagnóza   etiologie   terapie   MeSH
• lidé MeSH
• metabolický syndrom * diagnóza   patofyziologie   terapie   MeSH
• mladiství MeSH
• nealkoholová steatóza jater diagnóza   terapie   MeSH
• syndrom polycystických ovarií etiologie   komplikace   patofyziologie   MeSH
• syndromy spánkové apnoe komplikace   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• COVID-19 MeSH
• dostupnost zdravotnických služeb MeSH
• lidé MeSH
• pandemie MeSH
• syndromy spánkové apnoe * epidemiologie   komplikace   MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Česká republika MeSH

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia associated with a two-fold increase in mortality caused by a higher risk of stroke and heart failure. Currently, AF is present in ~ 2 % of the general population, and its incidence and prevalence are increasing. Obesity, hypertension, diabetes mellitus, obstructive sleep apnea, and alcohol consumption increase the risk of AF. Each unit of increase in BMI increases the risk of AF by 3 %, and intensive weight loss is also associated with reduced AF recurrence. Hypertension increases the risk of AF by 50 % in men and by 40 % in women, and explains ~ 20 % of new AF cases. Patients with obstructive sleep apnea are at four times higher risk of developing AF than subjects without sleep apnea. Higher concentrations of pro-inflammatory cytokines, higher amounts of epicardial adipose tissue, and a higher degree of ventricular diffuse myocardial fibrosis are present in AF patients and patients with the aforementioned metabolic disorders. Several prospective cohort studies and randomized trials have been initiated to show whether weight loss and treatment of other risk factors will be associated with a reduction in AF recurrences.

• MeSH
• diabetes mellitus * MeSH
• fibrilace síní * diagnóza   epidemiologie   MeSH
• hypertenze * komplikace   epidemiologie   MeSH
• lidé MeSH
• obezita komplikace   diagnóza   epidemiologie   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• syndromy spánkové apnoe * komplikace   diagnóza   epidemiologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• lidé MeSH
• syndromy spánkové apnoe * diagnóza   epidemiologie   klasifikace   komplikace   terapie   MeSH
• trvalý přetlak v dýchacích cestách metody   přístrojové vybavení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH