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Sympathetic Hyperactivity and Sleep Disorders in Individuals With Type 2 Diabetes.

Carolina López-Cano1, Liliana Gutiérrez-Carrasquilla1, Enric Sánchez1

  • 1Endocrinology and Nutrition Department, Institut de Recerca Biomèdica de Lleida (IRBLleida), Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Universitat de Lleida (UdL), Lleida, Spain.

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Summary

Type 2 diabetes patients often have sleep apnea-hypopnea syndrome (SAHS), linked to increased sympathetic activity. Nocturnal breathing issues in T2DM may drive this sympathetic overactivity, suggesting SAHS treatment could improve outcomes.

Keywords:
cardiovascular risksleep apnea-hypopnea syndromesleep breathingsympathetic hyperactivitytype 2 diabetes

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Area of Science:

  • Endocrinology
  • Sleep Medicine
  • Cardiology

Background:

  • Type 2 diabetes mellitus (T2DM) is associated with a higher prevalence and severity of sleep apnea-hypopnea syndrome (SAHS).
  • Both T2DM and SAHS exhibit increased sympathetic nervous system activity.
  • The relationship between sympathetic activity and sleep disturbances in T2DM requires further investigation.

Purpose of the Study:

  • To assess sympathetic nervous system activity in patients with T2DM.
  • To investigate the association between sympathetic activity and polysomnographic parameters in T2DM.
  • To explore the role of nocturnal breathing disturbances in mediating sympathetic activity in T2DM.

Main Methods:

  • Cross-sectional study involving 36 T2DM patients and 11 controls.
  • Respiratory polygraphy, cardiac variability, and 24-hour urine total metanephrine measurements were performed.
  • Multivariate regression analysis was used to examine interactions between variables.

Main Results:

  • SAHS was highly prevalent in the T2DM group, with a mean apnea-hypopnea index (AHI) indicating moderate severity.
  • Nocturnal urinary metanephrine concentrations were significantly higher than diurnal levels in T2DM patients (p=0.039).
  • Nocturnal metanephrine levels positively correlated with the percentage of sleep time with oxygen saturation <90% (CT90), with a significant interaction observed.

Conclusions:

  • Increased sympathetic activity in T2DM may be mediated by nocturnal breathing disturbances, specifically SAHS.
  • Diagnosing and treating SAHS could potentially modulate sympathetic activity.
  • Effective management of SAHS may contribute to improved T2DM control and reduced cardiovascular risk.