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Diabetes  Sleep Apnoea Sleeping Beauty or the Beast? – The Metabolic Syndrome from an Obstructive Sleep Apnoea Perspective Lise Tarnow, 1 Brigitte Klinkenbijl 2 and Holger Woehrle 3 1. Professor Chief Physician, Clinical Research Unit, Steno Diabetes Center, Copenhagen; 2. Market Development Manager Diabetes and Sleep Apnoea Europe, ResMed, Basel; 3. Medical Director Europe, ResMed Science Center and Consultant, Sleep and Ventilation Center Blaubeuren and Lung Center, Ulm Abstract Obstructive sleep apnoea (OSA) is a significant health concern. Patients with cardiovascular disease as well as patients with diabetes have a high prevalence of OSA, and the prevalence of coronary heart disease, heart failure, stroke and diabetes is increased in patients with OSA. Physiological responses to OSA include sympathetic activation, neurohumoral changes and inflammation, all of which are precursors for cardiovascular disease and diabetes. International guidelines are starting to recognise the importance of OSA for patients with cardiovascular conditions such as heart failure and hypertension. Diagnosis is important, and home-based sleep testing devices can facilitate this process. Treating OSA with continuous positive airway pressure (CPAP) has been shown to reduce blood pressure in patients with hypertension, but more research is needed to determine which components of the metabolic syndrome respond best to the addition of CPAP therapy. Keywords Obstructive sleep apnoea (OSA), sleep-disordered breathing (SDB), the metabolic syndrome, diabetes, cardiovascular disease, heart failure, hypertension, coronary artery disease, obesity, continuous positive airway pressure (CPAP), screening Disclosure: The authors have no conflicts of interest to declare. Acknowledgements: Nicola Ryan provided English language and medical writing support funded by ResMed. Received: 7 January 2013 Accepted: 30 January 2013 Citation: European Endocrinology, 2013;9(1):12–7 Correspondence: Lise Tarnow, Steno Diabetes Center A/S, Niels Steensens Vej 2, DK-2820 Gentofte, Denmark. E: ltar@steno.dk Support: The publication of this article was funded by ResMed. The views and opinions expressed are those of the authors and not necessarily those of ResMed. Introduction The first major epidemiological study reporting the prevalence of obstructive sleep apnoea syndrome (OSAS), which is the presence of OSA in combination with excessive sleepiness, was published by Young et al. in 1993. 1 OSA was documented in 2 % of middle-aged women and 4 % of middle-aged men. Later studies showed that OSA was even more common in the general population, with an overall prevalence of more than 20 % in men and 10 % in women, half of whom have moderate to severe sleep-disordered breathing (SDB). 2 In 2000, four studies were published that demonstrated associations between OSA and hypertension. 3–6 These were the first well-designed analyses conducted in large patient populations that showed the significant negative health effects of OSA. Since then, evidence for connections between OSA and numerous comorbidities has continued to grow. Interestingly, the presence of SDB in other cardiovascular diseases (CVDs) was found to be even higher than that in the general population for those aged 30–80 years. 7 The medical consequences of OSA are currently attributed to complex interactions between five factors – disturbed sleep, intrathoracic pressure swings, intermittent hypoxia, sympathetic activation and the mechanical consequences of snoring, resulting in a range of symptoms (see Figure 1). Much research has been carried out in OSA in relation to car accidents, and road, rail and air transport. It is well documented that timely and effective OSA treatment reduces motor vehicle crash risk. 8 For this, 12 and a wide variety of other reasons, sleep apnoea is widely considered to be a serious public health concern. 9 In the last decade, treatment for OSA began to be considered to have potential beneficial cardiovascular effects, in addition to relief of daytime sleepiness. Research shows an increased prevalence of coronary heart disease, heart failure, stroke and diabetes in patients with an apnoea–hypopnoea index (AHI) of five or more per hour. 10–14 Weight loss, upper airway surgery and, in severe cases, tracheotomy were the only available treatments for OSA until the 1980s. Collin Sullivan and his team invented continuous positive airway pressure (CPAP) as a noninvasive treatment approach. Since then, numerous studies have documented the positive effects of PAP. Peer-reviewed literature demonstrates that PAP can effectively treat, and avoid further deterioration of, most of the secondary consequences of SDB. 15–21 This has led to clinical acceptance of CPAP treatment as the optimal therapeutic strategy for OSA. Current CPAP devices are simple, straightforward and easy to use with a range of masks, allowing OSA treatment to be customised for each patient. Long-term compliance rates of at least 70 % after five years can be achieved. 22 Age and gender also contribute to adherence with CPAP therapy. 23 In this article, we review associations between OSA and several components of the metabolic syndrome (MetS) and discuss what can be carried out to effectively screen and treat patients, especially those in the high-risk subgroup. Reliable screening studies at all care © To u ch ME dical ME dia 2013