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European Endocrinology Highlights Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes Abd A Tahrani Centre of Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UK; Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK Abstract Obstructive sleep apnoea (OSA) is common and is associated with many vascular risk factors, such as hypertension, insulin resistance, albuminuria, dyslipidaemia, increased inflammation and endothelial dysfunction. Epidemiological studies have shown that OSA is associated with increased cardiovascular disease (CVD) and that continuous positive airway pressure (CPAP) might reduce CVD events in patients with OSA. In addition, OSA has also been shown to be associated with albuminuria, chronic kidney disease, a wide range of ocular diseases and peripheral neuropathy. Considering that CVD and microvascular complications are major contributors to the morbidity, mortality and the economic burden of diabetes and that OSA is common in patients with type 2 diabetes (T2D), it is important to understand the role of OSA in the development and/or progression of vascular disease in patients with T2D and to explore the impact of CPAP on diabetes-related vascular outcomes. The purpose of this article is to review the evidence for the relationship and impact of OSA on vascular disease and vascular risk factors particularly in patients with T2D. Keywords Type 2 diabetes, obstructive sleep apnoea, vascular disease, vascular risk Disclosure: Abd A Tahrani is a clinician scientist supported by the National Institute for Health Research (NIHR) in the UK. The views expressed in this publication are those of the author and not necessarily those of the National Health Service, the NIHR or the Department of Health. No funding was received for the publication of this article. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 1 July 2015 Accepted: 10 July 2015 Citation: European Endocrinology, 2015;11(2):81–9 Correspondence: Abd A Tahrani, Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK. E: Abd.Tahrani@nhs.net Diabetes-related macro- and microvascular complications contribute significantly to the increased morbidity, mortality, worsened quality of life and social and financial burden observed in patients with diabetes. 1–5 Hence, reducing the development and/or the progression of these complications is one of the main aims of treatment in patients with diabetes. Over the last 2 decades, strategies resulting in the improvements of glycaemic control, blood pressure (BP) and lipids and the use of renin angiotensin aldosterone inhibitors, resulted in reductions in cardiovascular disease (CVD) in patients with diabetes, but there was little impact on diabetic microvascular complications. 6 Nonetheless, both CVD and microvascular complications remain common and a better understanding of the pathogenesis of these complications is needed in order to identify new treatment strategies. Obstructive sleep apnoea (OSA) is common in patients with type 2 diabetes (T2D) (up to 86 % prevalence), which is not surprising considering that increasing age and obesity are common risk factors to both conditions. 7,8 OSA is characterised by upper airway instability during sleep that results in recurrent upper airway obstruction resulting in either complete or partial cessation of airflow (i.e. apnoea and hypopnoea, respectively). 9 The 110 recurrent obstructions of the upper airway usually result in recurrent oxygen desaturations/re-saturations, cyclical changes in intrathoracic pressure (as the patient attempts to breath against a blocked airway) and recurrent micro arousals that cause sleep fragmentation and reduction in slow wave and rapid eye movement (REM) sleep and result in termination of the apnoea/ hypopnoea episodes. 9 Several large epidemiological studies and randomised controlled trials (RCTs) have shown that OSA was associated with CVD and CVD risk factors in general populations, while the impact of OSA on vascular disease in patients with T2D has only gained attention in the last few years. 7,10,11 In this article the evidence of the relationship and impact of OSA on vascular disease and CVD risk factors will be reviewed, particularly in patients with T2D. Obstructive Sleep Apnoea and Vascular Risk Factors Obstructive Sleep Apnoea and Hypertension Several cross-sectional, prospective and interventional studies showed that OSA was associated with sustained hypertension, lack of the nocturnal dipping of BP and incident hypertension and that OSA treatment lowered BP. Most of these studies were not in patients with T2D, but the limited TOUCH ME D ICA L ME D IA