Elsevier

Diabetes & Metabolism

Volume 34, Issue 5, November 2008, Pages 447-454
Diabetes & Metabolism

Review
The metabolic syndrome, diabetes and lung dysfunctionSyndrome métabolique, diabète et dysfonction pulmonaire

https://doi.org/10.1016/j.diabet.2008.08.001Get rights and content

Abstract

Sleep-disordered breathing and sleep apnoea are conditions frequently associated with comorbidity, including obesity, diabetes, hypertension, insulin resistance (metabolic syndrome) and cardiovascular disease. The diabetic state (type 1 and type 2 diabetes) may be associated to diminished lung function and, in particular, decreased vital capacity, and the association between chronic obstructive pulmonary disease (COPD) and type 2 diabetes may be due to a shared inflammatory process. Also, the alteration in circulating endothelial progenitor cells found in respiratory disease, the metabolic syndrome and cardiovascular disease reflect a common condition of endothelial dysfunction.

Résumé

Des troubles respiratoires et des apnées du sommeil font partie d’un ensemble syndromique qui comprend obésité, diabète, hypertension, insulinorésistance (syndrome métabolique) et maladies cardiovasculaires. Le diabète, qu’il soit de type 1 ou de type 2, peut être associé à des altérations des fonctions respiratoires et notamment à une réduction de la capacité vitale. L’association entre bronchopneumopathie chronique obstructive (BPCO) et diabète pourrait être expliquée par un procès inflammatoire commun. L’altération des cellules endothéliales progénitrices mise en évidence au cours des affections respiratoires, du syndrome métabolique et des maladies cardiovasculaires pourrait avoir comme commun dénominateur une dysfonction endothéliale.

Section snippets

Abbreviations

    OSA

    obstructive sleep apnoea

    CRP

    C-reactive protein

    IL-6

    interleukin-6

    TNF-α

    tumor necrosis factor-alpha

    CPAP

    continuous positive airway pressure

    AHI

    apnoea/hypopnoea index

    ICAM-1

    intracellular adhesion molecule-1

    FVC

    forced vital capacity

    FEV

    forced expiratory flow

    ARIC

    atherosclerosis risk in communities

    NF-kB

    nuclear factor-kB

    IGT

    impaired glucose tolerance

    COPD

    chronic obstructive pulmonary disease

    SDB

    sleep-disordered breathing

    ER

    endoplasmic reticulum

    EPC

    endothelial progenitor cells

    MetSyn

    metabolic syndrome

    PAH

    pulmonary

The metabolic syndrome and sleep apnoea

OSA is a prevalent disorder particularly among middle-aged, obese men, although its presence in women as well as in lean individuals is being increasingly recognized. Indeed, 17–24% of adult men and 5–9% of women demonstrate an AHI of more than five events per hour, the originally proposed criteria for sleep apnoea [10]. A large majority of adult sleep apnoea sufferers present with many of the features of MetSyn. There is, in fact, a strong association between OSA and obesity, particularly the

Lung dysfunction and diabetes

Diabetes may be either a cause or a consequence of SDB, or it may be both. The diabetic status is associated with periodic breathing, a respiratory disorder induced by abnormal central respiratory control [33]. Among the participants of the Sleep Heart Health Study [32], the prevalence of periodic breathing was 5.4% and 2.5% in diabetics and in non-diabetics, respectively, with an odds ratio of 2.23. However, as type 2 diabetes is also associated with obesity, this may have an effect on the

Circulating progenitor cell alterations in metabolic and pulmonary diseases

One of the most exciting and recent advances in the knowledge of chronic disease pathogenesis is the recognition that bone marrow-derived progenitor cells have the ability to repopulate different tissues in addition to the haematopoietic lineages. Once these cells have reached the bloodstream, they are involved in repair and regeneration of the myocardium, endothelium, smooth and skeletal muscles, epithelium, bone and cartilage. Disturbance in one or more of these progenitor cell lineages may

Conclusion

SDB is a prevalent condition associated with significant comorbidity such as obesity, diabetes, hypertension, insulin resistance and cardiovascular disease. It has been seen that the severity of insulin resistance is correlated to the degree of SDB. Data from the literature support a two-way, pernicious association between sleep apnoea and insulin resistance. Visceral obesity and its consequential insulin resistance may, indeed, be the principal culprit leading to sleep apnoea which, in turn,

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