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Distinct impacts of sleep-disordered breathing on glycemic variability in patients with and without diabetes mellitus.

Abstract Sleep-disordered breathing (SDB) is highly prevalent in patients with diabetes mellitus (DM) and heart failure (HF) and contributes to poor cardiovascular outcomes. Enlarged glycemic variability (GV) is a risk factor of cardiac events independently of average blood glucose level, but the influence of SDB on GV is uncertain. In this study, we examined whether the impact of SDB on GV is modified by the presence of DM with or without HF.
PMID
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Mayor MeshTerms
Keywords
Journal Title plos one
Publication Year Start




PMID- 29261679
OWN - NLM
STAT- In-Process
LR  - 20171224
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 12
DP  - 2017
TI  - Distinct impacts of sleep-disordered breathing on glycemic variability in
      patients with and without diabetes mellitus.
PG  - e0188689
LID - 10.1371/journal.pone.0188689 [doi]
AB  - BACKGROUND: Sleep-disordered breathing (SDB) is highly prevalent in patients with
      diabetes mellitus (DM) and heart failure (HF) and contributes to poor
      cardiovascular outcomes. Enlarged glycemic variability (GV) is a risk factor of
      cardiac events independently of average blood glucose level, but the influence of
      SDB on GV is uncertain. In this study, we examined whether the impact of SDB on
      GV is modified by the presence of DM with or without HF. METHODS AND RESULTS: Two
      hundred three patients (67.5+/-14.1 [SD] years old, 132 males) who were admitted 
      to our institute for examination or treatment of DM and/or HF underwent
      continuous glucose monitoring and polysomnography. Both HbA1c (8.0+/-2.0 vs.
      5.7+/-0.4%) and mean amplitude of glycemic excursion (MAGE, median: 95.5 vs. 63.5
      mg/dl) were significantly higher in a DM group (n = 100) than in a non-DM group
      (n = 103), but apnea-hypopnea index (AHI: 29.0+/-22.7 vs. 29.3+/-21.5) was
      similar in the two groups. AHI was correlated with log MAGE in the non-DM group
      but not in the DM group, and multivariate regression analysis revealed that AHI
      was an independent variable for log MAGE in the non-DM group but not in the DM
      group. We then divided the non-DM patients into two subgroups according to BNP
      level (100 pg/ml). AHI was positively correlated with log MAGE (r = 0.74,
      p<0.001) in the non-DM low-BNP subgroup, but such a correlation was not found in 
      the non-DM high-BNP subgroup. Continuous positive airway pressure (CPAP) reduced 
      MAGE from 75.3 to 53.0 mg/dl in the non-DM group but did not reduce MAGE in the
      DM group. CONCLUSION: Severity of SDB was associated with higher GV, but DM as
      well as HF diminished the contribution of SDB to GV. Treatment with CPAP was
      effective for reduction of GV only in patients without DM.
FAU - Nakata, Kei
AU  - Nakata K
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
FAU - Miki, Takayuki
AU  - Miki T
AUID- ORCID: http://orcid.org/0000-0002-3104-4925
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
FAU - Tanno, Masaya
AU  - Tanno M
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
FAU - Ohnishi, Hirofumi
AU  - Ohnishi H
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
AD  - Department of Public Health, Sapporo Medical University School of Medicine,
      Sapporo, Japan.
FAU - Yano, Toshiyuki
AU  - Yano T
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
FAU - Muranaka, Atsuko
AU  - Muranaka A
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
FAU - Sato, Tatsuya
AU  - Sato T
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
AD  - Department of Cellular Physiology and Signal Transduction, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
FAU - Oshima, Hiroto
AU  - Oshima H
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
FAU - Tatekoshi, Yuki
AU  - Tatekoshi Y
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
FAU - Mizuno, Masashi
AU  - Mizuno M
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
FAU - Abe, Koki
AU  - Abe K
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
FAU - Miura, Tetsuji
AU  - Miura T
AD  - Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical
      University School of Medicine, Sapporo, Japan.
LA  - eng
PT  - Journal Article
DEP - 20171219
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
PMC - PMC5736206
EDAT- 2017/12/21 06:00
MHDA- 2017/12/21 06:00
CRDT- 2017/12/21 06:00
PHST- 2017/01/12 00:00 [received]
PHST- 2017/11/10 00:00 [accepted]
PHST- 2017/12/21 06:00 [entrez]
PHST- 2017/12/21 06:00 [pubmed]
PHST- 2017/12/21 06:00 [medline]
AID - 10.1371/journal.pone.0188689 [doi]
AID - PONE-D-17-00518 [pii]
PST - epublish
SO  - PLoS One. 2017 Dec 19;12(12):e0188689. doi: 10.1371/journal.pone.0188689.
      eCollection 2017.