Obstructive sleep apnoea and diabetes: An update

Current Opinion in Pulmonary Medicine

Volumn 19, Issue 6, 2013, Pages 631-638

  Tahrani, Abd A ^a,b   Ali, Asad ^c   Stevens, Martin J ^a,b  

^a UNIVERSITY OF BIRMINGHAM   (United Kingdom)

^b UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST   (United Kingdom)

^c UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST   (United Kingdom)

Author keywords

apnoea hypopnoea index; cardiovascular disease; diabetes mellitus; glucose; glycated haemoglobin; insulin resistance; nephropathy; neuropathy; retinopathy; sleep apnoea

Indexed keywords

HEMOGLOBIN A1C;

APNEA HYPOPNEA INDEX; B LYMPHOCYTE; DIABETIC NEPHROPATHY; DIABETIC NEUROPATHY; DIABETIC RETINOPATHY; DISEASE ASSOCIATION; DYSGLYCEMIA; GLUCOSE METABOLISM; HUMAN; HYPOXEMIA; INSULIN RESISTANCE; LIFESTYLE MODIFICATION; LYMPHOCYTE FUNCTION; METABOLIC REGULATION; NON INSULIN DEPENDENT DIABETES MELLITUS; OBESITY; POSITIVE END EXPIRATORY PRESSURE; PREDICTION; PREVALENCE; REM SLEEP; REVIEW; RISK FACTOR; SLEEP DISORDERED BREATHING; WEIGHT REDUCTION;

BLOOD GLUCOSE; CONTINUOUS POSITIVE AIRWAY PRESSURE; DIABETES COMPLICATIONS; DIABETES MELLITUS, TYPE 2; FEMALE; HEMOGLOBIN A, GLYCOSYLATED; HUMANS; INSULIN RESISTANCE; MALE; OBESITY; PROGNOSIS; RISK FACTORS; RISK REDUCTION BEHAVIOR; SLEEP APNEA, OBSTRUCTIVE; SLEEP, REM; TREATMENT OUTCOME;

EID: 84885171916     PISSN: 10705287     EISSN: 15316971     Source Type: Journal    
DOI: 10.1097/MCP.0b013e3283659da5     Document Type: Review

References (127)

1. International Diabetes Federation. IDF diabetes atlas. 2010; http://www. idf.org/diabetesatlas. [Accessed 30 May 2010]
2. Stumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: principles of pathogenesis and therapy. Lancet 2005; 365:1333-1346.
3. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 2006; 444:840-846.
4. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37:1595-1607.
5. Tahrani AA, Bailey CJ, Del PS, Barnett AH. Management of type 2 diabetes: new and future developments in treatment. Lancet 2011; 378: 182-197.
6. Scheer FA, Hilton MF, Mantzoros CS, Shea SA. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci U S A 2009; 106:4453-4458.
7. McMullan CJ, Schernhammer ES, Rimm EB, et al. Melatonin secretion and the incidence of type 2 diabetes. JAMA 2013; 309:1388-1396.
8. Leproult R, Van CE. Role of sleep and sleep loss in hormonal release and metabolism. Endocr Dev 2010; 17:11-21.
9. Cappuccio FP, Taggart FM, Kandala NB, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep 2008; 31:619-626.
10. Tiihonen M, Partinen M, Narvanen S. The severity of obstructive sleep apnoea is associated with insulin resistance. J Sleep Res 1993; 2:56-61.
11. Strohl KP, Novak RD, Singer W, et al. Insulin levels, blood pressure and sleep apnea. Sleep 1994; 17:614-618.
12. Grunstein RR, Stenlof K, Hedner J, Sjostrom L. Impact of obstructive sleep apnea and sleepiness on metabolic and cardiovascular risk factors in the Swedish Obese Subjects (SOS) Study. Int J Obes Relat Metab Disord 1995; 19:410-418.
13. Ip MS, Lam KS, Ho C, et al. Serum leptin and vascular risk factors in obstructive sleep apnea. Chest 2000; 118:580-586.
14. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 2000; 85:1151-1158.
15. Elmasry A, Lindberg E, Berne C, et al. Sleep-disordered breathing and glucose metabolism in hypertensive men\: A population-based study. J Intern Med 2001; 249:153-161.
16. Ip MS, Lam B, Ng MM, et al. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 2002; 165: 670-676.
17. Manzella D, Parillo M, Razzino T, et al. Soluble leptin receptor and insulin resistance as determinant of sleep apnea. Int J Obes Relat Metab Disord 2002; 26:370-375.
18. Punjabi NM, Sorkin JD, Katzel LI, et al. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002; 165:677-682.
19. Meslier N, Gagnadoux F, Giraud P, et al. Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 2003; 22:156-160.
20. Tassone F, Lanfranco F,Gianotti L, et al. Obstructive sleep apnoea syndrome impairs insulin sensitivity independently of anthropometric variables. Clin Endocrinol 2003; 59:374-379.
21. Barcelo A, Barbe F, Llompart E, et al. Effects of obesity on C-reactive protein level and metabolic disturbances in male patients with obstructive sleep apnea. Am J Med 2004; 117:118-121.
22. Punjabi NM, Shahar E, Redline S, et al. Sleep-disordered breathing, glucose intolerance, and insulin resistance. The Sleep Heart Health Study. Am J Epidemiol 2004; 160:521-530.
23. Makino S, Handa H, Suzukawa K, et al. Obstructive sleep apnoea syndrome, plasma adiponectin levels, and insulin resistance. Clin Endocrinol (Oxf) 2006; 64:12-19.
24. McArdle N, Hillman D, Beilin L, Watts G. Metabolic risk factors for vascular disease in obstructive sleep apnea. Am J Respir Crit Care Med 2007; 175:190-195.
25. Theorell-Haglow J, Berne C, Janson C, Lindberg E. Obstructive sleep apnoea is associated with decreased insulin sensitivity in females. Eur Respir J 2008; 31:1054-1060.
26. Tkacova R, Dorkova Z, Molcanyiova A, et al. Cardiovascular risk and insulin resistance in patients with obstructive sleep apnea. Med Sci Monit 2008; 14:CR438-CR444.
27. Punjabi NM, Beamer BA. Alterations in glucose disposal in sleep-disordered breathing. Am J Respir Crit Care Med 2009; 179:235-240.
28. Polotsky VY, Patil SP, Savransky V, et al. Obstructive sleep apnea, insulin resistance, and steatohepatitis in severe obesity. Am J Respir Crit Care Med 2009; 179:228-234.
29. Bhushan B, Misra A, Guleria R. Obstructive sleep apnea is independently associated wit. The metabolic syndrome in obese Asian Indians in northern India. Metab Syndr Relat Disord 2010; 8:431-435.
30. Togeiro SM, Carneiro G, Ribeiro Filho FF, et al. Consequences of obstructive sleep apnea on metabolic profile\: A population-based survey. Obesity 2012; 21:847-851.
31. Davies RJ, Turner R, Crosby J, Stradling JR. Plasma insulin and lipid levels in untreated obstructive sleep apnoea and snoring; their comparison with matched controls and response to treatment. J Sleep Res 1994; 3:180-185.
32. Stoohs RA, Facchini F, Guilleminault C. Insulin resistance and sleep-disordered breathing in healthy humans. Am J Respir Crit Care Med 1996; 154:170-174.
33. Saarelainen S, Lahtela J, Kallonen E. Effect of nasal CPAP treatment on insulin sensitivity and plasma leptin. J Sleep Res 1997; 6:146-147.
34. Gruber A, Horwood F, Sithole J, et al. Obstructive sleep apnoea is independently associated wit. The metabolic syndrome but not insulin resistance state. Cardiovasc Diabetol 2006; 5:22.
35. Sharma SK, Kumpawat S, Goel A, et al. Obesity, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleepdisordered breathing. Sleep Med 2007; 8:12-17.
36. Onat A, Hergenc G, Uyarel H, et al. Obstructive sleep apnea syndrome is associated with metabolic syndrome rather than insulin resistance. Sleep Breath 2007; 11:23-30.
37. Kapsimalis F, Varouchakis G, Manousaki A, et al. Association of sleep apnea severity and obesity with insulin resistance, C-reactive protein, and leptin levels in male patients with obstructive sleep apnea. Lung 2008; 186:209-217.
38. Barcelo A, Barbe F, de la Pena M, et al. Insulin resistance and daytime sleepiness in patients with sleep apnoea. Thorax 2008; 63:946-950.
39. Nena E, Steiropoulos P, Papanas N, et al. Sleepiness as a marker of glucose deregulation in obstructive sleep apnea. Sleep Breath 2012; 16:181-186.
40. Lindberg E, Theorell-Haglöw J, Svensson M, et al. Sleep apnea and glucose metabolism\: A long-term follow-up in a community-based sample. Chest 2012; 142:935-942.
41. Hermans MP, Ahn SA, Mahadeb YP, Rousseau MF. Sleep apnoea syndrome and 10-year cardiovascular risk in females with type 2 diabetes: relationship with insulin secretion and insulin resistance. Diabetes Metab Res Rev 2013; 29:227-234.
42. Pamidi S, Wroblewski K, Broussard J, et al.Obstructive sleep apnea in young lean men: impact on insulin sensitivity and secretion. Diabetes Care 2012; 35:2384-2389.
43. Lin QC, Zhang XB, Chen GP, et al. Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome in nonobese adults. Sleep Breath 2012; 16:571-578.
44. Duarte FH, Jallad RS, Amaro AC, et al. The impact of sleep apnea treatment on carbohydrate metabolism in patients with acromegaly. Pituitary 2012; 16:341-350.
45. Schahin SP, Nechanitzky T, Dittel C, et al. Long-term improvement of insulin sensitivity during CPAP therapy in the obstructive sleep apnoea syndrome. Med Sci Monit 2008; 14:CR117-CR121.
46. Tasali E, Chapotot F, Leproult R, et al. Treatment of obstructive sleep apnea improves cardiometabolic function in young obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2011; 96:365-374.
47. West SD, Nicoll DJ, Wallace TM, et al. Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and type 2 diabetes. Thorax 2007; 62:969-974.
48. Sharma SK, Agrawal S, Damodaran D, et al. CPAP fo. The metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med 2011; 365:2277-2286.
49. Hoyos CM, Killick R, Yee BJ, et al. Effects of testosterone therapy on sleep and breathing in obese men with severe obstructive sleep apnoea\: A randomized placebo-controlled trial. Clin Endocrinol 2012; 77:599-607.
50. Kritikou I, Basta M, Vgontzas AN, et al. Sleep apnea, sleepiness, inflammation and insulin resistance in middle-aged men and women. Eur Respir J 2013. [Epub ahead of print]
51. Yang D, Liu Z, Yang H, Luo Q. Effects of continuous positive airway pressure on glycemic control and insulin resistance in patients with obstructive sleep apnea\: A meta-analysis. Sleep Breath 2013; 17:33-38.
52. Iftikhar IH, Khan MF, Das A, Magalang UJ. Meta-analysis: continuous positive airway pressure improves insulin resistance in patients with sleep apnea without diabetes. AnnAm Thorac Soc 2013; 10:115-120.
53. Yang D, Liu Z, Yang H. The impact of effective continuous positive airway pressure on homeostasis model assessment insulin resistance in nondiabetic patients with moderate to severe obstructive sleep apnea. Diabetes Metab Res Rev 2012; 28:499-504.
54. Xu J, Long YS, Gozal D, Epstein PN. b-Cell death and proliferation after intermittent hypoxia: role of oxidative stress. Free Radic Biol Med 2009; 46:783-790.
55. Wang N, Khan SA, Prabhakar NR, Nanduri J. Impaired pancreatic beta cell function by chronic intermittent hypoxia. Exp Physiol 2013; 98:1376-1385.
56. Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes\: A population-based study. Am J Respir Crit Care Med 2005; 172:1590-1595.
57. Marshall NS, Wong KK, Phillips CL, et al. Is sleep apnea an independent risk factor for prevalent and incident diabetes in the Busselton Health Study? J Clin Sleep Med 2009; 5:15-20.
58. Botros N, Concato J, Mohsenin V, et al. Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med 2009; 122:1122-1127.
59. Celen YT, Hedner J, Carlson J, Peker Y. Impact of gender on incident diabetes mellitus in obstructive sleep apnea\: A 16-year follow-up. J Clin Sleep Med 2010; 6:244-250.
60. Wang X, Bi Y, Zhang Q, Pan F. Obstructive sleep apnoea and the risk of type 2 diabetes: A meta-analysis of prospective cohort studies. Respirology 2013; 18:140-146.
61. Brooks B, Cistulli PA, Borkman M, et al. Obstructive sleep apnea in obese noninsulin-dependent diabetic patients: effect of continuous positive airway pressure treatment on insulin responsiveness. J Clin Endocrinol Metab 1994; 79:1681-1685.
62. Resnick HE, Redline S, Shahar E, et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care 2003; 26:702-709.
63. West SD, Nicoll DJ, Stradling JR. Prevalence of obstructive sleep apnoea in men with type 2 diabetes. Thorax 2006; 61:945-950.
64. Einhorn D, Stewart DA, Erman MK, et al. Prevalence of sleep apnea in a population of adults with type 2 diabetes mellitus. Endocr Pract 2007; 13:355-362.
65. Laaban JP, Daenen S, Lé ger D, et al. Prevalence and predictive factors of sleep apnoea syndrome in type-2 diabetic patients. Diabetes Metab 2009; 35:372-377.
66. Foster GD, Sanders MH, Millman R, et al. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 2009; 32:1017-1019.
67. Lam DCL, Lui MMS, Lam JCM, et al. Prevalence and recognition of obstructive sleep apnea in chinese patients with type 2 diabetes mellitus. Chest 2010; 138:1101-1107.
68. Schober AK, Neurath MF, Harsch IA. Prevalence of sleep apnoea in diabetic patients. Clin Respir J 2011; 5:165-172.
69. Pillai A, Warren G, Gunathilake W, Idris I. Effects of sleep apnea severity on glycemic control in patients with type 2 diabetes prior to continuous positive airway pressure treatment. Diabetes Technol Ther 2011; 13:945-949.
70. Tahrani AA, Ali A, Raymond NT, et al. Obstructive sleep apnea and diabetic neuropathy\: A novel association in patients with type 2 diabetes. Am J Respir Crit Care Med 2012; 186:434-441.
71. Heffner JE, Rozenfeld Y, Kai M, et al. Prevalence of diagnosed sleep apnea among patients with type 2 diabetes in primary. Chest 2012; 141:1414-1421.
72. Lecomte P, Criniere L, Fagot-Campagna A, et al. Underdiagnosis of obstructive sleep apnoea syndrome in patients with type 2 diabetes in France: ENTRED 2007. Diabetes Metab 2013; 39:139-147.
73. Drager LF, Queiroz EL, Lopes HF, et al. Obstructive sleep apnea is highly prevalent and correlates with impaired glycemic control in consecutive patients wit. The metabolic syndrome. J Cardiometab Syndr 2009; 4:89-95.
74. Papanas N, Steiropoulos P, Nena E, et al. HbA1c is associated with severity of obstructive sleep apnea hypopnea syndrome in nondiabetic men. Vasc Health Risk Manag 2009; 5:751-756.
75. Kosseifi S, Bailey B, Price R, et al. The association between obstructive sleep apnea syndrome and microvascular complications in well controlled diabetic patients. Mil Med 2010; 175:913-916.
76. Aronsohn RS, Whitmore H, Van Cauter E, Tasali E. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med 2010; 181:507-513.
77. Pamidi S, Tasali E. Obstructive sleep apnea and type 2 diabetes: is there a link? FrontNeurol 2012; 3:126.
78. Tamura A, Kawano Y, Watanabe T, Kadota J. Obstructive sleep apnea increases hemoglobin A1c levels regardless of glucose tolerance status. Sleep Med 2012; 13:1050-1055.
79. Grimaldi D, Beccuti G, Tasali E, et al. Impact of REM versus non-REM obstructive sleep apnea on glycemic control in type 2 diabetes [abstract]. Sleep 2013; 36:A124.
80. Harsch IA, Schahin SP, Bruckner K, et al. The effect of continuous positive airway pressure treatment on insulin sensitivity in patients with obstructive sleep apnoea syndrome and type 2 diabetes. Respiration 2004; 71:252-259.
81. Babu AR, Herdegen J, Fogelfeld L, et al. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med 2005; 165:447-452.
82. Hassaballa HA, Tulaimat A, Herdegen JJ, Mokhlesi B. The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea. Sleep Breath 2005; 9:176-180.
83. Dawson A, Abel SL, Loving RT, et al. CPAP therapy of obstructive sleep apnea in type 2 diabetics improves glycemic control during sleep. J Clin Sleep Med 2008; 4:538-542.
84. Pallayova M, Donic V, Tomori Z. Beneficial effects of severe sleep apnea therapy on nocturnal glucose control in persons with type 2 diabetes mellitus. Diabetes Res Clin Pract 2008; 81:e8-e11.
85. West SD, Nicoll DJ, Wallace TM, et al. Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and type 2 diabetes. Thorax 2007; 62:969-974.
86. Shpirer I, Rapoport M, Stav D, Elizur A. Normal and elevated HbA1C levels correlate with severity of hypoxemia in patients with obstructive sleep apnea and decrease following CPAP treatment. Sleep Breath 2012; 16: 461-466.
87. Tasali E, Abraham V, Aronsohn R, et al. Effective CPAP treatment of obstructive sleep apnea improves glycemic control in type 2 diabetics [abstract]. Sleep 2013; 36:A124.
88. Hla KM, Young T, Finn L, et al. Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin Sleep Cohort Study. Sleep 2008; 31:795-800.
89. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000; 283:1829-1836.
90. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342:1378-1384.
91. Barbe F, Duran-Cantolla Jn, Capote F, et al. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 2010; 181:718-726.
92. Durá n-Cantolla J, Aizpuru F, Montserrat JM, et al. Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ 2010; 341:c5991.
93. Prasad B, Carley DW, Krishnan JA, et al. Effects of positive airway pressure treatment on clinical measures of hypertension and type 2 diabetes. J Clin Sleep Med 2012; 8:481-487.
94. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001; 414:813-820.
95. Brownlee M. The pathobiology of diabetic complications\: A unifying mechanism. Diabetes 2005; 54:1615-1625.
96. Tahrani AA, Askwith T, Stevens MJ. Emerging drugs for diabetic neuropathy. Expert Opin Emerg Drugs 2010; 15:661-683.
97. Tasali E, Ip MSM. Obstructive sleep apnea and metabolic syndrome: alterations in glucose metabolism and inflammation. Proc Am Thorac Soc 2008; 5:207-217.
98. Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med 2002; 165:934-939.
99. Lavie L. Oxidative stress\: A unifying paradigm in obstructive sleep apnea and comorbidities. Prog Cardiovasc Dis 2009; 51:303-312
100. Schulz R, Mahmoudi S, Hattar K, et al. Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea. Impact of continuous positive airway pressure therapy. Am J Respir Crit Care Med 2000; 162:566-570
101. Barcelo A, Miralles C, Barbe F, et al. Abnormal lipid peroxidation in patients with sleep apnoea. Eur Respir J 2000; 16:644-647
102. Carpagnano GE, Kharitonov SA, Resta O, et al. 8-Isoprostane, a marker of oxidative stress, is increased in exhaled breath condensate of patients with obstructive sleep apnea after night and is reduced by continuous positive airway pressure therapy. Chest 2003; 124:1386-1392
103. Lavie L, Vishnevsky A, Lavie P. Evidence for lipid peroxidation in obstructive sleep apnea. Sleep 2004; 27:123-128
104. Minoguchi K, Yokoe T, Tanaka A, et al. Association between lipid peroxidation and inflammation in obstructive sleep apnoea. Eur Respir J 2006; 28:378-385
105. Yamauchi M, Nakano H, Maekawa J, et al. Oxidative stress in obstructive sleep apnea. Chest 2005; 127:1674-1679
106. Jelic S, Lederer DJ, Adams T, et al. Vascular inflammation in obesity and sleep apnea. Circulation 2010; 121:1014-1021
107. Tan KC, Chow WS, Lam JC, et al. Advanced glycation endproducts in nondiabetic patients with obstructive sleep apnea. Sleep 2006; 29:329-333
108. Allahdadi KJ, Duling LC, Walker BR, Kanagy NL. Eucapnic intermittent hypoxia augments endothelin-1 vasoconstriction in rats: role of PKC{delta}. Am J Physiol Heart Circ Physiol 2008; 294:H920-H927
109. de la Pena M, Barcelo A, Barbe F, et al. Endothelial function and circulating endothelial progenitor cells in patients with sleep apnea syndrome. Respiration 2008; 76:28-32
110. Lavie L, Kraiczi H, Hefetz A, et al. Plasma vascular endothelial growth factor in sleep apnea syndrome: effects of nasal continuous positive air pressure treatment. Am J Respir Crit Care Med 2002; 165:1624-1628
111. Schulz R, Hummel C, Heinemann S, et al. Serum levels of vascular endothelial growth factor are elevated in patients with obstructive sleep apnea and severe nighttime hypoxia. Am J Respir Crit Care Med 2002; 165:67-70
112. Valipour A, Litschauer B, Mittermayer F, et al. Circulating plasma levels of vascular endothelial growth factor in patients with sleep disordered breathing. Respir Med 2004; 98:1180-1186
113. Rangemark C, Hedner JA, Carlson JT, et al. Platelet-function and fibrinolyticactivity in hypertensive and normotensive sleep-apnea. Sleep 1995; 18:188-194
114. Arnardottir ES, Mackiewicz M, Gislason T, et al. Molecular signatures of obstructive sleep apnea in adults\: A review and perspective. Sleep 2009; 32:447-470
115. Atkeson A, Yeh SY, Malhotra A, Jelic S. Endothelial function in obstructive sleep apnea. Prog Cardiovasc Dis 2003; 51:351-362
116. Tahrani AA, Ali A, Raymond NT, et al. Obstructive sleep apnea and diabetic nephropathy\: A cohort study. Diabetes Care 2013 (in press)
117. Rice TB, Foster GD, Sanders MH, et al. The relationship between obstructive sleep apnea and self-reported stroke or coronary heart disease in overweight and obese adults with type 2 diabetes mellitus. Sleep 2012; 35:1293-1298
118. Shiba T, Maeno T, Saishin Y, et al. Nocturnal intermittent serious hypoxia and reoxygenation in proliferative diabetic retinopathy cases. Am J Ophthalmol 2010; 149:959-963
119. West SD,Groves DC, Lipinski HJ, et al. The prevalence of retinopathy in men with type 2 diabetes and obstructive sleep apnoea. Diabet Med 2010; 27:423-430
120. Tahrani AA, Dodson P, Ali A, et al. Obstructive sleep apnoea is associated with sight threatening retinopathy and predict. The development of preproliferative and proliferative retinopathy in patients with type 2 diabetes\: A longitudinal analysis [abstract]. Eur J Ophthalmol 2013; 23:449
121. Rudrappa S, Warren G, Idris I. Obstructive sleep apnoea is associated wit. The development and progression of diabetic retinopathy, independent of conventional risk factors and novel biomarkers for diabetic retinopathy. Br J Ophthalmol 2012; 96:1535
122. Altaf Q, Dodson P, Ali A, et al. Obstructive sleep apnoea is associated with sight threatening retinopathy and predict. The development of preproliferative and proliferative retinopathy in patients with type 2 diabetes\: A longitudinal analysis. Diabet Med 2013; 30:E5
123. Mason RH, Kiire CA, Groves DC, et al. Visual improvement following continuous positive airway pressure therapy in diabetic subjects with clinically significant macular oedema and obstructive sleep apnoea: proof of principle study. Respiration 2012; 84:275-282
124. Furukawa S, Saito I, Yamamoto S, et al. Nocturnal intermittent hypoxia as an associated risk factor for microalbuminuria in Japanese patients with type 2 diabetes mellitus. Eur J Endocrinol 2013; 169:239-246
125. Ozol D, Carlioglu A, Karamanli H, et al. Influence of snoring on microalbuminuria in diabetic patients. Sleep Breath 2011; 15:295-300
126. Buyukaydin B, Akkoyunlu ME, Kazancioglu R, et al. The effect of sleep apnea syndrome of the development of diabetic nephropathy in patients with type 2 diabetes. Diabetes Res Clin Prac 2012; 98:140-143
127. Kuna ST, Reboussin DM, Borradaile KE, et al. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep 2013; 36:641-649A.