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• W2083465083 endingPage "139" @default.
• W2083465083 startingPage "128" @default.
• W2083465083 abstract "Epidemiological data suggest that sleep apnea–hypopnea syndrome (SAHS) is independently associated with the development of insulin resistance and glucose intolerance. Moreover, despite significant methodological limitations, some studies report a high prevalence of SAHS in patients with type 2 diabetes mellitus (DM2). A recent meta-analysis shows that moderate–severe SAHS is associated with an increased risk of DM2 (relative risk = 1.63 [09–2.45]), compared to the absence of apneas and hypopneas. Common alterations in various pathogenic pathways add biological plausibility to this relationship. Intermittent hypoxia and sleep fragmentation, caused by successive apnea–hypopnea episodes, induce several intermediate disorders, such as activation of the sympathetic nervous system, oxidative stress, systemic inflammation, alterations in appetite-regulating hormones and activation of the hypothalamic–pituitary–adrenal axis which, in turn, favor the development of insulin resistance, its progression to glucose intolerance and, ultimately, to DM2. Concomitant SAHS seems to increase DM2 severity, since it worsens glycemic control and enhances the effects of atherosclerosis on the development of macrovascular complications. Furthermore, SAHS may be associated with the development of microvascular complications: retinopathy, nephropathy or diabetic neuropathy in particular. Data are still scant, but it seems that DM2 may also worsen SAHS progression, by increasing the collapsibility of the upper airway and the development of central apneas and hypopneas. Diversos datos epidemiológicos muestran que el síndrome de apneas-hipopneas del sueño (SAHS) se relaciona independientemente con el desarrollo de resistencia a la insulina e intolerancia a la glucosa. Además, y pese a la existencia de notables limitaciones metodológicas, algunos estudios refieren una elevada prevalencia de SAHS en pacientes con diabetes tipo 2 (DM2). Un reciente metaanálisis muestra que el SAHS moderado-grave se asocia a un mayor riesgo de DM2 (riesgo relativo = 1,63 [09–2,45]), en relación con la ausencia de apneas-hipopneas. La existencia de alteraciones comunes de diversas vías patogénicas le proporciona plausibilidad biológica a esta relación. La hipoxia intermitente y la fragmentación del sueño, originadas por la sucesión de episodios de apneas-hipopneas, inducen diversos trastornos intermedios, como la activación del sistema nervioso simpático, el estrés oxidativo, la inflamación sistémica, alteraciones en las hormonas reguladoras del apetito y activación del eje hipotálamo-hipófiso-suprarrenal, que favorecen el desarrollo de resistencia a la insulina, así como su progresión a intolerancia a la glucosa y, en última instancia, a DM2. La coexistencia del SAHS parece agravar la evolución de la DM2, al empeorar el control glucémico y potenciar el efecto de la aterosclerosis en el desarrollo de complicaciones macrovasculares. Además, el SAHS podría asociarse al desarrollo de complicaciones microvasculares, particularmente la retinopatía, nefropatía o neuropatía diabéticas. Aunque todavía escasos, algunos datos sugieren que la DM2 también podría empeorar la evolución del SAHS, al favorecer la colapsabilidad de la vía aérea superior y potenciar la aparición de apneas-hipopneas centrales." @default.
• W2083465083 created "2016-06-24" @default.
• W2083465083 creator A5076903718 @default.
• W2083465083 creator A5078491071 @default.
• W2083465083 creator A5082562216 @default.
• W2083465083 date "2015-03-01" @default.
• W2083465083 modified "2023-10-18" @default.
• W2083465083 title "Sleep Apnea–Hypopnea Syndrome and Type 2 Diabetes. A Reciprocal Relationship?" @default.
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