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Medicine Matters Home Article of the Week Obstructive Sleep Apnea Dynamically Increases Nocturnal Plasma Free Fatty Acids, Glucose, and Cortisol during Sleep

Obstructive Sleep Apnea Dynamically Increases Nocturnal Plasma Free Fatty Acids, Glucose, and Cortisol during Sleep

ARTICLE: Obstructive Sleep Apnea Dynamically Increases Nocturnal Plasma Free Fatty Acids, Glucose, and Cortisol during Sleep.

AUTHORS: Swati Chopra, Aman Rathore, Haris Younas, Luu V. Pham, Chenjuan Gu, Aleksandra Beselman, Il-Young Kim, Robert R. Wolfe, Jamie Perin, Vsevolod Y. Polotsky, Jonathan C. Jun

JOURNAL: J Clin Endocrinol Metab. 2017 Jun 8. doi: 10.1210/jc.2017-00619. [Epub ahead of print]


CONTEXT: Obstructive sleep apnea (OSA) is associated with diabetes and cardiovascular disease. This association may be related to metabolic changes that transpire during sleep in OSA.

OBJECTIVE: To examine the impact of OSA, elicited by cessation of continuous positive airway pressure (CPAP), on frequently sampled nocturnal metabolic markers including plasma free fatty acids (FFA), glucose, insulin, triglycerides, cortisol, and lactate; as well as glucoseproduction, oral glucose tolerance, blood pressure, endothelial function, cholesterol, and high sensitivity C-reactive protein (hsCRP).

DESIGN AND SETTING: Randomized crossover trial of CPAP, versus CPAP withdrawal.

PATIENTS: Thirty-one patients with moderate-severe OSA acclimated to CPAP.

INTERVENTION: Patients underwent attended polysomnography while sleeping with therapeutic CPAP, or after CPAP withdrawal, in random order. Venous blood was sampled at ∼20 min intervals on both nights. In 11 patients, we assessed glucose kinetics with an infusion of 6,6-[2H2]glucose.

RESULTS: CPAP withdrawal caused recurrence of OSA associated with hypoxemia, sleep disruption, and heart rate elevation. CPAP withdrawal dynamically increased nocturnal FFA (p = 0.007), glucose (p = 0.028), and cortisol (p = 0.037), in proportion to respiratory event frequency, heart rate elevation, or sleep fragmentation. Diabetes predisposed to glucose elevation. CPAP withdrawal also increased systolic blood pressure (p = 0.017) and augmentation index (p = 0.008), but did not affect insulin, triglycerides, glucose production, oral glucosetolerance, cholesterol, or hsCRP.

CONCLUSION: OSA recurrence during CPAP withdrawal increases FFA and glucose during sleep, associated with sympathetic and adrenocortical activation. Recurring exposure to these metabolic changes may foster diabetes and cardiovascular disease.

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Kelsey Bennett