Treatment Effects of Short-Term Continuous Positive Airway Pressure on Blood Glucose Control in Type 2 Diabetic Patients with Obstructive Sleep Apnea Syndrome.

PURPOSE: The study aimed at assessing glucose control measured with a continuous glucose monitoring system (CGMS) before and after short-term continuous positive airway pressure (CPAP). MATERIALS AND METHODS: Twenty-four type 2 diabetic patients (T2DM) with Obstructive sleep apnea syndrome (OSAS) (mean age 55.0 ± 9.0 years; BMI 29.5 ± 5.2 kg/m2) were admitted and kept under diet control for 2 days, then underwent 2 overnight polysomnographies: a diagnostic study and one with CPAP titration. Then they were treated by CPAP during sleep for the following three nights. Participants were divided into subgroup D (only diet control) and subgroup M (with DM medication). CGMS was utilized over the last five days. Glucose control was also assessed with plasma insulin and a clinical measure of insulin resistance (HOMA-IR) index. RESULTS: The mean (±SD) apnea-hypopnea index (AHI) at diagnostic polysomnography was 51.2 ± 22.4 (range 10-88) events/h. CPAP treatment in the subjects with OSAS resulted in the index of oxygenation desaturations being reduced from 33.3 ± 20.1 to 1.1 ± 1.6 (P =0.00). CGMS showed mean 24-hours glucose values significantly lower after CPAP treatment than at baseline in both subgroups (7.97±1.31 vs 7.52±0.94, P=0.033 in subgroup D; and 7.72±1.51 vs 7.17±1.21, P=0.05 in subgroup M), as the fasting plasma insulin levels and HOMA-IR were also decreased significantly after CPAP treatment (13.0 ± 7.5µU/mL vs 10.8 ± 5.4µU/mL, P=0.044; and 4.2 ± 2.2 vs 3.1±1.7, P=0.003, respectively). Standard deviation (SD) and mean amplitude of glucose excursions (MAGE) were also decreased in the subgroup D (1.91 ± 1.10 vs 1.61 ± 1.20, P=0.014; 1.26 ± 1.13 vs 1.01 ± 0.98, P=0.008, respectively) only. CONCLUSION: Short-term CPAP treatment in OSAS with type 2 diabetic patients is accompanied by a decrease in blood glucose level and improved insulin sensitivity. Glucose variability was reduced but only in the patients with diet control.

Toxoplasma gondii infection in patients with lung diseases in Shandong province, eastern China.

Toxoplasma gondii, an intracellular protozoan parasite, can induce various clinical symptoms. T. gondii has been considered to play an important role in the pathogenesis of lung diseases. This survey was conducted to explore the correlation between T. gondii infection and lung diseases through a case-control study carried out in Shandong province, eastern China. In the present survey, T. gondii IgG antibodies were found in 76/398 (19.10%) of patients with lung diseases, which was significantly higher (P < 0.001) than the level found in the control subjects (35/398; 8.79%) through serological diagnosis. Patients with lung cancer have the highest T. gondii seroprevalence (26.19%), followed by Pulmonary cyst (25.00%), Tuberculosis (17.07%), Pneumonia (16.33%) and chronic obstructive pulmonary disease (COPD) (16.05%). Moreover, a semi-nest PCR targeted T. gondii B1 gene was employed to detect the T. gondii DNA in the blood samples. T. gondii DNA was detected in 5.53% blood samples of patients with lung diseases and 2.51% control subjects, respectively. The present study firstly shows that T. gondii has a high probability to infect the patients with lung diseases. Thus, the potential presence of T. gondii in patients with lung diseases should be appreciated during in the course of treatment and safeguard procedures should be implemented to protect vulnerable patients with lung diseases.

Toxoplasma gondii Infection in Diabetes Mellitus Patients in China: Seroprevalence, Risk Factors, and Case-Control Studies.

The association between Toxoplasma gondii (T. gondii) infection and diabetes mellitus remains controversial. With the improvement of living standards, the prevalence rate of diabetes is steadily increasing in China. Thus, it is necessary to explore the possible association between toxoplasmosis and diabetes mellitus in China. Hence, case-control studies were conducted to explore the T. gondii seroprevalence and identify the risk factors and possible transmission routes of T. gondii infection in different types of diabetes, including type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM) patients in China. Four hundred serum samples for each type of diabetes mellitus, matched with 400 control subjects for each group, were collected and examined for anti-T. gondii IgG and IgM antibodies using commercially available enzyme immunoassay kits. The total T. gondii seroprevalence in T1DM, T2DM, and GDM patients was 16.50%, 23.50%, and 21.25%, respectively. Each type of diabetes mellitus patients had a significantly higher T. gondii seroprevalence than the control subjects. Multivariate regression identified three variables as risk factors for T. gondii infection in diabetes patients, including keeping cats at home and consumption of raw oysters for T1DM patients and consumption of raw/undercooked meat and raw oysters for T2DM patients, which may help to guide future research and control policies in diabetes mellitus patients.

[Daytime hypercapnia in patients with obstructive sleep apnea hypopnea syndrome].

OBJECTIVES: To evaluate the incidence and factors related to daytime CO2 retention (PaCO2 ≥ 45 mm Hg, 1 mm Hg = 0.133 kPa) in Chinese patients with obstructive sleep apnea hypopnea syndrome. METHODS: 1441 patients with OSAHS had daytime arterial blood gas analysis were recruited from 2007 to 2009 in Peking University People's Hospital. 145 patients underwent pulmonary function test and had FEV1/FVC ratio over 70% were under further analysis. Sex, age, BMI, pulmonary function, polysomnography (PSG) and blood gas analysis results were recorded. Linear regression analysis was used to evaluate the relationship between PaCO2 levels and related parameters. Comparison was done between hypercanpnic and eucapnic patients. RESULTS: Daytime hypercapnia occurred in 25.2% of the 1441 patients with OSAHS, and 26.9% in the 145 OSAHS patients who had lung function test and with FEV1/FVC ratio over 70%. PaCO2 was correlated with BMI, PaO2 and the severity of nocturnal hypoxemia as reflected by the mean SpO2 and SIT90. This was also confirmed by the comparison between the hypercapnic and eucapnic patients. CONCLUSIONS: Hypercapnia occurs in a large part of patients with OSAHS and normal FEV1/FVC. BMI, nocturnal hypoxemia and daytime PaO2 level are all contributed to the development of daytime CO2 retention in OSAHS.

[Effects of continuous positive airway pressure upon the un-treatment hour changes of blood glucose level in patients with obstructive sleep apnea hypopnea syndrome and type 2 diabetes].

OBJECTIVE: To assess the effects of short-term continuous positive airway pressure (CPAP) upon un-treatment hour glucose control via a continuous glucose monitoring system (CGMS) in patients with obstructive sleep apnea hypopnea syndrome and type 2 diabetes (OWD). METHODS: A total of 23 case of hospitalized OWD were recruited. CGMS was applied for 2 days before and 4 days during CPAP treatment. The treatment hour (6 h, 0:00 - 6:00) and un-treatment hour (14 h, 6:00 - 22:00) glucose level and glucose variability were analyzed. Insulin resistance was assessed with fasting plasma blood glucose (FPG), plasma insulin (FINS) and homeostatic model assessment of insulin resistance index (HOMA-IR). RESULTS: The short-term CPAP treatment corrected sleep-disordered breathing and induced significant decreases of treatment and un-treatment hour glucose level ((7.07 ± 2.02) mmol/L vs (6.34 ± 1.57) mmol/L, (8.04 ± 1.99) mmol/L vs (7.64 ± 1.81) mmol/L, both P < 0.05). Glucose variability of treatment and un-treatment hours significantly decreased after CPAP treatment (0.41 ± 0.24 vs 0.29 ± 0.18, 1.02 ± 0.50 vs 0.78 ± 0.45, all P < 0.05). Short-term treatment also induced an increase of insulin sensitivity, as indicated by a significant decrease of HOMA-IR (4.02 ± 2.07 vs 3.08 ± 1.58, P < 0.05). CONCLUSION: Short-term CPAP treatment in OWD may improve not only insulin resistance but also blood glucose and glucose variability during treatment and un-treatment hours.

[Effect of continuous positive airway pressure upon 24 h changes of blood glucose level in patients with obstructive sleep apnea hypopnea syndrome and type 2 diabetes].

OBJECTIVE: To assess the effect of short-term continuous positive airway pressure (CPAP) upon 24 h glucose control via a continuous glucose monitoring system (CGMS) in patients with obstructive sleep apnea hypopnea syndrome and type 2 diabetes (OWD). METHODS: Eleven cases of hospitalized OWD with age 43 - 70 (56 +/- 10) years old, body mass index 22.3 - 38.3 (28.5 +/- 5.5) kg/m(2) and apnea hypopnea index (AHI) 12 - 68 (45 +/- 23) times/h was recruited. CGMS was applied 2 days before and 4 days during CPAP treatment. The 24 h, treatment hours (6 h, 0:00-6:00) and non- treatment hours (18 h) glucose level and glucose variability were analyzed. Insulin resistance was assessed with fasting plasma blood glucose (FBG), plasma insulin (FINS) and homeostatic model assessment of insulin resistance index (HOMA-IR). RESULTS: Short-term CPAP treatment corrected sleep disordered breathing, and induced significant decreases of 24 h and treatment hours blood glucose level [(7.97 +/- 1.31) vs (7.52 +/- 0.94) mmol/L, (7.24 +/- 1.51) vs (6.77 +/- 1.65) mmol/L, both P < 0.05). Glucose variability of 24 h and treatment hours and non-treatment hours significantly decreased after CPAP treatment (1.22 +/- 0.34 vs 0.89 +/- 0.28, 0.43 +/- 0.24 vs 0.31 +/- 0.18, 1.23 +/- 0.89 vs 0.49 +/- 0.26, all P < 0.05). Short-term treatment also induced increase of insulin sensitivity, as indicated by a significant decrease of HOMA-IR (3.65 +/- 1.93 vs 2.79 +/- 1.68, P < 0.05). CONCLUSION: Short-term CPAP treatment in OWD may have an improving effect not only upon insulin resistance but also upon whole-day blood glucose and glucose variability.

[Effect of noninvasive ventilation on chemoresponsiveness in patients with sleep apnea and chronic obstructive pulmonary disease].

OBJECTIVE: To investigate the effect of noninvasive ventilation on respiratory control in patients with chronic obstructive pulmonary disease (COPD) combined with sleep a apnea-hypopnea syndrome (SAHS)-overlap syndrome (OS). METHODS: Ten body mass index, apnea-hypopnea index, and age-matched OSAHS patients, 5 being hypercapnic (PaCO(2) > 45 mm Hg) OSAHS patients with normal FEV(1)/FVC, and 5 being OSAHS patients with COPD and the mean FEV(1)/FVC of 59% +/- 6% underwent bi-level positive airway pressure (BiPAP) treatment. Hypoxic responses, including the ratio of the change in minute ventilation (DeltaVE) to the change in arterial oxygen saturation (DeltaSaO(2)), and hypercapnic responses (DeltaVE/DeltaPaCO(2) ratio) were tested during wakefulness before treatment and 6 weeks after the treatment. RESULTS: Before treatment, the DeltaVE/DeltaSaO(2) ratios of the OS and OSAHS patients were (-0.023 +/- 0.049) L.min(-1).%(-1) and (-0.16 +/- 0.06) L.min(-1).%(-1) respectively, both lower than the laboratory normal value [(-0.35 +/- 0.21) L.min(-1).%(-1)]. The DeltaVE/DeltaPaCO(2) ratio of the OS patients was (0.54 +/- 0.16) L.mm Hg(-1), significantly lower than the normal value [(1.26 +/- 0.54) L.mm.Hg(-1), P < 0.05]. After receiving 6 weeks of noninvasive ventilation treatment, the hypoxic response of OSAHS patients were (-0.16 +/- 0.06) L.min(-1).%(-1), significantly higher than that before treatment [(-0.36 +/- 0.14) L.min(-1).%(-1)], and hypercapnic response of the OSAHS patients was (1.30 +/- 0.62) L.min(-1).mm Hg(-1), significantly lower than that before treatment [(1.78 +/- 0.93) L.min(-1).mm Hg(-1)], both bring within the normal ranges. In the patients with OS, the hypercapnic response was unchanged [(0.54 +/- 0.16) vs (0.51 +/- 0.23) L.min(-1).mm Hg(-1)], and the hypoxic responses increased significantly but still remained at a very low level [(-0.023 +/- 0.049) vs (-0.09 +/- 0.007) L.min(-1).%(-1)] after treatment. CONCLUSION: Hypercapnic and hypoxic responses in patients with OS and in patients with OSAHS respond differently after pressure support ventilation. This indicates that depressed chemoresponsiveness in patients with OS may not be only a response to sleep-disordered breathing.