Altered REM sleep architecture in patients with Myotonic dystrophy type 1: is related to sleep apnea?

OBJECTIVE: To determine the sleep architecture and sleep respiratory abnormalities and to correlate with sleep symptoms in patients with Myotonic dystrophy type 1 (DM1). METHODS: We recruited a cohort of genetically confirmed patients with DM1, who attended the Neuromuscular clinic between July 2016 and December 2019. Clinical, sleep and whole night polysomnography data were collected. The analysis of sleep architecture, sleep respiratory parameters and comparison with healthy controls (HC) was performed in our sleep laboratory. RESULTS: A total of 59 patients with DM1 underwent sleep evaluation. Hypersomnolence in 42 (77.8%), ESS>10 in 23 (39%), and PSQI>5 in 18 (30.5%) were found in patients with DM1. Thirty-one (68.89%) patients with DM1 and 22 (95.65%) HC had more than 4-h of total sleep time (TST). More than 4 h of TST was taken to compare respiratory and sleep architecture parameters. Patients with DM1 had reduced sleep efficiency, reduced N2 sleep, and increase in N1 sleep, wake index, stage shift index, nocturnal sleep-onset REM periods compared to HC. AHI>15 was found in 16 (51.61%) DM1 and in 3 HC (13.64%). AHI had positive correlation with BMI, but not with age, ESS or disease progression (MIRS). All DM1 with AHI>15; 8(80%) and 1(33.33%) in AHI5to15, and AHI<5 groups, respectively had hypersomnolence. CONCLUSION: In this first study on Indian cohort, daytime hypersomnolence, poor nocturnal sleep quality, sleep architecture irregularities are identified to be common in patients with DM1. These abnormalities may be explained by sleep-related breathing disorders that are highly prevalent in these patients.

Correlation of Waist to Calf Circumference Ratio and Carotid Intima-Media Thickness in Diabetes Mellitus.

INTRODUCTION: Diabetes mellitus is a well-known risk factor for cardiovascular disease because of the accelerated process of atherosclerosis. Obesity is an established risk factor and has gained immense importance in recent studies as an important risk factor for clinical cardiovascular disease, yet the fundamental component stays unclear. Calf circumference is another form for lean mass and peripheral subcutaneous fat and is inversely associated with the occurrence of carotid plaques (CP). Multiplicative and opposite effects of both Calf Circumference (CC) and Waist Circumference (WC) in the event of CP suggest that the two measures should be taken into account commonly while assessing vascular risk profile. AIMS & OBJECTIVES: To ascertain if waist to calf circumference ratio (WCR) is a marker of carotid atherosclerosis in patients with type 2 diabetes mellitus, and the correlation between waist to calf circumference ratio and carotid intima-media thickness (CIMT ) in patients with Type 2 diabetes. MATERIALS AND METHODS: A cross-sectional study at Hospital affiliated to Kasturba Medical college Mangalore from Sept 2016 to Sept 2018. Patients with type 2 DM as per ADA criteria, age >18years, are recruited for the study. RESULTS AND DISCUSSION: In our study, with 150 population, 25 patients had carotid atherosclerosis and 20 patients had CIMT>1.1. The waist circumference in patients with CA is in the range of 93.07, and 99.85 & the CC in patients with CA is in the range of 29.49 to 31.25. The WCR in patients with CA is in the range of 3.12 to 3.26. The difference was statistically significant with a p-value of <0.05. In our study, it was found that WC and WCR correlated well with carotid atherosclerosis, and surprisingly, calf circumference also correlated with carotid atherosclerosis but not as significant as both WC and WCR. CONCLUSION: To conclude, in our population-based study of 150 subjects, we found that carotid atherosclerosis is significantly more in people with increased waist calf circumference ratio. WCR may be a new, useful, and practical anthropometric index that facilitates the early identification of diabetic subjects with high risk for cardiovascular disease. Validation of this finding in individual populations is required. Future studies should test the association of calf circumference with carotid intima-media thickness and carotid plaques using better measures than ultrasound, such as magnetic resonance imaging. Further research focusing on underlying mechanisms in the role of lean mass and peripheral fat mass is required.