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EDİTÖRE MEKTUP
LETTER TO THE EDITOR

Doi: 10.5578/tt.9612
Tuberk Toraks 2015;63(4):300-301

Geliş Tarihi/Received: 26.04.2015 • Kabul Ediliş Tarihi/Accepted: 10.05.2015

Diyabetik nöropati obstrüktif uyku apne sendromlu olgularda
siklik alternan patern oranlarini etkiler mi?

Asiye KANBAY1, Handan İNÖNÜ KÖSEOĞLU2, Oğuz KÖKTÜRK3


1 İstanbul Medeniyet Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Uyku Bozukları Ünitesi, İstanbul, Türkiye

1 Unit of Sleep Disorders, Department of Chest Diseases, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey

2 Gaziosmanpaşa Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Tokat, Türkiye

2 Department of Chest Diseases, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey

3 Gazi Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Ankara, Türkiye

3 Department of Chest Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey

Obstructive sleep apnea syndrome (OSAS) is characterized by an intermittent, complete or partial upper airway obstruction during sleep causing hypoxia, sleep disruption, daytime sleepiness, mental and physical effects, is the second most common respiratory condition; affecting 0.3-4% of the middle-aged population (1). OSAS is strongly associated with cardio-metabolic derangements. Intermittent hypoxia, sleep fragmentation and sympathetic activation are the main causes of insulin resistance.  There is growing strong evidence related to an independent contribution of OSAS to the development of cardiometabolic diseases and associated risk factors such as inflammation, diabetes mellitus, hypertension, and chronic kidney disease (2).

Diabetes mellitus (DM) is one of the most common chronic diseases that affect the somatic and the autonomic nervous system. Several studies indicate an association between OSAS and diabetic neuropathy (3). Keller et al. have shown that autonomic neuropathy may play a role in upper airway collapse among diabetic patients (4).

Cyclic alternating pattern (CAP) which is an important marker of unstable sleep is recently defined as a metrics of sleep physiology. The phenomen is a periodic electroencephalography (EEG) activity of non-rapid eyes movement (NREM) sleep. Today, CAP is known as an arousal which is the oscillation of the EEG activity. This issue is not limited in the EEG activities but reflects on the ongoing autonomic activity and behavioral functions.  CAP can be seen in all age groups (5). In the knowledge of our investigation, there is no study about CAP rate in diabetic patients with OSAS. Does diabetic neuropathy affect the CAP rates in this population? In the other words: How does diabetic neuropathy alter the autonomic activity in these people. To address these questions, further prospective studies are warranted to evaluate the role of diabetic neuropathy and CAP rates in patients with OSAS.

REFERENCES

  1. Kanbay A, Hasanoglu HC. A new prognostic marker for obstructive sleep apnea: hepcidin. Med Hypotheses 2007;69:1381-2.
  2. Pamidi S, Tasali E. Obstructive sleep apnea and type 2 diabetes: is therea link? Frontiers in Neurology 2012;126:2-13.
  3. American Diabetes Association. Proceedings of a consensus development conference on standardized measures in diabetic neuropathy. Autonomic nervous system testing Diabetes Care 1992;15:1095-103.
  4. Keller T, Hader C, Zeeuw De J, Rasche K. Obstructive Sleep Apnea Syndrome: Effect of Diabetes and Autonomic Neuropathy. Journal Of Physiology and Pharmacology. 2007;58(Suppl 5):S313-S8.
  5. Parrino L, Ferri R, Bruni O, Terzano MG. Cyclic alternating pattern (CAP): The marker of sleep instability. Sleep Medicine Reviews 2012;16:27-45.

Yazışma Adresi (Address for Correspondence)

Dr. Asiye KANBAY

İstanbul Medeniyet Üniversitesi Tıp Fakültesi,

Göğüs Hastalıkları Anabilim Dalı,

Uyku Bozuklukları Ünitesi,

İSTANBUL - TURKEY

e-mail: kanbaydr@yahoo.com

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