osa and diabetes mellitus dec... · osa and diabetes mellitus richard s. goodstein do, fccp haggin...
TRANSCRIPT
New Understanding of Adipocytes
Adipokines
Regulatory role in Insulin
sensitivity/ resistance
Regulatory role in systemic
inflammatory process
Immunologically active
Changing concept of an inert
adipocyte to that of an active
participant in metabolism is key
to our discussion !
OBESITY IS PRO-INFLAMMATORY
STIMULATES
LEPTIN
STIMULATES TGF- beta
INCREASES
TNF/ IL-6
REDUCES
Ob- R
OBESITY
Obesity as Pro-Inflammatory
State
In obesity as adipocytes hypertrophy
Increase in “ activated (Th-1) “
macrophages
Increase in pro-inflammatory cytokines
Increase FFA
DM II / Fatty Liver/ Asthma / MetS
IGF-1 DEFICENCY
Decreased peripheral utilization of
glucose
Increased Insulin resistance
Increased hepatic gluconeogenesis
Increased adipose uptake
Central adiposity
Leptin
Increased adiposity
Down regulates T regulator cells (Treg)
Increases Th-1 pro-inflammatory state
Increases Reactive Oxygen Species
(ROS)
Increases TGF-beta which increases ASM
and BHR . Increases Vascular SM and
PAH.
CPAP in DM
Increases IGF-1
Increases GH
Reduces Ghrelin
Reduces Leptin
Normalizes Circadian Counter-
regulatory hormones
HOMEOSTATIC METABOLIC ASESSMENT (HOMA)
• AHI>5.
• Low SpO2
• CT90 (Time in which SpO2 < 90%)
THESE MARKERS WERE INDEPENDENT OF BMI AGE , GENDER , SMOKING AND ETOH CONSUMPTION.
Theorell-Haglow et al. Eur Respir J. 2008:31;1054-1060.
GLUCOSE INTOLERANCE
• Total Sleep Time < 7-8 hours
• Sleep fragmentation
• Decreased or absence of REM Sleep