Advances in sleep research 睡眠的研究进展
摘要
It is well established that there are relationships of sleep-disordered breathing (especially obstructive sleep apnea), sleep architecture, sleep duration, and other sleep disorders with various metrics of insulin resistance and dysglycemia. However, our understanding of these relationships is still evolving, and is sometimes confusing and occasionally contradictory. Comparison of studies is hampered by the lack of uniform definitions of what is being measured, limitations of self-reporting, short duration of studies, and accounting for severity of co-morbidities. Four articles in this issue of the Journal of Diabetes provide significant contributions to our understanding of the relationship between sleep and diabetes. Zhang et al. studied the prevalence of obstructive sleep apnea (OSA) in a population of type 2 diabetics (T2DM) hospitalized primarily for poor glycemic control and examined the relationships between demographics and co-morbidities.1 The hospital is an opportunistic setting for diagnosing OSA and, indeed, screening for OSA may become part of guidelines for in-hospital management of T2DM (AACE/ACE).2 Our Scripps research team helped validate the convenient portable Apnea-Link device used by this study to measure OSA, and found it to be comparable to polysomnography (Erman et al.).3 The researchers were careful in accounting for as many variables as possible, including potential ascertainment bias in who consented to the study versus who did not. The overall OSA prevalence of 66.7% is consistent with prior studies, although the prevalence at different severities of OSA is difficult to compare across studies. Also consistent was the observation that, controlling for co-morbidities, OSA did not appear to have an independent association with coronary artery disease, hypertension, or diabetic microvascular complications. A new additional observation was that “lowest oxygen saturation was independently associated with the presence of PDR (proliferative diabe