title: Obstructive sleep apnea syndrome causes a pseudo-Cushing's state in Japanese obese patients with type 2 diabetes mellitus.
abstract: Activation of the hypothalamic-pituitary-adrenal axis has been reported in some patients with the obstructive sleep apnea syndrome (OSAS). In current study, we investigated whether OSAS affect the screening test for subclinical Cushing's disease using 0.5 mg overnight dexamethasone suppression test (DST) in Japanese obese diabetic patients with OSAS. Among Japanese obese patients with type 2 diabetes mellitus who had been hospitalized in our department, we selected 20 patients with moderate to severe untreated OSAS (apnea-hypoxia index, AHI, of ≥15 events/hour). All patients underwent 0.5 mg DST. The same test was repeated in patients with positive response of it within a few days after continuous positive airway pressure (CPAP) therapy. We found that five patients showed positive response of DST (25%). Three of these patients continued to use CPAP, and they showed normal response of DST after CPAP therapy. Serum cortisol after 0.5 mg DST measured before CPAP therapy correlated significantly with fasting serum cortisol level (r=0.764, p<0.0001), but not with various clinical parameters, including AHI (p=0.784), body mass index (p=0.984), waist circumference (p=0.957), HbA1c (p=0.261), fasting plasma glucose (p=0.420) and HOMA-IR (p=0.500). Our study show that OSAS causes a pseudo-Cushing's syndrome in obese patients with type 2 diabetes mellitus, which phenomena can be reversed by CPAP therapy.
authors.affiliation: Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tamada
authors.forename: Michio
authors.initials: M
authors.lastname: Otsuki
authors.forename: Susumu
authors.initials: S
authors.lastname: Kashine
authors.forename: Ayumu
authors.initials: A
authors.lastname: Hirata
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Onodera
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Kitamura
authors.forename: Iichiro
authors.initials: I
authors.lastname: Shimomura
mesh_terms: D000302:Adrenal Cortex / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000378:metabolism; D000328:Adult; D015992:Body Mass Index; D045422:Continuous Positive Airway Pressure; D003480:Cushing Syndrome / Q000175:diagnosis; D003894:Deamino Arginine Vasopressin; D003907:Dexamethasone; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism; D007564:Japan; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D047748:Pituitary ACTH Hypersecretion / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010902:Pituitary Gland / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology*; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*
chemical_list: D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003894:Deamino Arginine Vasopressin; D006854:Hydrocortisone