title: Cardiovascular autonomic neuropathy contributes to sleep apnea in young and lean type 1 diabetes mellitus patients.
abstract: Knowledge about association between sleep apnea and cardiovascular autonomic neuropathy (CAN) in type 1 diabetes mellitus (T1DM) might give some insight into the pathogenesis of this condition in these patients. In obese patients, excessive central adiposity, including a large neck circumference, can contribute to obstructive sleep apnea (OSA). Its presence in non-obese patients, however, indicates that it could be correlated with autonomic neuropathy. The aim of this study was to compare the prevalence of OSA in young and lean T1DM patients with and without CAN. We studied 20 adult, non-obese, T1DM patients who were divided into two groups according to the results of the cardiovascular autonomic reflex tests (CARTs). These two groups (9 with CAN and 11 without CAN) were compared to a control group of 22 healthy individuals, who were matched by age and BMI. A polysomnography was performed and sleep was analyzed. The CAN+ group had a significantly higher prevalence of sleep apnea compared to the other groups (67% CAN+; 23% CAN-; 4.5% controls: CAN+ vs. Control; p = 0.006 and CAN+ vs. CAN-; p = 0.02). The CAN- group had higher sleep efficiency compared to the CAN+ group, demonstrating impaired sleep architecture in diabetics with this chronic complication. In conclusion, OSA may be related to the presence of CAN in young and lean T1DM patients. It could contribute to worse the prognosis and reducing the quality of life of these patients without specific treatment of these conditions.
authors.affiliation: Endocrinology and Diabetes Division, Medicine Department, Universidade Federal de São Paulo , São Paulo , Brazil.
authors.forename: Carolina Castro Porto Silva
authors.initials: CC
authors.lastname: Janovsky
authors.affiliation: Endocrinology and Diabetes Division, Medicine Department, Universidade Federal de São Paulo , São Paulo , Brazil.
authors.forename: Luiz Clemente de Souza Pereira
authors.initials: LC
authors.lastname: Rolim
authors.affiliation: Endocrinology and Diabetes Division, Medicine Department, Universidade Federal de São Paulo , São Paulo , Brazil.
authors.forename: João Roberto
authors.initials: JR
authors.lastname: de Sá
authors.affiliation: Sleep Medicine Division, Psychobiology Department, Universidade Federal de São Paulo , São Paulo , Brazil.
authors.forename: Dalva
authors.initials: D
authors.lastname: Poyares
authors.affiliation: Sleep Medicine Division, Psychobiology Department, Universidade Federal de São Paulo , São Paulo , Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.affiliation: Clinical Neurology Division, Neurology and Neurosurgery Department, Universidade Federal de São Paulo , São Paulo , Brazil.
authors.forename: Ademir Baptista
authors.initials: AB
authors.lastname: Silva
authors.affiliation: Endocrinology and Diabetes Division, Medicine Department, Universidade Federal de São Paulo , São Paulo , Brazil.
authors.forename: Sergio Atala
authors.initials: SA
authors.lastname: Dib
keywords: diabetic autonomic neuropathy; diabetic complications; heart function tests; obstructive sleep apnea; polysomnography; type 1 diabetes mellitus