Ca&Bone

[The influence of menopause-related obesity and related changes of body fat distribution on the severity of sleep apnea]

GYŐRFI MÁRIA1, SANDRA SÁNDOR1, SZAKÁCS ZOLTÁN2

FEBRUARY 14, 2007

Ca&Bone - 2007;10(01)

[INTRODUCTION - The menopause is associated with an enhanced risk of obesity. During the postmenopausal period changes in the distribution of body fat lead to a variety of disorders. Obesity is among the major risk factors for Obstructive Sleep Apnea Syndrome (OSAS). The prevalence of OSAS increases after the menopause. This study was intended to explore the relationship between the severity of sleep apnea and the quantity, as well as the distribution of body fat in postmenopausal women with this condition. PATIENTS AND METHODS - Sixty-two postmenopausal women (aged 58.6±7.4 years) were studied. Patients suffering from OSAS - established by cardiorespiratory polygraphy - were enrolled. None of the subjects received hormone replacement therapy during the trial. Total and regional quantity of body fat was determined by dualenergy X-ray absorptiometry (DXA). The distribution of body fat, the ratio of android-to-gynoid regional fat, as well as body mass index were automatically calculated by the software of the DXA machine. A specific region was defined to measure the fat content of the cervical region, extending from the mental protuberance to the clavicular plane. The reliability coefficient of the test method was calculated to check the accuracy of regional body fat measurement. The severity of obstructive sleep apnea was determined by cardiorespiratory polygraphy and expressed using the apnea/hypopnea index. RESULTS - Testing for independence in this population revealed the lack of independence between android-type obesity and severe OSAS. Specifically, 74% of patients with severe OSAS were obese (BMI>30 kg/m2). As with the android-type, the khi square test similarly refuted the independence between obesity and the severity of OSAS. Fat content of the cervical region was 25.2% in mild and moderate, and 30.2% in severe OSAS. Two-Sample t-test demonstrated the significant influence of cervical fat content on OSAS severity. CONCLUSION - Elevated BMI, android-type obesity, and higher relative fat content of the cervical region all aggravate obstructive sleep apnea in postmenopausal women.]

AFFILIATIONS

  1. Magyar Honvédség Központi Honvédkórház, Reumatológiai Osztály
  2. Magyar Honvédség Központi Honvédkórház, Alvásdiagnosztikai és Terápiás Centrum

COMMENTS

0 comments

Further articles in this publication

Ca&Bone

[István Holló, MD, professor 1926-2007]

SZŰCS János

Ca&Bone

[Dear Readers and Colleagues!]

HORVÁTH CSABA

Ca&Bone

[The increase of fracture risk in type 1 and type 2 diabetes mellitus]

HULLÓ DANIELLA

[Studies in the last couple of years found more and more convincing evidence about the fact that impaired glucose metabolism leads to structural changes in the skeletal system leading toward osteoporosis. While patients with type 1 diabetes mellitus have decreased bone density, measurement showed increased bone mineral density in patients with type 2 diabetes mellitus. Despite these differences, risk of vertebral and nonvertebral fractures is increased in both groups of diabetic patients. Decreased pancreatic beta cell function is accompanied by several hormonal disturbances leading to decreased bone formation even in the early stage of diabetes. Peak bone mass of diabetic children is lower than found in nondiabetic children. Late complications of diabetes, vascular and neuronal impairments, impaired renal function, and secondary hormonal disturbances are added to this process. IGF-1 may have a crucial role in the pathogenesis of osteoporosis in diabetes. The structure of the molecule is similar to insulin. IGF-1 has effect on normal bone formation, inhibits the apoptosis and interferes with several other metabolic pathways. IGF-1 mediates the effect of growth hormone to the muscular and skeletal system. IGF-1 level decreases with age, and lower level of IGF-1 is found in diabetic patients. Long term complications of diabetes can also occur, which may enhance the process of bone resorption. Although the evidence is growing that fracture risk is higher in diabetic patiens, there are still scientists who question the association between the two disorders.]

Ca&Bone

[Disturbances of the bone metabolism in type 1 diabetic patients]

KERÉNYI ZSUZSA, TAMÁS GYULA, TABÁK Gy. Ádám, SPEIZER SZABINA, SPEER Gábor, MÉSZÁROS SZILVIA, LAKATOS Péter, HORVÁTH CSABA

[AIMS - Because of contradictory data in literature our aim was to study bone metabolic disturbances and their correlates with anthropometric and metabolic parameters in type 1 diabetic patients (T1DM). Since quantitative bone ultrasound (QUS) measures bone qualities different from BMD, and it has only been scarcely investigated in T1DM, our aim was to describe covariates of QUS parameters. PATIENTS AND METHODS - Osteodensitometry was performed (lumbal spine, femur neck - DEXA; calcaneal ultrasound) on 115 T1DM patients (34 male, 81 female; mean age: 41.4±11 [± SD] yrs; BMI: 23.9±3.0 kg/m2; diabetes duration: 21.6±11.7 yrs; HbA1c: 8.1±1.3%). In addition anthropometric, blood pressure and laboratory parameters (HbA1c, lipids, renal function, fibrinogen, homocystein, PTH, TSH, β-CrossLaps, vitamine D3, osteocalcin, osteoprotegerin) were measured, data using a questionnaire were collected. RESULTS - The prevalence of osteoporosis was 9/112 (8%). A further 21/62 patients with osteopenia were found. Disturbances of bone metabolism have been more frequently proven on lumbal spine (p<0.001). Using multiple linear regression modelling, the independent covariates of osteopathy were systolic blood pressure, body weight, β-CrossLaps and cystatin C. The average broadband ultrasound attenuation (BUA) was 114.2±14.9 in males vs. 108.4±16.3 dB/MHz in females (p=0.07), the mean speed of sound (SOS) 1552±26 in males vs. 1559±32 m/s in females (p=0.32). SOS values in addition to bone density were associated with fracture risk. The independent covariates of BUA were body weight and height (R=0.473, p<0.001), and of SOS only fibrinogen (R=0.305, p=0.032). CONCLUSIONS - According to our results the prevalence of osteoporosis in acceptable controlled T1DM patients is relatively low. The more common metabolic calcipenic osteopathy show a correlation with body weight, markers of bone resorption and diabetic complications/co-morbidities (nephropathy, hypertension) being therefore not only an a priori consequence but also a complication of diabetes mellitus. Our data provide baseline data of QUS in type 1 diabetic patients. Because of the frequency of lower bone mineral content and their known high fracture risk bone metabolism screening of T1DM patients has to be considered.]

Ca&Bone

[Higher bone fracture prevalence in postmenopausal pollen allergic women]

FERENCZ VIKTÓRIA, MÉSZÁROS SZILVIA, CSUPOR EMŐKE, TÓTH EDIT, BORS Katalin, FALUS ANDRÁS, HORVÁTH CSABA

[Our aim was to investigate whether pollen allergy can affect bone mass and fractures in postmenopausal women. A total of 125 postmenopausal pollen allergic women (mean age 61.26 years) were split into four groups: treated neither with H1 histamine receptor (H1R) antagonist nor with inhaled corticosteroid (n=43), treated only with H1R antagonist (n=53), treated both with H1R antagonist and inhaled corticosteroid (n=17), treated only with inhaled corticosteroid (n=12) for at least five years, seasonally. One-hundred non-allergic postmenopausal subjects matched for age, body mass index (BMI) and age at menopause served as controls. Overweight and obesity (25 kg/m2 ≤ BMI) were common among allergic women (76%). Allergic patients without treatment had a slightly lower bone density than their non-allergic mates. Untreated allergic had almost triple the rate of prevalent low-energy fractures (distal forearm, hip and clinical vertebral fractures: 34.9%) compared to non-allergic women (13%, χ2 p=0.003). Bone fracture occurred more often in H1R-only treated patients (30.19%) than in controls (χ2 p=0.01), however, clinical vertebral or hip fractures developed neither in those treated only with H1R antagonist nor in those who received both H1R antagonist and inhaled corticosteroid. Bone fractures were more frequent among patients with inhaled steroid treatment than among patients with a combined treatment of inhaled steroid and antihistamine (50% vs. 29.4%). BMI predicted prevalent fractures at 1.278 (95% CI, 1.047 to 1.559, p=0.016) for 1 kg/m2 increase among untreated allergic patients. In conclusion we found a high prevalence of low-energy fractures among pollen-allergic postmenopausal women, which was associated with obesity. It is possible that the H1R antagonists compensate for the negative effect of pollen-allergy and the adverse effect of inhaled corticosteroid treatment on bone fracture risk.]

All articles in the issue

Related contents

Clinical Neuroscience

Positive airway pressure normalizes glucose metabolism in obstructive sleep apnea independent of diabetes and obesity

KABELOĞLU Vasfiye, SENEL Benbir Gulçin, KARADENIZ Derya

The relationship among obstructive sleep apnea syndrome (OSAS), type 2 diabetes mellitus (DM2) and obesity is very complex and multi-directional. Obesity and increased visceral fat are important perpetuating factors for DM2 in patients with OSAS. On the other hand, OSAS itself leads to obesity by causing both leptin and insulin resistance as a consequence of activation of the sympathetic nervous system. Risk for developing DM2 further increases in patients with OSAS and obesity. Data regarding effects of positive airway pressure (PAP) therapy, gold standard treatment for OSAS, on glycemic control were inconsistent due to variability in duration of and adherence to PAP therapy. In our cohort study we investigated effects of PAP treatment on glucose metabolism in normal-weighted non-diabetic OSAS patients, in obese non-diabetic OSAS patients, and in OSAS patients with DM2. We prospectively analyzed 67 patients diagnosed with OSAS and documented to be effectively treated with PAP therapy for three months. Apnea-hypopnea index was highest in the diabetic group, being significantly higher than in the normal-weighted group (p=0.021). Mean HOMA values were significantly higher in obese (p=0.002) and diabetic group (p=0.001) than normal-weighted group; the differences were still significant after PAP therapy. HbA1c levels were significantly higher in diabetic group compared to those in normal-weighted (p=0.012) and obese (p=0.001) groups. After PAP treatment, decrease in HbA1c levels were significant in normal-weighted (p=0.008), obese (p=0.034), and diabetic (p=0.011) groups. There was no correlation with the change in HbA1c levels and age (p=0.212), BMI (p=0.322), AHI (p=0.098) or oxygen levels (p=0.122). Our study showed that treatment of OSAS by PAP therapy offers beneficial effect on glucose metabolism, not only in diabetic patients, but also in obese and normal-weighted OSAS patients. Although data regarding overall effects of PAP therapy on glycemic control present contradictory results in the literature, it should be emphasized that duration and adherence to PAP therapy were main determinants for beneficial outcome of treatment.

Lege Artis Medicinae

[The possibilities of pharmacological treatment of obesity]

PADOS Gyula, SIMONYI Gábor, BEDROS J. Róbert

[There have been attempts to treat obesity with medicines for nearly 100 years, since the discovery of ephedrine. For decades amphetamine derivates and agents stimulating or inhibiting the release of noradrenaline and dopamine have been applied. However, most of theses drugs had to be gradually withdrawn, due to their adverse effects on the cardiovascular and central nervous system or their sympaticotonic effect. Dexfenfluramine (Isolipan), which was introduced in the 90s, did not have such side effects, but it turned out to potentially cause valvular heart disease. Finally, sibutramin (Reductil) was introduced, which again had to be withdrawn in 2010 due to its hypertensive and cardiovascular side effects. After all, we were left without any appetite-suppressant drugs. Orlistat therapy, (Xenical 120 mg, alli 60 mg - OTC), which inhibits the absorption of fat, can eliminate only 30% of the consumed food’s fat content, at the price of gastrointestinal side effects. The latest result of research carried out wordwide is that in 2012 the FDA approved commercial distribution of the selective 5HT2/c serotonin agonist lorcaserin (Belviq), which enhances satiety, in the USA. Unfortunately, in 2013 the EMEA temporarily postponed the lauch of this drug, until certain adverse effects are excluded. For diabetic patients, the GLP-1 agonist exenatid and the GLP-analog liraglutid, which can also reduce body weight, are available in the form of injections.]

Clinical Oncology

[Obesity and cancer]

VALTINYI Dorottya

[The role of obesity in the development of cancer is well-known from ages. However, these days we witness the explosion-like increase of obesity, globally, but mainly in the economically advanced population, and, which is even more alarming, among youngsters. The prognosis of the obesity-related cancer is rather poor, therefore, the prevention, including the screening, have outstanding importance. Unfortunately, the participation of the obes persons, especially obes women, in these programs is very low. The diagnostics and therapies should consider the special features of obesity, which are related to the magnitude, distribution, composition of fatty tissue connected to the changes in pharmacokinetics. Moreover, the problems might be complicated with obesity-associated non-tumorous severe diseases (e.g. cardiovascular, diabetes type 2).This review covers different aspects of obesity-cancer relationships, with an emphasis on everyday oncology.]

Lege Artis Medicinae

[THE WORLDWIDE EPIDEMIC OF TYPE 2 DIABETES - CAUSES AND CONSEQUENCES]

JERMENDY György

[The prevalence of type 2 diabetes mellitus has recently dramatically increased worldwide. While many factors contribute to the startling data, including changes in the diagnostic criteria of glucose intolerance, increase of life expectancy, manifestation of diabetes at younger ages, and increased detection of unrecognized diabetes due to more efficient screening, the genuine, steep rise in the incidence of diabetes is explained by the increasing prevalence of obesity. Among the late complications of both diabetes and obesity, cardiovascular diseases are particularly important. Insulin resistance due to visceral obesity plays a central role in the pathomechanism of type 2 diabetes. In the prevention of both type 2 diabetes and obesity, non-pharmacological intervention such as life style changes should be considered first. Supplementary pharmacological treatment should target all cardiovascular risk factors.]

Hypertension and nephrology

[Deeper analysis of nebivolol effects]

KÉKES Ede

[Author presents the formation of nitric oxide as a largest vasodilator of human endothelium as well as the endothelial dysfunction a result of formation at adrenergic stimulus. He demonstrates in detail the benefits of selective β-1 blocker and β-3 adrenergic agonist nebivolol in the vascular system. This drug has also receptor independent effects. Complex effects of nebivolol causes vasodilation, inhibits oxidative stress and it is capable to neutralize the effects of free oxygen radicals and as a result the endothelial function will be better. Its clinical effects and the less wellknown beneficial properties are listed. The use of drug is discussed especially in hypertensives with smoking, COPD or PAD. The β-3 agonist effect provides positive reactions not only in the adipocytes and the myocardial tissue. but in the skeletal muscle as well: Increase in energy expenditure - as a compensatory mechanism - is increased in obesity and the glucose uptake + storage on skeletal muscle cells are increased in hyperglycemia. The insulin sensitivity will be better, leptin level is decreased, adiponectin level is increased by nebivolol. It is assumed this drug has antidiabetic and anti-obesity effects.]