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The relationship between obstructive sleep apnea and intra-epidermal nerve fiber density, PARP activation and foot ulceration in patients with type 2 diabetes
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Altaf, Quratul-ain Altaf, Ali, Asad, Piya, Milan K., Raymond, Neil T. and Tahrani, Abd A. (Almagid) (2016) The relationship between obstructive sleep apnea and intra-epidermal nerve fiber density, PARP activation and foot ulceration in patients with type 2 diabetes. Journal of Diabetes and its Complications, 30 (7). pp. 1315-1320. doi:10.1016/j.jdiacomp.2016.05.025 ISSN 1056-8727.
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Official URL: http://dx.doi.org/10.1016/j.jdiacomp.2016.05.025
Abstract
Background:
Obstructive sleep apnea (OSA) is associated with increased nitrosative stress, endothelial dysfunction, and peripheral neuropathy in patients with type 2 diabetes. We hypothesized that OSA is associated with Poly ADP ribose polymerase (PARP) activation, lower intra-epidermal nerve fiber density (IENFD), and diabetic foot ulceration (DFU).
Methods:
A cross-sectional study of adults with type 2 diabetes recruited from a secondary care hospital in the UK. OSA was assessed by multi-channel home-based cardio-respiratory device (Alice PDX, Philips Respironics). DPN was assessed using the Michigan Neuropathy Screening Instrument (MNSI). IENFD and % PAR stained nuclei were assessed using immunohistochemistry staining on skin biopsies. DFU was assessed based on MNSI.
Results:
Skin biopsies and DFU data were available from 52 and 234 patients respectively. OSA was associated with lower IENFD (12.75 ± 1.93 vs. 10.55 ± 1.62 vs. 9.42 ± 1.16 fibers/mm of epidermis for no OSA, mild OSA and moderate to severe OSA respectively, p < 0.001). Following adjustment, mild (B = − 2.19, p = 0.002) and moderate to severe OSA (B = − 3.45, p < 0.001) were independently associated with IENFD. The apnea hypopnea index (AHI) was associated with IENFD following adjustment (B = − 2.45, p < 0.001). AHI was associated with percentage of PAR stained nuclei following adjustment (B = 13.67, p = 0.025). DFU prevalence was greater in patients with OSA (7.1% vs. 28.1% vs. 26.2% for patients with no OSA, mild OSA and moderate to severe OSA respectively, p = 0.001). Following adjustment, OSA was associated with DFU (OR 3.34, 95% CI 1.19–9.38, p = 0.022).
Conclusions:
OSA is associated with lower IENFD, PARP activation and DFU in patients with type 2 diabetes. Our findings suggest that OSA is associated with small fiber neuropathy. PARP activation is a potential mechanisms linking OSA to DPN and endothelial dysfunction in patients with type 2 diabetes. Whether OSA treatment will have a favorable impact on these parameters and DFU requires interventional studies.
Item Type: | Journal Article | ||||||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||||
Journal or Publication Title: | Journal of Diabetes and its Complications | ||||||||||
Publisher: | Elsevier Inc. | ||||||||||
ISSN: | 1056-8727 | ||||||||||
Official Date: | September 2016 | ||||||||||
Dates: |
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Volume: | 30 | ||||||||||
Number: | 7 | ||||||||||
Page Range: | pp. 1315-1320 | ||||||||||
DOI: | 10.1016/j.jdiacomp.2016.05.025 | ||||||||||
Status: | Peer Reviewed | ||||||||||
Publication Status: | Published | ||||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||||
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