Diabetic Central Neuropathy: A Cause of Central Sleep Apnea
Main Article Content
Abstract
Diabetes Mellitus, prolonged hyperglycemia, causes peripheral and central nervous system dysfunction. Chronic hyperglycemia causes changes in the sorbitol, inositol and taurine content of peripheral and central nervous system tissue. The proteins in these tissues are also altered by glycosylation end products. The changes in metabolites impair growth and development of nerves and the increased glycosylation end products make the proteins stiff, sticky and prone to physical injury. This activity stimulated by hyperglycemia impairs the normal function of the peripheral and central nervous system. Manifestations of this tissue injury have been loss of sensation and increased pain in the extremities, loss of proprioception when standing, dysregulation of gastrointestinal motility, and heart rate. Also noted in children are delayed maturation of cognitive function during childhood and more rapid decline of cognitive function with increasing age and increasing HbA1c.
Sleep apnea has become an important cause of heart failure and death commonly linked to type 2 diabetes and obesity. Continuous pressure airway pressure (CPAP) does overcome the periods of obstruction and prevents the morbidity associated with obstructive sleep apnea (OSA). Forty-Six percent of type 1 diabetic patients have absence of effort sleep apnea which means it is a central lack of drive to breath. There is evidence of change of structure in the medulla of subjects with type 1 diabetes as well as evidence of injuries in the medulla that cause cessation of breathing. These observations indicate that central neuropathy caused by hyperglycemia does cause central sleep apnea and possibly death.
Article Details
How to Cite
MALONE, John.
Diabetic Central Neuropathy: A Cause of Central Sleep Apnea.
Medical Research Archives, [S.l.], v. 9, n. 12, dec. 2021.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2608>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v9i12.2608.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Jacobson AM, Ryan CM, Braffett BH, et al. and the DCCT/EDIC Research Group. Cognitive performance declines in older adults with type 1 diabetes: results from 32 years of follow-up in the DCCT and EDIC study. Lancet Diabetes Endocrinol. 2021; 9(7):436-45.
3. Mazaika PK, Weinzimer SA, Mauras N, et al. Diabetes Research in Children Network (DirecNet). Variations in Brain Volume and Growth in Young Children with Type 1 Diabetes. Diabetes 2016; 65(2): 476-485.
4. Mauras N, Buckingham B, White NH, et al. Impact of Type 1 Diabetes in the Developing Brain in Children: A Longitudinal Study. Diabetes Care, 2021; 44: 1-10.
5. Brands AM, Biessels GJ, de Haan EH, et al. The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care 2005; 28: 726-35.
6. Naguib JM, Kulinskaya E, Lomax CL, Garralda ME. Neuro-cognitive performance in children with type 1 diabetes--a meta-analysis. J Pediatric Psychology 2009; 34: 271-82.
7. Hershey T, Craft S, Bhargava N, White NH. Memory and insulin-dependent diabetes mellitus (IDDM): effects of childhood-onset and severe hypoglycemia. Journal of International Neuropsychology Society 1997; 3: 509-20.
8. Salem MA, Matta LF, Tantawy AA, et al. Single-photon emission tomography (SPECT) study of regional cerebral blood flow in normoalbuminuric children and adolescents with type 1 diabetes. Pediatr. Diabetes 2002; 3:155-62.
9. Quirce R, Carril JM, Jiménez-Bonilla JF, et al. Semi-quantitative assessment of cerebral blood flow with 99mTc-HMPAO SPET in type I diabetic patients with no clinical history of cerebrovascular disease. Eur J Nucl Med Mol Imaging. 1997; 24: 1507-13.
10. Hyllienmark L, Maltez J, Dandenell A, Ludvigsson J, Brismar T. EEG abnormalities with and without relation to severe hypoglycemia in adolescents with type 1 diabetes. Diabetologia 2005; 48: 412-9.
11. Seidl R, Birnbacher R, Hauser E, Bernert G, Freilinger M, Schober E. Brainstem auditory evoked potentials and visually evoked potentials in young patients with IDDM. Diabetes Care 1996; 19: 1220-24.
12. de Boer IH, for the DCCT/EDIC Research Group. Renal Disease and related findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Diabetes Care 2014, 37(1):24-30. PMC3867994. 133.
13. Jacobson AM, Paterson A, Ryan C, et al., and the DCCT/EDIC Research Group. The associations of apolipoprotein E and angiotensin converting enzyme polymorphisms and cognitive function in type 1 diabetes based on an 18 year follow-up of the DCCT cohort. Diabetic Medicine 2010; 27(1):15-22. PMC3043372.
The DCCT/EDIC Research Group (Writing Committee: Jacobson AM, Ryan CM, Cleary P, et al. Long-term effect of diabetes and its treatment on cognitive function. N Engl J Med 2007; 356(18):1842-1852. PMC2701294
14. Sharma JBR, Lee D, Hachinski V, Chan RKT. Cerebral Atrophy in Young, Otherwise Healthy Patients with Type 1 Diabetes Mellitus. Neurology 2003; (Supplement 3) 60:
15. Wessels AM, Simsek S, Remijnse PL, et al. Voxel-based morphometry demonstrates reduced grey matter density on brain MRI in patients with diabetic retinopathy. Diabetologia 2006; 49: 2474-80.
16. Malone JI, Benford SA, Malone J, Jr. Taurine prevents galactose-induced cataracts. J. Diabetes Complicat. 1993; 7: 44-48.
17. Chen X, Pan Z, Liu D, Han X. Effect of taurine on human fetal neuron cells: proliferation and differentiation. Adv. Exp. Med. Biol. 1998; 442: 397-403.
18. Uchida Y, Sugiura S, Nishita Y, Saji N, Sone M, Ueda H. Age-related hearing loss and cognitive decline – The potential mechanisms linking the two. Aurisa Nasus Larynx 2019; 46: 1-9.
19. Braffett BH, Lorenzi GM, Cowie CC, et al. and the DCCT/EDIC Research Group. Risk factors for hearing impairment in type 1 diabetes. Endocr Pract 2019; 25(12):1243-54. PMC7217092.
20. Puri BK, Lewis HJ, Saeed N, Davey NJ. Volumetric Change of the Lateral Ventricles in the Human Brain Following Glucose Loading. Exp. Physiol. 1999; 84: 223-226.
21. Chohan H, Senkevich K, Patel RK, et al. Type 2 Diabetes as a Determinant of Parkinson’s disease Risk and Progression. Mov Disord 2021; 36: 1420-1429.
22. Szendroedi J, Phielix E, Roden M, The role of mitochondria in insulin resistance and type 2 diabetes mellitus. Nat Rev Endocrinol. 2011; 8: 92-103.
23. Maluf FC, Feder D, de Siqueira Carvalho AA. Analysis of the Relationship between Type II Diabetes Mellitus and Parkinson’s Disease: a Systemic Review. Parkinson’s Disease 2019; 2019: 1-14. https://doi.org/10.1155/2019/4951379
24. Horvatha I, Wittung-Stafshedea P. Crosstalk between amyloidogenic proteins in type-2 diabetes and Parkinson’s disease. PNAS USA 2016; 113: 12473-12477.
25. Chapman A, Meyer C, Renehan E, Hill KD, Browning CJ. Exercise intervention for the improvement of falls-related outcomes among older adults with diabetes mellitus: A systemic review and meta-analyses. . J. Diabetes Complicat. 2017; 31: 631- 645.
26. Corriveau H , Prince F, Hébert R, et al. Evaluation of postural stability in elderly with diabetic neuropathy. Diabetes Care 2000; 23: 1187-1191.
27. Schwartz AV , Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care 2002; 25: 1749-1754.
28. Myers SF, Ross MD. Morphological evidence of vestibular pathology in long-term experimental diabetes mellitus, II: connective tissue and neuroepithelial pathology. Acta Otolaryngol. 1987; 104: 40-49.
29. Gawron W, Pospiech L, Orendorz-Fraczkowska K, Noczyska A. Are there any disturbances in vestibular organ of children and young adults with Type 1 diabetes? Diabetologia 2002; 45: 728-734.
30. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Diabetes vestibular dysfunction, and falls: analyses from the National Health and Nutrition Examination Survey. Otol. Neurotol. 2010; 31: 1445-1450.
31. Bodranghien F, Bastian A, Casali C, et al. Consensus Paper: Revisiting the Symptoms and Signs of Cerebellar Syndrome. Cerebellum 2016; 15: 369-391.
32. D’Silva LJ, Lin J, Staeecker H, Whitney SL, Kluding PM. Impact of Diabetic Complications on Balance and Falls: Contribution of the Vestibular System. Physical Therapy 2016; 96: 400-409.
33. Lacuey N, Hampson JP, Harper RM, Miller JP, Lhatoo S. Limbic and paralimbic structures driving central ictal apnea. Neurology 2019; 92: e655-669.
34. Reutrakul S, Mokhlesi B. Obstructive Sleep Apnea and Diabetes. A state of the Art Review. Chest 2017; 152: 10701086.
35. Banghoej AM, Nerild HH, Kristensen PL , Pedersen-Bjergaard U, et al. Obstructive sleep apnea is frequent in patients with type 1 diabetes. J. Diabetes Complicat. 2017; 31: 156-161.
36. Dempsey JA. Central sleep apnea: misunderstood and mistreated! [version 1; peer review: 2 approved]. F1000Research 2019, 8(F1000 Faculty Rev):981.
37. Eckert DJ, Jordan AS, Merchia P, Mallotra A. Central Sleep Apnea Pathophysiology and Treatment. Chest, 2007; 131: 595-607.
38. Glotzbach SF, Baldwin RB, Lederer NE, Tansey PA, Ariangno RI. Periodic breathing in preterm babies: incidence and characteristics. Pediatrics 1989; 84: 785-792.
39. West JB, Peters RM, Aksnes G, Maret KH, Milledge JS, Schoene RB. Normal periodic breathing at altitudes of 6300 and 8050 m. J. Appl. Physiol. 1986; 61: 280-287.
40. McDonald M, Fang J, Pittman SD, White DP, Malhotra A. The current prevalence of sleep-disordered breathing in congestive heart failure patients untreated with beta-blockers. J Clin Sleep Med. 2008; 4: 38-42.
41. Leung RS, Diep TM, Bowman ME, Lorenzi-Filho G, Bradley TD. Provocation of ventricular ectopy by Cheyne-Stokes respiration in patients with heart failure. Sleep 2004; 27: 1337-1343.
42. Mehra R. Sleep apnea and the heart. Cleve Clin J Med. 2019; 86: (Supplement 1) 12-18.
43. Alheid GF, McCrimmon DR. The chemical neuroanatomy of breathing. Respir Physiol Neurobiol. 2008; 164: 3-11.
44. Nobis WP, Schuele S, Templer JW, et al. Amygdala-Stimulation-Induced Apnea Is Attention and Nasal-Breathing Dependent. Ann. Neurol. 2018; 83: 460-471.
45. Orr JE, Malhotra A, Sands SA. Pathogenesis of central and complex sleep apnea. Respirology 2017; 2: 43-52.
46. Martin CL, Albers JW, Pop-Busui R, DCCT/EDIC Research Group. Neuropathy and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care 2014; 37: 31-38.
2. Jacobson AM, Ryan CM, Braffett BH, et al. and the DCCT/EDIC Research Group. Cognitive performance declines in older adults with type 1 diabetes: results from 32 years of follow-up in the DCCT and EDIC study. Lancet Diabetes Endocrinol. 2021; 9(7):436-45.
3. Mazaika PK, Weinzimer SA, Mauras N, et al. Diabetes Research in Children Network (DirecNet). Variations in Brain Volume and Growth in Young Children with Type 1 Diabetes. Diabetes 2016; 65(2): 476-485.
4. Mauras N, Buckingham B, White NH, et al. Impact of Type 1 Diabetes in the Developing Brain in Children: A Longitudinal Study. Diabetes Care, 2021; 44: 1-10.
5. Brands AM, Biessels GJ, de Haan EH, et al. The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care 2005; 28: 726-35.
6. Naguib JM, Kulinskaya E, Lomax CL, Garralda ME. Neuro-cognitive performance in children with type 1 diabetes--a meta-analysis. J Pediatric Psychology 2009; 34: 271-82.
7. Hershey T, Craft S, Bhargava N, White NH. Memory and insulin-dependent diabetes mellitus (IDDM): effects of childhood-onset and severe hypoglycemia. Journal of International Neuropsychology Society 1997; 3: 509-20.
8. Salem MA, Matta LF, Tantawy AA, et al. Single-photon emission tomography (SPECT) study of regional cerebral blood flow in normoalbuminuric children and adolescents with type 1 diabetes. Pediatr. Diabetes 2002; 3:155-62.
9. Quirce R, Carril JM, Jiménez-Bonilla JF, et al. Semi-quantitative assessment of cerebral blood flow with 99mTc-HMPAO SPET in type I diabetic patients with no clinical history of cerebrovascular disease. Eur J Nucl Med Mol Imaging. 1997; 24: 1507-13.
10. Hyllienmark L, Maltez J, Dandenell A, Ludvigsson J, Brismar T. EEG abnormalities with and without relation to severe hypoglycemia in adolescents with type 1 diabetes. Diabetologia 2005; 48: 412-9.
11. Seidl R, Birnbacher R, Hauser E, Bernert G, Freilinger M, Schober E. Brainstem auditory evoked potentials and visually evoked potentials in young patients with IDDM. Diabetes Care 1996; 19: 1220-24.
12. de Boer IH, for the DCCT/EDIC Research Group. Renal Disease and related findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Diabetes Care 2014, 37(1):24-30. PMC3867994. 133.
13. Jacobson AM, Paterson A, Ryan C, et al., and the DCCT/EDIC Research Group. The associations of apolipoprotein E and angiotensin converting enzyme polymorphisms and cognitive function in type 1 diabetes based on an 18 year follow-up of the DCCT cohort. Diabetic Medicine 2010; 27(1):15-22. PMC3043372.
The DCCT/EDIC Research Group (Writing Committee: Jacobson AM, Ryan CM, Cleary P, et al. Long-term effect of diabetes and its treatment on cognitive function. N Engl J Med 2007; 356(18):1842-1852. PMC2701294
14. Sharma JBR, Lee D, Hachinski V, Chan RKT. Cerebral Atrophy in Young, Otherwise Healthy Patients with Type 1 Diabetes Mellitus. Neurology 2003; (Supplement 3) 60:
15. Wessels AM, Simsek S, Remijnse PL, et al. Voxel-based morphometry demonstrates reduced grey matter density on brain MRI in patients with diabetic retinopathy. Diabetologia 2006; 49: 2474-80.
16. Malone JI, Benford SA, Malone J, Jr. Taurine prevents galactose-induced cataracts. J. Diabetes Complicat. 1993; 7: 44-48.
17. Chen X, Pan Z, Liu D, Han X. Effect of taurine on human fetal neuron cells: proliferation and differentiation. Adv. Exp. Med. Biol. 1998; 442: 397-403.
18. Uchida Y, Sugiura S, Nishita Y, Saji N, Sone M, Ueda H. Age-related hearing loss and cognitive decline – The potential mechanisms linking the two. Aurisa Nasus Larynx 2019; 46: 1-9.
19. Braffett BH, Lorenzi GM, Cowie CC, et al. and the DCCT/EDIC Research Group. Risk factors for hearing impairment in type 1 diabetes. Endocr Pract 2019; 25(12):1243-54. PMC7217092.
20. Puri BK, Lewis HJ, Saeed N, Davey NJ. Volumetric Change of the Lateral Ventricles in the Human Brain Following Glucose Loading. Exp. Physiol. 1999; 84: 223-226.
21. Chohan H, Senkevich K, Patel RK, et al. Type 2 Diabetes as a Determinant of Parkinson’s disease Risk and Progression. Mov Disord 2021; 36: 1420-1429.
22. Szendroedi J, Phielix E, Roden M, The role of mitochondria in insulin resistance and type 2 diabetes mellitus. Nat Rev Endocrinol. 2011; 8: 92-103.
23. Maluf FC, Feder D, de Siqueira Carvalho AA. Analysis of the Relationship between Type II Diabetes Mellitus and Parkinson’s Disease: a Systemic Review. Parkinson’s Disease 2019; 2019: 1-14. https://doi.org/10.1155/2019/4951379
24. Horvatha I, Wittung-Stafshedea P. Crosstalk between amyloidogenic proteins in type-2 diabetes and Parkinson’s disease. PNAS USA 2016; 113: 12473-12477.
25. Chapman A, Meyer C, Renehan E, Hill KD, Browning CJ. Exercise intervention for the improvement of falls-related outcomes among older adults with diabetes mellitus: A systemic review and meta-analyses. . J. Diabetes Complicat. 2017; 31: 631- 645.
26. Corriveau H , Prince F, Hébert R, et al. Evaluation of postural stability in elderly with diabetic neuropathy. Diabetes Care 2000; 23: 1187-1191.
27. Schwartz AV , Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care 2002; 25: 1749-1754.
28. Myers SF, Ross MD. Morphological evidence of vestibular pathology in long-term experimental diabetes mellitus, II: connective tissue and neuroepithelial pathology. Acta Otolaryngol. 1987; 104: 40-49.
29. Gawron W, Pospiech L, Orendorz-Fraczkowska K, Noczyska A. Are there any disturbances in vestibular organ of children and young adults with Type 1 diabetes? Diabetologia 2002; 45: 728-734.
30. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Diabetes vestibular dysfunction, and falls: analyses from the National Health and Nutrition Examination Survey. Otol. Neurotol. 2010; 31: 1445-1450.
31. Bodranghien F, Bastian A, Casali C, et al. Consensus Paper: Revisiting the Symptoms and Signs of Cerebellar Syndrome. Cerebellum 2016; 15: 369-391.
32. D’Silva LJ, Lin J, Staeecker H, Whitney SL, Kluding PM. Impact of Diabetic Complications on Balance and Falls: Contribution of the Vestibular System. Physical Therapy 2016; 96: 400-409.
33. Lacuey N, Hampson JP, Harper RM, Miller JP, Lhatoo S. Limbic and paralimbic structures driving central ictal apnea. Neurology 2019; 92: e655-669.
34. Reutrakul S, Mokhlesi B. Obstructive Sleep Apnea and Diabetes. A state of the Art Review. Chest 2017; 152: 10701086.
35. Banghoej AM, Nerild HH, Kristensen PL , Pedersen-Bjergaard U, et al. Obstructive sleep apnea is frequent in patients with type 1 diabetes. J. Diabetes Complicat. 2017; 31: 156-161.
36. Dempsey JA. Central sleep apnea: misunderstood and mistreated! [version 1; peer review: 2 approved]. F1000Research 2019, 8(F1000 Faculty Rev):981.
37. Eckert DJ, Jordan AS, Merchia P, Mallotra A. Central Sleep Apnea Pathophysiology and Treatment. Chest, 2007; 131: 595-607.
38. Glotzbach SF, Baldwin RB, Lederer NE, Tansey PA, Ariangno RI. Periodic breathing in preterm babies: incidence and characteristics. Pediatrics 1989; 84: 785-792.
39. West JB, Peters RM, Aksnes G, Maret KH, Milledge JS, Schoene RB. Normal periodic breathing at altitudes of 6300 and 8050 m. J. Appl. Physiol. 1986; 61: 280-287.
40. McDonald M, Fang J, Pittman SD, White DP, Malhotra A. The current prevalence of sleep-disordered breathing in congestive heart failure patients untreated with beta-blockers. J Clin Sleep Med. 2008; 4: 38-42.
41. Leung RS, Diep TM, Bowman ME, Lorenzi-Filho G, Bradley TD. Provocation of ventricular ectopy by Cheyne-Stokes respiration in patients with heart failure. Sleep 2004; 27: 1337-1343.
42. Mehra R. Sleep apnea and the heart. Cleve Clin J Med. 2019; 86: (Supplement 1) 12-18.
43. Alheid GF, McCrimmon DR. The chemical neuroanatomy of breathing. Respir Physiol Neurobiol. 2008; 164: 3-11.
44. Nobis WP, Schuele S, Templer JW, et al. Amygdala-Stimulation-Induced Apnea Is Attention and Nasal-Breathing Dependent. Ann. Neurol. 2018; 83: 460-471.
45. Orr JE, Malhotra A, Sands SA. Pathogenesis of central and complex sleep apnea. Respirology 2017; 2: 43-52.
46. Martin CL, Albers JW, Pop-Busui R, DCCT/EDIC Research Group. Neuropathy and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care 2014; 37: 31-38.