Rapid Improvement of Blood Glucose Level after Prosthetic Mandibular Advancement in a Patient with Diabetes Mellitus and Obstructive Sleep Apnea
DOI:
https://doi.org/10.17140/DROJ-1-110Keywords:
Obstructive sleep apnea, Continuous glucose monitoring system, Prosthetic mandibular, advancement, Type 2 diabetes mellitus, Insulin resistanceAbstract
Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is often associated with impaired glucose metabolism. However, the effects of Prosthetic Mandibular Advancement (PMA) on blood glucose levels and insulin resistance remain unclear. Therefore, we assessed the immediate effect of PMA on glycemic control measured using a Continuous Glucose Monitoring System (CGMS) in a patient with Type 2 Diabetes Mellitus (T2DM) and OSAS. Case presentation: A 77-year-old Japanese woman with T2DM was diagnosed with OSAS
with a Respiratory Disturbance Index (RDI) of 39.3. Because the patient did not accept Continuous Positive Airway Pressure (CPAP) therapy, she wore a PMA that advanced the mandible 7 mm forward. Overnight sleep apnea monitoring and CGM were performed before and after wearing the PMA. PMA induced a marked reduction in RDI from 39.3 to 12.8, an increase in the minimum hemoglobin saturation from 78.0% to 87.0%, and a decrease in the number of episodes of oxygen desaturation of >4% below baseline in during the bedtime from 31.3 /h to 12.1 /h. The mean glucose level markedly improved with PMA from 126.1 to 100.5 mg/dL. Conclusion: The patient with showed improvement in RDI and glucose levels after wearing the PMA overnight. To our knowledge, this is the first case of a patient with OSAS and T2DM showing a beneficial effect of PMA on rapid glycemic control. CGMS may greatly help to promote
compliance with the treatment of OSAS in patients with T2DM.
References
Chin K, Oga T, Takahashi K, et al. Associations between ob-structive sleep apnea, metabolic syndrome, working population in Japan. Sleep. 2010; (33): 89-95.
Coughlin SR, Mawdlsey L, Mugarza JA, et al. Obstructive sleep apnea is independently associated with an increased preva-lence of metabolic syndrome. Eur Heart J. 2004; 25: 735-741. doi: 10.1016/j.ehj.2004.02.021
Tiihonen M, Partinen M, Narvanen S. The severity of obstruc-tive sleep apnea is associated with insulin resistance. J Sleep Res. 1993; 2: 56-61.
Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep ap-nea and daytime sleepiness and fatigue: relation to visceral obe-sity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab. 2000; 85: 1151-1158.
Punjabi MN, Sorkin JD, Katzel LI, et al. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med. 2002; 165: 677-678. doi: 10.1164/ajrccm.165.5.2104087
Babu A, Herdegen J, Fogelfeld L, et al. Type 2 diabetes, gly-cemic control, and continuous positive airway pressure in ob-structive sleep apnea. Arch Intern Med. 2005; 165: 447-452. doi: 10.1001/archinte.165.4.447
Hassaballa H, Tulaimat A, Herdegen J, et al. The effect of continuous positive airway pressure on glucose control in dia-betic patients with severe obstructive sleep apnea. Sleep Breath. 2005; 9: 176-180. doi: 10.1007/s11325-005-0033-y
Mastrototaro J. The MiniMed Continuous glucose monitoring system (CGMS). J Pediatr Endocrinol Metab. 1999; 12: 751- 758.
ASDA-Diagnostic Classification Steering Committee. The International Classification of Sleep Disorders. Diagnostic and Coding Manual, 2nd ed. Lawrence, KS: Allen Press Inc, Wash-ington DC, 1997.
Peled N, Kassirer M, Shitrit D, et al. The association of OSAS with insulin resistance, inflammation and metabolic syn-drome. Respir Med. 2007; 101: 2007.
Tamura A, Kawano Y, Watanabe T, et al. Relationship be-tween the severity of obstructive sleep apnea and impaired glu-cose metabolism in patients with obstructive sleep apnea. Respir Med. 2008; 102: 1412-1416. doi: 10.1016/j.rmed.2008.04.020
Meslier N, Gagnadoux F, Giraud P, et al. Impaired glu-cose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J. 2003; 22: 156-160. doi: 10.1183/09031936.03.00089902
Ip MS, Lam B, Ng MM, et al. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002; 165: 670-676.
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