Home ▶ Unknown
June 2012

Obstructive Sleep Apnea is Associated with Diabetic Peripheral Neuropathy

Obstructive sleep apnea (OSA) is independently associated with diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM), according to a new study from researchers in the UK. The severity of DPN is also correlated with the degree of OSA and the severity of nocturnal hypoxemia.

“OSA is known to be associated with inflammation and oxidative stress, so we hypothesized that it would be associated with peripheral neuropathy in patients with T2DM,” said lead author Abd Tahrani, MD, clinical lecturer in endocrinology and diabetes at the University of Birmingham in the UK. “This is the first report to identify an independent association between OSA and DPN in these patients.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

In the observational cross-sectional study, DPN was assessed with the Michigan Neuropathy Screening instrument in 234 adults with T2DM. OSA was assessed with a single overnight home-based cardio-respiratory sleep study using a portable multi-channel device.

OSA was independently associated with DPN even after adjustment for a number of possible confounders, including ethnicity, gender, age at diabetes diagnosis, and diabetes duration, and remained independently associated with DPN after further adjustment for obesity and other risk factors for DPN. In addition, DPN severity was significantly correlated with OSA severity and nocturnal hypoxemia severity. The relationship between OSA severity and DPN severity remained significant after adjustment for age, obesity, diabetes duration, gender and estimated glomerular filtration rate.

The researchers also found that OSA was associated with increased nitrosative/oxidative stress and impaired microvascular blood flow regulation, which could explain the relationship observed between OSA and DPN. “In patients with T2DM, OSA may aggravate and amplify glucose toxicity, which has significant implications for tissues which are susceptible to the complications of diabetes,” said Dr. Tahrani.

The study had some limitations, including its cross-sectional design and lack of an interventional arm, making proof of causation necessary in additional prospective studies.

“Additional prospective and interventional studies are also needed to examine the role of OSA and intermittent hypoxemia in the development and progression of DPN in patients with both early and advanced diabetes, and to assess the potential impact of continuous positive airway pressure (CPAP) treatment on DPN,” Dr. Tahrani said.

To read the article in full, please visit: http://www.thoracic.org/about/newsroom/press-releases/resources/tahrani.pdf.

Contact for article: Dr. Abd A Tahrani, MIDRU, Birmingham Heartlands Hospital, Birmingham B9 5SS,
UK Phone: +44-7801549960
Email: a.a.tahrani@bham.ac.uk

American Thoracic Society Applauds EPA's National Ambient Air Quality Standard

The American Thoracic Society applauds the Environmental Protection Agency’s proposed lower National Ambient Air Quality Standard for fine particulate matter.

“Extensive scientific evidence has shown that exposure to particle pollution is associated with premature death and a wide variety of significant health issues, including cardiovascular and respiratory problems,” said ATS President Monica Kraft, M.D. "Particulate matter is also associated with the development of chronic respiratory disease. With this new rule, the EPA has taken an important step toward improving public health."

The EPA’s action is in response to a court order to issue proposed rules in June and finalize a revised standard for particulate matter by this December. The current standard of 15 ug/m3 annual average and 35 ug/m3 daily average was established in 2006 during the Bush Administration and has been rejected by the courts as failing to protect public health as required under the Clean Air Act. The courts remanded the standard back to the EPA for reconsideration. The Obama Administration initially agreed to review the standard by 2011, but later announced that it would address the standard in 2013.

As a result of further court action from the environmental community, the courts ordered the EPA to issue a proposed particulate matter standard by June 15, 2012, and a final standard by December 14, 2012. The EPA’s new proposed rule is in the range of: 12-13 ug/m3 annual average/35 ug/m3 daily average.

The ATS is pleased that the EPA is moving forward with this important public health rule. The ATS supports a particulate matter standard of 11 ug/m3 annual average and 25 ug/m3 daily average, and will review the proposed rule and will submit comments during the open public comment period.

Supreme Court Upholds Affordable Care Act

June 28, 2012

The American Thoracic Society is pleased that the U.S. Supreme Court has upheld the constitutionality of the Affordable Care Act, including the so-called individual mandate.

While far from perfect, the law extends health insurance coverage to the majority of Americans while providing an overall structure for the U.S. health care system.

In the majority opinion written by Chief Justice John Roberts, the Supreme Court did note that another key provision of the Affordable Care Act—the expansion of Medicaid—is constitutional but that it would be unconstitutional for the federal government to withhold new Medicaid funds for non-compliance with the expansion provisions.

“Nothing in our opinion precludes Congress from offering funds under the Affordable Care Act to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use,” the Court ruled. “What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”

The American Thoracic Society believes health care is a right for all Americans. For the first time in our nation’s history, a system has been created to move us closer toward fulfillment of health care as a right for all Americans.

The American Thoracic Society looks forward to continuing to work with states, Congress and the Administration to both implement and improve this important legislation.

Read the Court’s full opinion by clicking here.