@article {Mart{\'\i}nezCer{\'o}n2015128,
	title = {S{\'\i}ndrome de apneas-hipopneas del sue{\~n}o y diabetes tipo 2. {\textquestiondown}Una relaci{\'o}n de ida y vuelta?},
	journal = {Archivos de Bronconeumolog{\'\i}a},
	volume = {51},
	number = {3},
	year = {2015},
	note = {n/a},
	pages = {128 - 139},
	abstract = {<p>Resumen Diversos datos epidemiol{\'o}gicos muestran que el s{\'\i}ndrome de apneas-hipopneas del sue{\~n}o (SAHS) se relaciona independientemente con el desarrollo de resistencia a la insulina e intolerancia a la glucosa. Adem{\'a}s, y pese a la existencia de notables limitaciones metodol{\'o}gicas, algunos estudios refieren una elevada prevalencia de \{SAHS\} en pacientes con diabetes tipo 2 (DM2). Un reciente metaan{\'a}lisis muestra que el \{SAHS\} moderado-grave se asocia a un mayor riesgo de \{DM2\} (riesgo relativo\&$\#$xa0;=\&$\#$xa0;1,63 [1,09-2,45]), en relaci{\'o}n con la ausencia de apneas-hipopneas. La existencia de alteraciones comunes de diversas v{\'\i}as patog{\'e}nicas le proporciona plausibilidad biol{\'o}gica a esta relaci{\'o}n. La hipoxia intermitente y la fragmentaci{\'o}n del sue{\~n}o, originadas por la sucesi{\'o}n de episodios de apneas-hipopneas, inducen diversos trastornos intermedios, como la activaci{\'o}n del sistema nervioso simp{\'a}tico, el estr{\'e}s oxidativo, la inflamaci{\'o}n sist{\'e}mica, alteraciones en las hormonas reguladoras del apetito y activaci{\'o}n del eje hipot{\'a}lamo-hip{\'o}fiso-suprarrenal, que favorecen el desarrollo de resistencia a la insulina, as{\'\i} como su progresi{\'o}n a intolerancia a la glucosa y, en {\'u}ltima instancia, a DM2. La coexistencia del \{SAHS\} parece agravar la evoluci{\'o}n de la DM2, al empeorar el control gluc{\'e}mico y potenciar el efecto de la aterosclerosis en el desarrollo de complicaciones macrovasculares. Adem{\'a}s, el \{SAHS\} podr{\'\i}a asociarse al desarrollo de complicaciones microvasculares, particularmente la retinopat{\'\i}a, nefropat{\'\i}a o neuropat{\'\i}a diab{\'e}ticas. Aunque todav{\'\i}a escasos, algunos datos sugieren que la \{DM2\} tambi{\'e}n podr{\'\i}a empeorar la evoluci{\'o}n del SAHS, al favorecer la colapsabilidad de la v{\'\i}a a{\'e}rea superior y potenciar la aparici{\'o}n de apneas-hipopneas centrales. Abstract Epidemiological data suggest that sleep apnea-hypopnea syndrome (SAHS) is independently associated with the development of insulin resistance and glucose intolerance. Moreover, despite significant methodological limitations, some studies report a high prevalence of \{SAHS\} in patients with type 2 diabetes mellitus (DM2). A recent meta-analysis shows that moderate-severe \{SAHS\} is associated with an increased risk of \{DM2\} (relative risk\&$\#$xa0;=\&$\#$xa0;1.63 [1.09 to 2.45]), compared to the absence of apneas and hypopneas. Common alterations in various pathogenic pathways add biological plausibility to this relationship. Intermittent hypoxia and sleep fragmentation, caused by successive apnea-hypopnea episodes, induce several intermediate disorders, such as activation of the sympathetic nervous system, oxidative stress, systemic inflammation, alterations in appetite-regulating hormones and activation of the hypothalamic-pituitary-adrenal axis which, in turn, favor the development of insulin resistance, its progression to glucose intolerance and, ultimately, to DM2. Concomitant \{SAHS\} seems to increase \{DM2\} severity, since it worsens glycemic control and enhances the effects of atherosclerosis on the development of macrovascular complications. Furthermore, \{SAHS\} may be associated with the development of microvascular complications: retinopathy, nephropathy or diabetic neuropathy in particular. Data are still scant, but it seems that \{DM2\} may also worsen \{SAHS\} progression, by increasing the collapsibility of the upper airway and the development of central apneas and hypopneas.</p>
},
	keywords = {Glucose},
	issn = {0300-2896},
	doi = {http://dx.doi.org/10.1016/j.arbres.2014.06.017},
	url = {http://www.sciencedirect.com/science/article/pii/S0300289614002749},
	author = {Elisabet Mart{\'\i}nez Cer{\'o}n and Raquel Casitas Mateos and Francisco Garc{\'\i}a-R{\'\i}o}
}
