Sleep architecture, insulin resistance and the nasal cycle: Implications for positive airway pressure therapy

Journal of Insulin Resistance

Field Value
Title Sleep architecture, insulin resistance and the nasal cycle: Implications for positive airway pressure therapy
Creator Crofts, Catherine A.P. Neill, Alister Campbell, Angela Bartley, Jim White, David E.
Subject public health; health technology sleep apnoea; metabolic disease; sympathovagal balance; sleep architecture; hyperinsulinaemia
Description Background: The global pandemic of metabolic disease is worsening. The metabolic theory of obesity proposes that hormonal changes, especially hyperinsulinaemia, precede metabolic disease development. Although quality sleep is recognised as a key factor for good health, less is known about disrupted sleep as a risk factor for hyperinsulinaemia. Aim: To explore the relationship between sleep, especially sleep architecture and the nasal cycle, on insulin secretion in obstructive sleep apnoea (OSA) with comorbid metabolic disease. This review includes a discussion of the potential role of Rest-Activity-Cycler positive airway pressure (RACer-PAP), a novel non-pharmacological OSA treatment strategy. Methods: A narrative review of all the relevant papers known to the authors was conducted. This review also included results from a polysomnographic sleep clinic pilot study (n = 3) comparing sleep efficiency of RACer-PAP to nasal continuous positive airways pressure (n-CPAP) in OSA patients.  Results: Metabolic disease is strongly associated with disturbed sleep. Sleep architecture influences cerebral hormonal secretion, lateral shifts in the autonomic nervous system and nasal airflow dominance. Disturbed sleep shortens short-wave sleep periods, decreasing insulin sensitivity and glucose tolerance. Improvements to metabolic function during n-CPAP treatment are inconsistent. If RACer-PAP demonstrates superior effects on sleep architecture and autonomic function, it may offer advantages in OSA patients with comorbid metabolic disease. Conclusion: Improving sleep architecture by maintaining the nasal cycle proposes a novel non-pharmacological treatment paradigm for treating OSA with comorbid metabolic disease. Research is required to demonstrate if RACer-PAP therapy influences whole night sleep architecture, sympathovagal balance and markers of metabolic disease.
Publisher AOSIS
Contributor KiwiNet Health Innovation Hub AUT
Date 2018-03-28
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Narrative review
Format text/html application/epub+zip application/xml application/pdf
Identifier 10.4102/jir.v3i1.34
Source Journal of Insulin Resistance; Vol 3, No 1 (2018); 6 pages 2519-7533 2412-2785
Language eng
Coverage global — —
Rights Copyright (c) 2018 Catherine A.P. Crofts, Alistair Neil, Angela Campbell, Jim Bartley, David E. White