Weight and metabolic effects of cpap in obstructive sleep apnea patients with obesity

<p>Abstract</p> <p>Background</p> <p>Obstructive sleep apnea (OSA) is associated with obesity, insulin resistance (IR) and diabetes. Continuous positive airway pressure (CPAP) rapidly mitigates OSA in obese subjects but its metabolic effects are not well-characterized. We postulated that CPAP will decrease IR, ghrelin and resistin and increase adiponectin levels in this setting.</p> <p>Methods</p> <p>In a pre- and post-treatment, within-subject design, insulin and appetite-regulating hormones were assayed in 20 obese subjects with OSA before and after 6 months of CPAP use. Primary outcome measures included glucose, insulin, and IR levels. Other measures included ghrelin, leptin, adiponectin and resistin levels. Body weight change were recorded and used to examine the relationship between glucose regulation and appetite-regulating hormones.</p> <p>Results</p> <p>CPAP effectively improved hypoxia. However, subjects had increased insulin and IR. Fasting ghrelin decreased significantly while leptin, adiponectin and resistin remained unchanged. Forty percent of patients gained weight significantly. Changes in body weight directly correlated with changes in insulin and IR. Ghrelin changes inversely correlated with changes in IR but did not change as a function of weight.</p> <p>Conclusions</p> <p>Weight change rather than elimination of hypoxia modulated alterations in IR in obese patients with OSA during the first six months of CPAP therapy.</p

The role of leptin in the respiratory system: an overview

Since its cloning in 1994, leptin has emerged in the literature as a pleiotropic hormone whose actions extend from immune system homeostasis to reproduction and angiogenesis. Recent investigations have identified the lung as a leptin responsive and producing organ, while extensive research has been published concerning the role of leptin in the respiratory system. Animal studies have provided evidence indicating that leptin is a stimulant of ventilation, whereas researchers have proposed an important role for leptin in lung maturation and development. Studies further suggest a significant impact of leptin on specific respiratory diseases, including obstructive sleep apnoea-hypopnoea syndrome, asthma, COPD and lung cancer. However, as new investigations are under way, the picture is becoming more complex. The scope of this review is to decode the existing data concerning the actions of leptin in the lung and provide a detailed description of leptin's involvement in the most common disorders of the respiratory system

The effect of continuous positive airway pressure on metabolic variables in patients with obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is increasingly considered as a risk factor for metabolic disturbances, such as diabetes mellitus or dyslipidaemia. Continuous positive airway pressure (CPAP) therapy, the standard treatment for patients with OSA, may improve various metabolic variables, such as insulin sensitivity, glucose metabolism, lipids, fat distribution and adipokines. Several observational and uncontrolled clinical studies claim an improvement of these metabolic variables through the use of CPAP. However, there is only a limited number of clinical randomised controlled trials (RCTs) evaluating the effect of CPAP on metabolic variables. In this review, we summarise and discuss non-randomised studies and RCTs evaluating the effect of CPAP on metabolic variables in patients with OSA. In summary, the currently available body of evidence does not support a clinically important effect of CPAP treatment on any of the investigated metabolic variables. However, some investigators found small, but statistically significant changes in some metabolic variables, thus beneficial effects of CPAP treatment in selected patient cohorts cannot be excluded. To answer this question, more data from RCTs with well-defined study populations are warranted

COVID-19 Infektion als ein Mitauslöser eines Typ-1-Diabetes mellitus bei einem Kind mit Hochrisikokonstellation - oder Koinzidenz?

Background: The cytotoxic effects of COVID-19 raise the question of a possible relation between COVID-19 infection and new-onset type 1 diabetes. We report the case of an eight-year-old boy with new-onset type 1 diabetes and an asymptomatic COVID-19 infection.Case presentation: The eight-year-old boy was hospitalized on December 18th, 2020 due to increased polyuria during the preceding 1 week. Type 1 diabetes was diagnosed with autoantibodies against glutamic acid decarboxylase, tyrosine phosphatase and insulin. The Hba1c value was 11.6%. Upon admission, the PCR test for COVID-19 was positive, the duration of the infection was not clear due to the asymptomatic course, and antibodies were initially negative. Significantly elevated antibodies against COVID-19 were detected 15 days later.Conclusion: The laboratory findings led us to the hypothesis that the boy already had an increased risk of developing autoimmune diseases (HLA DR3-DQB1*02:01 and DR4-DQB1*03:02 positive). The Hba1c value allows speculation that the diabetes manifestation was already "on the way" and that a relatively recent COVID-19 infection could have accelerated the process. The findings are in contrast to a recent report in which COVID-19 infection preceded the manifestation of an insulin-dependent diabetes mellitus by about 5-7 weeks. Due to the paucity of reports, cases with a suspected connection between diabetes mellitus and COVID-19 infection should be entered into the CoviDiab registry (https://covidiab.e-dendrite.com).Hintergrund: Die zytotoxischen Wirkungen von COVID-19 werfen die Frage nach einem möglichen Zusammenhang zwischen der COVID-19-Infektion und neu auftretendem Typ-1-Diabetes auf. Wir berichten über den Fall eines achtjährigen Jungen mit neu aufgetretenem Typ-1-Diabetes und asymptomatischer COVID-19-Infektion.Falldarstellung: Der achtjährige Junge wurde am 18. Dezember 2020 wegen zunehmender Polyurie seit 1 Woche ins Krankenhaus eingeliefert. Der Typ-1-Diabetes wurde klinisch und mit Autoantikörpern gegen Glutaminsäure-Decarboxylase, gegen Tyrosinphosphatase und Insulin diagnostiziert. Der Hba1c-Wert betrug 11,6%. Bei Aufnahme war die PCR für COVID-19 positiv, die Dauer der Infektion war aufgrund des asymptomatischen Verlaufs nicht klar. Die Antikörper gegen COVID-19 waren initial negativ. 15 Tage später wurden signifikant erhöhte Antikörper gegen COVID-19 nachgewiesen.Schlussfolgerung: Die Laborergebnisse führten uns zu der Hypothese, dass der Junge bereits ein erhöhtes Risiko für die Entwicklung von Autoimmunerkrankungen hatte (HLA DR3-DQB1*02:01 und DR4-DQB1*03:02 jeweils positiv). Der Hba1c-Wert lässt Spekulationen zu, dass die Diabetes-Manifestation bereits "auf dem Weg" war und dass eine relativ kürzliche COVID-19-Infektion den gesamten Prozess beschleunigt hat. Die Ergebnisse stehen im Gegensatz zu einem 2020 veröffentlichten Bericht, in dem eine COVID-19-Infektion etwa 5-7 Wochen vor der Manifestation eines insulinpflichtigen Diabetes mellitus auftrat. Aufgrund des Mangels an Berichten sollten Fälle mit Verdacht auf einen Zusammenhang zwischen Diabetes mellitus und COVID-19-Infektion in das CoviDiab-Register (https://covidiab.e-dendrite.com) eingepflegt werden

Seroprävalenz von COVID-19-Antikörpern beim Raumpflegepersonal und beim Personal einer onkologischen Station in einer kommunalen Klinik

Aim: To prevent shedding of the novel COVID-19 virus in hospitals, strict hygiene measures and surveillance of the staff and patients is mandatory. Studying the available literature, we assumed that monitoring of the cleaning staff may sometimes be a "blind spot" in surveillance. Although the cleaning personnel is not entrusted with the medical and nursing care of patients, the extent of patient contacts in this group may be comparable to medical personnel and even increase in times of a visit ban in many hospitals. The aim of this study was to investigate the prevalence of COVID-19 infections already undergone in this group. Methods: Antibody titers (IgA and IgG) against COVID-19 were measured in the cleaning staff from June 15th to 30th, 2020 in our clinic. Antibodies against COVID-19 were determined using ELISA (EUROIMMUN(TM), PerkinElmer, Inc. Company). For purposes of comparison, the same procedure was performed in the staff of the oncology ward, who were regarded as an important group due to their high-risk patients.Results: During the study period, 45 members of the cleaning staff and 20 members of the oncology ward were tested. Significantly elevated IgA antibody titers were detected in 1 person in the first group and in 1 person in the second group. Significantly elevated IgG antibody titers were not detected in the first group and in 1 person of the second group. In case of positive or indeterminate testing, swabs for direct virus detection were taken, but were negative in all cases.Conclusion: The prevalence of already undergone infections in both groups is low, as to be expected due to the still low incidence of COVID-19 infections in the German federal state of Thuringia. However, the presence of such antibodies in the cleaning personnel demonstrates the need for equally strict surveillance in this group.Einleitung: Um die Verbreitung des neuartigen COVID-19-Virus in Krankenhäusern zu verhindern, sind strenge Hygienemaßnahmen und die Überwachung des Personals und der Patienten obligatorisch. Nach Sichtung der verfügbaren Literatur entsteht der Eindruck, dass die Überwachung des Reinigungspersonals manchmal ein "blinder Fleck" bei der Überwachung ist. Obwohl das Reinigungspersonal nicht mit der medizinischen und pflegerischen Versorgung der Patienten betraut ist, kann das Ausmaß der Patientenkontakte in dieser Gruppe mit denen der Pflege vergleichbar sein und in Zeiten eines Besuchsverbots in vielen Krankenhäusern sogar zunehmen. Ziel dieser Studie war es, die Prävalenz bereits überstandener COVID-19-Infektionen in dieser Gruppe zu untersuchen.Methoden: Die Antikörpertiter (IgA und IgG) gegen COVID-19 wurden beim Raumpflegepersonal vom 15. bis 30. Juni 2020 in unserer Klinik bestimmt. Die Antikörperbestimmung gegen COVID-19 wurde mit einem ELISA (EUROIMMUNTM, PerkinElmer, Inc. Company) durchgeführt. Zu Vergleichszwecken wurde bei den Mitarbeitern der Onkologiestation das gleiche Procedere vorgenommen, da wir diese Mitarbeiter aufgrund ihrer Hochrisikopatienten als ebenfalls für eine Überwachung wichtige Gruppe betrachteten.Ergebnisse: Während des Studienzeitraums wurden 45 Mitarbeiter des Raumpflegepersonals und 20 Mitglieder der Onkologiestation getestet. Signifikant erhöhte IgA-Antikörpertiter wurden in beiden Gruppen bei je 1 Person nachgewiesen. Signifikant erhöhte IgG-Antikörpertiter wurden in der ersten Gruppe nicht und in der zweiten Gruppe bei 1 Person nachgewiesen. Bei positiven und grenzwertigen Tests wurden Abstriche für einen direkten Virusnachweis entnommen, die jedoch in allen Fällen negativ waren.Diskussion: Die Prävalenz bereits durchgemachter Infektionen ist in beiden Gruppen gering, was aufgrund der noch geringen Inzidenz von COVID-19-Infektionen im Bundesland Thüringen zu erwarten war. Das Vorhandensein solcher Antikörper beim Raumpflegepersonal zeigt jedoch, dass auch in dieser Gruppe eine strikte Überwachung sinnvoll ist

Molecular heterogeneity of serum follicle-stimulating hormone in hypogonadal patients before and during androgen replacement therapy and in normal men.

OBJECTIVE: The present study was performed to characterize the molecular heterogeneity of serum FSH in normal males and to investigate the possible influence of testosterone on serum FSH in androgen-deficient men before and during testosterone administration. DESIGN AND PATIENTS: Serum samples were taken at 10-minute intervals between 0730 and 0830 h from nine healthy, eugonadal men and from eight men with primary hypogonadism (Klinefelter's syndrome). In the hypogonadal patients, sampling was performed before treatment (n = 8), 4-5 days after the first and the third injection of 250 mg testosterone enanthate given intramuscularly at three-weekly intervals (n = 6), as well as 3 months after the onset of therapy (n = 3). Sampling was repeated 7 days apart in two of the nine healthy volunteers. MEASUREMENTS: Aliquots from the individual serum samples were pooled and fractionated by chromatofocusing in the pH range 6-3. Immunoreactive FSH was measured by immunofluorometric assay (IFMA) in each fraction and the individual serum samples. In each serum pool, bioactive FSH was determined by in-vitro bioassay (rat Sertoli cell aromatase bioassay), testosterone by RIA and LH by IFMA. RESULTS: After grouping the percentage of immunoreactive FSH recovered in the individual fractions into intervals of 0.5 pH units, significant differences between controls and patients were observed in the pH regions 4-4.5, 5.5-6 and 6-6.5. No statistically significant changes in the isoform distribution of FSH were detected during therapy in the Klinefelter patients. A high degree of variability, which did not follow a common pattern, was observed in the isoform distribution of FSH within the same individuals, both in the hypogonadal patients during treatment and in the two normal men whose blood samples were taken on two different occasions. CONCLUSIONS: Serum FSH is highly heterogeneous in normal and hypogonadal men. There is a spontaneous intra-individual variability in the relative abundance of the different FSH isoforms in serum that may most probably be related to metabolic deglycosylation of FSH. Minor but significant differences in the molecular heterogeneity of serum FSH could be demonstrated in Klinefelter patients compared to normal men. These differences are not modified by administration of testosterone enanthate at doses achieving normal androgenization, suggesting that factors different from testosterone may modulate FSH pleomorphism

Antikörperspiegel und Antigen-Schnelltests bei älteren Patienten mit SARS-CoV-2-Pneumonie im Vergleich zu Mitarbeitern einer "Coronastation" und einer Intensivstation

Aim: The majority of patients hospitalized with COVID-19 are older individuals. Age and the comorbidities typically associated with it usually go hand in hand with a less favorable course of the disease. We were interested in the antibody response in this particular patient group as well as in the results of rapid antigen testing.Methods: In 30 elderly patients (>75 years), antibody titers (IgA and IgG) against COVID-19 were measured, and rapid antigen testing was determined about 3 weeks after the onset of symptoms of SARS-CoV-2 infection. The results were compared with those of a "high-risk" group consisting of "Covid-19" ward regular staff, as well as with "low-risk" staff consisting of members of the intensive care unit (ICU). The antibody titer against SARS-CoV-2 was determined by ELISA (EUROIMMUN(TM), PerkinElmer, Inc. Company); for rapid antigen testing, we used the SARS-CoV-2 Rapid Antigen test (Roche®).Results: Our investigations demonstrate a robust antibody response in the majority of elderly, comorbid patients about three weeks after the onset of infection. At this timepoint, most of the results of rapid antigen testing were negative. Furthermore, in the group of employees of our clinic ("Covid-19" ward vs. the ICU staff), the prevalence of antibodies was very low and antigen testing was negative in the whole ICU group.Conclusion: Although frequently comorbid, elderly patients are capable of significantly increasing antibodies against COVID-19 about 3 weeks after the onset of infection. Since the viral load can be assumed to have been low at that point, rapid antigen testing was negative in most cases. In the test group of employees of our clinic ("Covid-19" ward vs. the ICU staff), the data demonstrate that - given adequate protective measures - the risk of infection is not higher in a "Covid-19" ward compared to other wards.Ziel: Die Mehrheit der mit COVID-19 ins Krankenhaus eingelieferten Patienten ist im höheren Lebensalter. Das Alter und die typischerweise damit verbundenen Komorbiditäten sind mit einem ungünstigeren Krankheitsverlauf verbunden. Wir waren an der Antikörperantwort in dieser Patientengruppe sowie an den Ergebnissen von Antigen-Schnelltests interessiert.Methode: Bei 30 älteren Patienten (>75 Jahre) wurden Antikörpertiter (IgA und IgG) gegen COVID-19 bestimmt und der Antigen-Schnelltest ungefähr 3 Wochen nach Auftreten der Symptome der SARS-CoV-2 Infektion bestimmt. Die Ergebnisse wurden mit denen einer "Hochrisikopopulation" verglichen, die aus regulärem Personal einer "Corona"-Station besteht, sowie mit einem "Niedrigrisiko"-Personal, das aus Mitgliedern der Intensivstation besteht. Die Antikörperbestimmung gegen SARS-CoV-2 wurde mittels ELISA (EUROIMMUN(TM), PerkinElmer, Inc. Company) durchgeführt. Für die Antigen-Schnelltests verwendeten wir den SARS-CoV-2-Rapid-Antigen-Test (Roche®).Ergebnisse: Unsere Untersuchungen zeigen eine "robuste" Antikörperantwort bei der Mehrzahl der älteren, komorbiden Patienten etwa drei Wochen nach Beginn der Infektion. Die meisten Ergebnisse von Antigen-Schnelltests waren zu diesem Zeitpunkt negativ. Darüber hinaus war in der Gruppe der Mitarbeiter der Klinik ("Corona"-Station im Vergleich zum Personal auf der Intensivstation) die Prävalenz von Antikörpern sehr gering und die Antigentests in der gesamten Gruppe auf der Intensivstation negativ.Schlussfolgerung: Obwohl häufig komorbid, können ältere Patienten etwa 3 Wochen nach Beginn der Infektion einen signifikanten Anstieg der Antikörper gegen SARS-CoV-2 verzeichnen. Da die Viruslast zu diesem Zeitpunkt als gering angenommen werden kann, war der Antigen-Schnelltest erwartungsgemäß in den meisten Fällen negativ. In der Gruppe der Mitarbeiter der Klinik ("Corona"-Station im Vergleich zum Personal auf der Intensivstation) zeigen die Daten, dass bei angemessenen Schutzmaßnahmen das Infektionsrisiko in einer Station für Corona-Erkrankte im Vergleich zu anderen Stationen nicht höher ist