阻塞性睡眠呼吸暂停合并2型糖尿病的机制_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HONG Xueling ¹ ,  LI Yongxia ¹ , AI Li ² , LIU Zhijuan ² , ZHOU Fan ¹

1. ;
2. ;

Corresponding author：

LI Yongxia, Email: yongxiali999@163.com

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DOI：

10.7507/1671-6205.202310072

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Citation： HONG Xueling, LI Yongxia, AI Li, LIU Zhijuan, ZHOU Fan. 阻塞性睡眠呼吸暂停合并2型糖尿病的机制. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(9): 666-672. doi: 10.7507/1671-6205.202310072 Copy

1.	王君, 郑小兵, 张希龙, 等. 心血管病患者中阻塞性睡眠呼吸暂停的临床特征及危险因素分析. 临床肺科杂志, 2022, 27(6): 817-821.
2.	Iturriaga R. Carotid body contribution to the physio‐pathological consequences of intermittent hypoxia: role of nitro‐oxidative stress and inflammation. J Physiol, 2023: JP284112.
3.	赵莎, 雷璇, 熊佳敏, 等. 阻塞性睡眠呼吸暂停综合征与炎症相关性研究进展. 中国比较医学杂志, 2022, 32(11): 101-106.
4.	Roden M, Shulman GI. The integrative biology of type 2 diabetes. Nature, 2019, 576(7785): 51-60.
5.	Shen H, Zhao J, Liu Y, et al. Interactions between and Shared Molecular Mechanisms of Diabetic Peripheral Neuropathy and Obstructive Sleep Apnea in Type 2 Diabetes Patients. J Diabetes Res, 2018, 2018: 1-15.
6.	Faria A, Laher I, Fasipe B, et al. Impact of Obstructive Sleep Apnea and Current Treatments on the Developmentand Progression of Type 2 Diabetes. Curr Diabetes Rev, 2022, 18(9): e160222201169.
7.	Alterki A, Abu-Farha M, Al Shawaf E, et al. Investigating the Relationship between Obstructive Sleep Apnoea, Inflammation and Cardio-Metabolic Diseases. Int J Mol Sci, 2023, 24(7): 6807.
8.	Khaire SS, Gada JV, Utpat KV, et al. A study of glycemic variability in patients with type 2 diabetes mellitus with obstructive sleep apnea syndrome using a continuous glucose monitoring system. Clin Diabetes Endocrinol, 2020, 6(1): 10.
9.	Pugliese G, Barrea L, Laudisio D, et al. Sleep Apnea, Obesity, and Disturbed Glucose Homeostasis: Epidemiologic Evidence, Biologic Insights, and Therapeutic Strategies. Curr Obes Rep, 2020, 9(1): 30-38.
10.	Marathe PH, Gao HX, Close KL. American Diabetes Association Standards of Medical Care in Diabetes 2017. J Diabetes, 2017, 9(4): 320-324.
11.	Butt A M, Syed U, Arshad A. Predictive Value of Clinical and Questionnaire Based Screening Tools of Obstructive Sleep Apnea in Patients With Type 2 Diabetes Mellitus. Cureus, 2021, 13(9): e18009.
12.	Ota H, Fujita Y, Yamauchi M, et al. Relationship Between Intermittent Hypoxia and Type 2 Diabetes in Sleep Apnea Syndrome. Int J Mol Sci, 2019, 20(19): 4756.
13.	Kurinami N, Sugiyama S, Ijima H, et al. Clinical usefulness of the body muscle-to-fat ratio for screening obstructive sleep apnea syndrome in patients with inadequately controlled type 2 diabetes mellitus. Diabetes Res Clin Pract, 2018, 143: 134-139.
14.	Li M, Li X, Lu Y. Obstructive Sleep Apnea Syndrome and Metabolic Diseases. Endocrinology, 2018, 159(7): 2670-2675.
15.	Gabryelska A, Karuga F F, Szmyd B, et al. HIF-1α as a Mediator of Insulin Resistance, T2DM, and Its Complications: Potential Links With Obstructive Sleep Apnea. Front Physiol, 2020, 11: 1035.
16.	Prabhakar NR, Peng YJ, Nanduri J. Hypoxia-inducible factors and obstructive sleep apnea. J Clin Invest, 2020, 130(10): 5042-5051.
17.	Nagao A, Kobayashi M, Koyasu S, et al. HIF-1-Dependent Reprogramming of Glucose Metabolic Pathway of Cancer Cells and Its Therapeutic Significance. Int J Mol Sci, 2019, 20(2): 238.
18.	Sacramento JF, Ribeiro MJ, Rodrigues T, et al. Insulin resistance is associated with tissue-specific regulation of HIF-1α and HIF-2α during mild chronic intermittent hypoxia. Respir Physiol Neurobiol, 2016, 228: 30-38.
19.	Carlessi R, Chen Y, Rowlands J, et al. GLP-1 receptor signalling promotes β-cell glucose metabolism via mTOR-dependent HIF-1α activation. Sci Rep, 2017, 7(1): 2661.
20.	Maniaci A, Iannella G, Cocuzza S, et al. Oxidative Stress and Inflammation Biomarker Expression in Obstructive Sleep Apnea Patients. J Clin Med, 2021, 10(2): 277.
21.	Orrù G, Storari M, Scano A, et al. Obstructive Sleep Apnea, oxidative stress, inflammation and endothelial dysfunction-An overview of predictive laboratory biomarkers. Eur Rev Med Pharmacol Sci, 2020, 24(12): 6939-6948.
22.	Kargar B, Zamanian Z, Hosseinabadi MB, et al. Understanding the role of oxidative stress in the incidence of metabolic syndrome and obstructive sleep apnea. BMC Endocr Disord, 2021, 21(1): 77.
23.	杨丽娟, 汪鸿. OSAS合并心脑血管病的炎性机制及研究的进展. 心血管康复医学杂志, 2022, 31(4): 524-527.
24.	Pau MC, Zinellu A, Mangoni A A, et al. Evaluation of Inflammation and Oxidative Stress Markers in Patients with Obstructive Sleep Apnea (OSA). J Clin Med, 2023, 12(12): 3935.
25.	张士珑, 卢海燕. 阻塞性睡眠呼吸暂停低通气综合征与NF-κB、TNF-α和IL-6的关系. 北京口腔医学, 2018, 26(2): 118-120.
26.	Zhang J, Tian L, Guo L. Changes of aldosterone levels in patients with type 2 diabetes complicated by moderate to severe obstructive sleep apnea–hypopnea syndrome before and after treatment with continuous positive airway pressure. J Int Med Res, 2019, 47(10): 4723-4733.
27.	Labarca G, Gower J, Lamperti L, et al. Chronic intermittent hypoxia in obstructive sleep apnea: a narrative review from pathophysiological pathways to a precision clinical approach. Sleep Breath, 2020, 24(2): 751-760.
28.	Ma M, Liu H, Yu J, et al. Triglyceride is independently correlated with insulin resistance and islet beta cell function: a study in population with different glucose and lipid metabolism states. Lipids Health Dis, 2020, 19(1): 121.
29.	Anusree SS. Insulin resistance in 3T3-L1 adipocytes by TNF-α is improved by punicic acid through upregulation of insulin signalling pathway and endocrine function, and downregulation of proinflammatory cytokines. Biochimie, 2018, 146: 79-86.
30.	Masenga SK, Kabwe LS, Chakulya M, et al. Mechanisms of Oxidative Stress in Metabolic Syndrome. Int J Mol Sci, 2023, 24(9): 7898.
31.	Dludla PV, Mabhida S E, Ziqubu K, et al. Pancreatic β-cell dysfunction in type 2 diabetes: Implications of inflammation and oxidative stress. World J Diabetes, 2023, 14(3): 130-146.
32.	Cunha-Guimaraes J P, Guarino M P, Timóteo A T, et al. Carotid body chemosensitivity: early biomarker of dysmetabolism in humans. Eur J Endocrinol, 2020, 182(6): 549-557.
33.	Roder F, Strotmann J, Fox H, et al. Interactions of Sleep Apnea, the Autonomic Nervous System, and Its Impact on Cardiac Arrhythmias. Curr Sleep Med Rep, 2018, 4(2): 160-169.
34.	Carpentier AC. 100 ^th anniversary of the discovery of insulin perspective: insulin and adipose tissue fatty acid metabolism. Am J Physiol Endocrinol Metab, 2021, 320(4): E653-E670.
35.	Shobatake R, Ota H, Takahashi N, et al. The Impact of Intermittent Hypoxia on Metabolism and Cognition. Int J Mol Sci, 2022, 23(21): 12957.
36.	Protasiewicz Timofticiuc D. Stop-Bang Questionnaire – an Easy Tool for Identifying Obstructive Sleep Apnea Syndrome in Patients with Type 2 Diabetes Mellitus. Acta Endocrinol (Buchar), 2022, 18(1): 49-57.
37.	Koh HCE, Van Vliet S, Cao C, et al. Effect of obstructive sleep apnea on glucose metabolism. Eur J Endocrinol, 2022, 186(4): 457-467.
38.	Foster G D, Borradaile KE, Sanders MH, et al. A Randomized Study on the Effect of Weight Loss on Obstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes. Arch Intern Med, 2009, 169(17): 1619-1626.
39.	Or Koca A, İriz A, Hazır B, et al. Relationships of orexigenic and anorexigenic hormones with body fat distribution in patients with obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol, 2023, 280(5): 2445-2452.
40.	Yang Q, Xu H, Zhang H, et al. Serum triglyceride glucose index is a valuable predictor for visceral obesity in patients with type 2 diabetes: a cross-sectional study. Cardiovasc Diabetol, 2023, 22(1): 98.
41.	Perger E, Taranto-Montemurro L. Upper airway muscles: influence on obstructive sleep apnoea pathophysiology and pharmacological and technical treatment options. Curr Opin Pulm Med, 2021, 27(6): 505-513.
42.	Wei Z, Chen Y, Upender R P. Sleep Disturbance and Metabolic Dysfunction: The Roles of Adipokines. Int J Mol Sci, 2022, 23(3): 1706.
43.	Gasmi A, Noor S, Menzel A, et al. Obesity and Insulin Resistance: Associations with Chronic Inflammation, Genetic and Epigenetic Factors. Curr Med Chem, 2021, 28(4): 800-826.
44.	Duan Y, Zhang S, Li Y, et al. Potential regulatory role of miRNA and mRNA link to metabolism affected by chronic intermittent hypoxia. Front Genet, 2022, 13: 963184.
45.	D'Angelo GF, De Mello AA F, Schorr F, et al. Muscle and visceral fat infiltration: A potential mechanism to explain the worsening of obstructive sleep apnea with age. Sleep Med, 2023, 104: 42-48.
46.	Ma B, Li Y, Wang X, et al. Association Between Abdominal Adipose Tissue Distribution and Obstructive Sleep Apnea in Chinese Obese Patients. Front Endocrinol (Lausanne), 2022, 13: 847324.
47.	Huang X, Huang X, Guo H, et al. Intermittent hypoxia-induced METTL3 downregulation facilitates MGLL-mediated lipolysis of adipocytes in OSAS. Cell Death Discov, 2022, 8(1): 352.
48.	Musutova M, Weiszenstein M, Koc M, et al. Intermittent Hypoxia Stimulates Lipolysis, But Inhibits Differentiation and De Novo Lipogenesis in 3T3-L1 Cells. Metab Syndr Relat Disord, 2020, 18(3): 146-153.
49.	Rehman K, Akash MSH. Mechanism of Generation of Oxidative Stress and Pathophysiology of Type 2 Diabetes Mellitus: How Are They Interlinked?J Cell Biochem, 2017, 118(11): 3577-3585.
50.	Acosta-Montaño P, García-González V. Effects of Dietary Fatty Acids in Pancreatic Beta Cell Metabolism, Implications in Homeostasis. Nutrients, 2018, 10(4): 393.
51.	Yan G, Li F, Elia C, et al. Association of lipid accumulation product trajectories with 5-year incidence of type 2 diabetes in Chinese adults: a cohort study. Nutr Metab (Lond), 2019, 16: 72.
52.	Xu X, Xu J. Effects of different obesity-related adipokines on the occurrence of obstructive sleep apnea. Endocr J, 2020, 67(5): 485-500.
53.	Kozu Y, Kurosawa Y, Yamada S, et al. Cluster analysis identifies a pathophysiologically distinct subpopulation with increased serum leptin levels and severe obstructive sleep apnea. Sleep Breath, 2021, 25(2): 767-776.
54.	Isaksen VT, Larsen MA, Goll R, et al. Correlations between modest weight loss and leptin to adiponectin ratio, insulin and leptin resensitization in a small cohort of Norwegian individuals with obesity. Endocr Metab Sci, 2023, 12: 100134.
55.	Buonfiglio D, Tchio C, Furigo I, et al. Removing melatonin receptor type 1 signaling leads to selective leptin resistance in the arcuate nucleus. J Pineal Res, 2019, 67(2): e12580.
56.	Catalina MO S, Redondo PC, Granados MP, et al. New Insights into Adipokines as Potential Biomarkers for Type-2 Diabetes Mellitus. Curr Med Chem, 2019, 26(22): 4119-4144.
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62.	Celikhisar H, Ilkhan GD. Alterations in Serum Adropin, Adiponectin, and Proinflammatory Cytokine Levels in OSAS. Can Respir J, 2020, 2020: 2571283.
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1. 王君, 郑小兵, 张希龙, 等. 心血管病患者中阻塞性睡眠呼吸暂停的临床特征及危险因素分析. 临床肺科杂志, 2022, 27(6): 817-821.
2. Iturriaga R. Carotid body contribution to the physio‐pathological consequences of intermittent hypoxia: role of nitro‐oxidative stress and inflammation. J Physiol, 2023: JP284112.
3. 赵莎, 雷璇, 熊佳敏, 等. 阻塞性睡眠呼吸暂停综合征与炎症相关性研究进展. 中国比较医学杂志, 2022, 32(11): 101-106.
4. Roden M, Shulman GI. The integrative biology of type 2 diabetes. Nature, 2019, 576(7785): 51-60.
5. Shen H, Zhao J, Liu Y, et al. Interactions between and Shared Molecular Mechanisms of Diabetic Peripheral Neuropathy and Obstructive Sleep Apnea in Type 2 Diabetes Patients. J Diabetes Res, 2018, 2018: 1-15.
6. Faria A, Laher I, Fasipe B, et al. Impact of Obstructive Sleep Apnea and Current Treatments on the Developmentand Progression of Type 2 Diabetes. Curr Diabetes Rev, 2022, 18(9): e160222201169.
7. Alterki A, Abu-Farha M, Al Shawaf E, et al. Investigating the Relationship between Obstructive Sleep Apnoea, Inflammation and Cardio-Metabolic Diseases. Int J Mol Sci, 2023, 24(7): 6807.
8. Khaire SS, Gada JV, Utpat KV, et al. A study of glycemic variability in patients with type 2 diabetes mellitus with obstructive sleep apnea syndrome using a continuous glucose monitoring system. Clin Diabetes Endocrinol, 2020, 6(1): 10.
9. Pugliese G, Barrea L, Laudisio D, et al. Sleep Apnea, Obesity, and Disturbed Glucose Homeostasis: Epidemiologic Evidence, Biologic Insights, and Therapeutic Strategies. Curr Obes Rep, 2020, 9(1): 30-38.
10. Marathe PH, Gao HX, Close KL. American Diabetes Association Standards of Medical Care in Diabetes 2017. J Diabetes, 2017, 9(4): 320-324.
11. Butt A M, Syed U, Arshad A. Predictive Value of Clinical and Questionnaire Based Screening Tools of Obstructive Sleep Apnea in Patients With Type 2 Diabetes Mellitus. Cureus, 2021, 13(9): e18009.
12. Ota H, Fujita Y, Yamauchi M, et al. Relationship Between Intermittent Hypoxia and Type 2 Diabetes in Sleep Apnea Syndrome. Int J Mol Sci, 2019, 20(19): 4756.
13. Kurinami N, Sugiyama S, Ijima H, et al. Clinical usefulness of the body muscle-to-fat ratio for screening obstructive sleep apnea syndrome in patients with inadequately controlled type 2 diabetes mellitus. Diabetes Res Clin Pract, 2018, 143: 134-139.
14. Li M, Li X, Lu Y. Obstructive Sleep Apnea Syndrome and Metabolic Diseases. Endocrinology, 2018, 159(7): 2670-2675.
15. Gabryelska A, Karuga F F, Szmyd B, et al. HIF-1α as a Mediator of Insulin Resistance, T2DM, and Its Complications: Potential Links With Obstructive Sleep Apnea. Front Physiol, 2020, 11: 1035.
16. Prabhakar NR, Peng YJ, Nanduri J. Hypoxia-inducible factors and obstructive sleep apnea. J Clin Invest, 2020, 130(10): 5042-5051.
17. Nagao A, Kobayashi M, Koyasu S, et al. HIF-1-Dependent Reprogramming of Glucose Metabolic Pathway of Cancer Cells and Its Therapeutic Significance. Int J Mol Sci, 2019, 20(2): 238.
18. Sacramento JF, Ribeiro MJ, Rodrigues T, et al. Insulin resistance is associated with tissue-specific regulation of HIF-1α and HIF-2α during mild chronic intermittent hypoxia. Respir Physiol Neurobiol, 2016, 228: 30-38.
19. Carlessi R, Chen Y, Rowlands J, et al. GLP-1 receptor signalling promotes β-cell glucose metabolism via mTOR-dependent HIF-1α activation. Sci Rep, 2017, 7(1): 2661.
20. Maniaci A, Iannella G, Cocuzza S, et al. Oxidative Stress and Inflammation Biomarker Expression in Obstructive Sleep Apnea Patients. J Clin Med, 2021, 10(2): 277.
21. Orrù G, Storari M, Scano A, et al. Obstructive Sleep Apnea, oxidative stress, inflammation and endothelial dysfunction-An overview of predictive laboratory biomarkers. Eur Rev Med Pharmacol Sci, 2020, 24(12): 6939-6948.
22. Kargar B, Zamanian Z, Hosseinabadi MB, et al. Understanding the role of oxidative stress in the incidence of metabolic syndrome and obstructive sleep apnea. BMC Endocr Disord, 2021, 21(1): 77.
23. 杨丽娟, 汪鸿. OSAS合并心脑血管病的炎性机制及研究的进展. 心血管康复医学杂志, 2022, 31(4): 524-527.
24. Pau MC, Zinellu A, Mangoni A A, et al. Evaluation of Inflammation and Oxidative Stress Markers in Patients with Obstructive Sleep Apnea (OSA). J Clin Med, 2023, 12(12): 3935.
25. 张士珑, 卢海燕. 阻塞性睡眠呼吸暂停低通气综合征与NF-κB、TNF-α和IL-6的关系. 北京口腔医学, 2018, 26(2): 118-120.
26. Zhang J, Tian L, Guo L. Changes of aldosterone levels in patients with type 2 diabetes complicated by moderate to severe obstructive sleep apnea–hypopnea syndrome before and after treatment with continuous positive airway pressure. J Int Med Res, 2019, 47(10): 4723-4733.
27. Labarca G, Gower J, Lamperti L, et al. Chronic intermittent hypoxia in obstructive sleep apnea: a narrative review from pathophysiological pathways to a precision clinical approach. Sleep Breath, 2020, 24(2): 751-760.
28. Ma M, Liu H, Yu J, et al. Triglyceride is independently correlated with insulin resistance and islet beta cell function: a study in population with different glucose and lipid metabolism states. Lipids Health Dis, 2020, 19(1): 121.
29. Anusree SS. Insulin resistance in 3T3-L1 adipocytes by TNF-α is improved by punicic acid through upregulation of insulin signalling pathway and endocrine function, and downregulation of proinflammatory cytokines. Biochimie, 2018, 146: 79-86.
30. Masenga SK, Kabwe LS, Chakulya M, et al. Mechanisms of Oxidative Stress in Metabolic Syndrome. Int J Mol Sci, 2023, 24(9): 7898.
31. Dludla PV, Mabhida S E, Ziqubu K, et al. Pancreatic β-cell dysfunction in type 2 diabetes: Implications of inflammation and oxidative stress. World J Diabetes, 2023, 14(3): 130-146.
32. Cunha-Guimaraes J P, Guarino M P, Timóteo A T, et al. Carotid body chemosensitivity: early biomarker of dysmetabolism in humans. Eur J Endocrinol, 2020, 182(6): 549-557.
33. Roder F, Strotmann J, Fox H, et al. Interactions of Sleep Apnea, the Autonomic Nervous System, and Its Impact on Cardiac Arrhythmias. Curr Sleep Med Rep, 2018, 4(2): 160-169.
34. Carpentier AC. 100 ^th anniversary of the discovery of insulin perspective: insulin and adipose tissue fatty acid metabolism. Am J Physiol Endocrinol Metab, 2021, 320(4): E653-E670.
35. Shobatake R, Ota H, Takahashi N, et al. The Impact of Intermittent Hypoxia on Metabolism and Cognition. Int J Mol Sci, 2022, 23(21): 12957.
36. Protasiewicz Timofticiuc D. Stop-Bang Questionnaire – an Easy Tool for Identifying Obstructive Sleep Apnea Syndrome in Patients with Type 2 Diabetes Mellitus. Acta Endocrinol (Buchar), 2022, 18(1): 49-57.
37. Koh HCE, Van Vliet S, Cao C, et al. Effect of obstructive sleep apnea on glucose metabolism. Eur J Endocrinol, 2022, 186(4): 457-467.
38. Foster G D, Borradaile KE, Sanders MH, et al. A Randomized Study on the Effect of Weight Loss on Obstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes. Arch Intern Med, 2009, 169(17): 1619-1626.
39. Or Koca A, İriz A, Hazır B, et al. Relationships of orexigenic and anorexigenic hormones with body fat distribution in patients with obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol, 2023, 280(5): 2445-2452.
40. Yang Q, Xu H, Zhang H, et al. Serum triglyceride glucose index is a valuable predictor for visceral obesity in patients with type 2 diabetes: a cross-sectional study. Cardiovasc Diabetol, 2023, 22(1): 98.
41. Perger E, Taranto-Montemurro L. Upper airway muscles: influence on obstructive sleep apnoea pathophysiology and pharmacological and technical treatment options. Curr Opin Pulm Med, 2021, 27(6): 505-513.
42. Wei Z, Chen Y, Upender R P. Sleep Disturbance and Metabolic Dysfunction: The Roles of Adipokines. Int J Mol Sci, 2022, 23(3): 1706.
43. Gasmi A, Noor S, Menzel A, et al. Obesity and Insulin Resistance: Associations with Chronic Inflammation, Genetic and Epigenetic Factors. Curr Med Chem, 2021, 28(4): 800-826.
44. Duan Y, Zhang S, Li Y, et al. Potential regulatory role of miRNA and mRNA link to metabolism affected by chronic intermittent hypoxia. Front Genet, 2022, 13: 963184.
45. D'Angelo GF, De Mello AA F, Schorr F, et al. Muscle and visceral fat infiltration: A potential mechanism to explain the worsening of obstructive sleep apnea with age. Sleep Med, 2023, 104: 42-48.
46. Ma B, Li Y, Wang X, et al. Association Between Abdominal Adipose Tissue Distribution and Obstructive Sleep Apnea in Chinese Obese Patients. Front Endocrinol (Lausanne), 2022, 13: 847324.
47. Huang X, Huang X, Guo H, et al. Intermittent hypoxia-induced METTL3 downregulation facilitates MGLL-mediated lipolysis of adipocytes in OSAS. Cell Death Discov, 2022, 8(1): 352.
48. Musutova M, Weiszenstein M, Koc M, et al. Intermittent Hypoxia Stimulates Lipolysis, But Inhibits Differentiation and De Novo Lipogenesis in 3T3-L1 Cells. Metab Syndr Relat Disord, 2020, 18(3): 146-153.
49. Rehman K, Akash MSH. Mechanism of Generation of Oxidative Stress and Pathophysiology of Type 2 Diabetes Mellitus: How Are They Interlinked?J Cell Biochem, 2017, 118(11): 3577-3585.
50. Acosta-Montaño P, García-González V. Effects of Dietary Fatty Acids in Pancreatic Beta Cell Metabolism, Implications in Homeostasis. Nutrients, 2018, 10(4): 393.
51. Yan G, Li F, Elia C, et al. Association of lipid accumulation product trajectories with 5-year incidence of type 2 diabetes in Chinese adults: a cohort study. Nutr Metab (Lond), 2019, 16: 72.
52. Xu X, Xu J. Effects of different obesity-related adipokines on the occurrence of obstructive sleep apnea. Endocr J, 2020, 67(5): 485-500.
53. Kozu Y, Kurosawa Y, Yamada S, et al. Cluster analysis identifies a pathophysiologically distinct subpopulation with increased serum leptin levels and severe obstructive sleep apnea. Sleep Breath, 2021, 25(2): 767-776.
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