RESUMEN
Insomnia is a serious and widespread public health problem, but is often undetected and patients do not receive needed treatment. Insomnia is often comorbid with other diseases and conditions, such as arterial hypertension, type 2 diabetes mellitus, pain syndromes, anxiety and depressive disorders, etc. A separate problem is drug-induced insomnia, when patients develop symptoms due to other diseases treatments. Insomnia has a negative effect on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and decreased quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so clinical guidelines draft for the evaluation and treatment of insomnia in multimorbid patients is proposed. Diagnostic methods are reviewed and recommendations are given for the treatment of acute and chronic insomnia and features of the treatment of insomnia in multimorbid patients. A clinical algorithm has been proposed to determine treatment tactics in multimorbid patients.
Asunto(s)
Guías de Práctica Clínica como Asunto , Trastornos del Inicio y del Mantenimiento del Sueño , Humanos , Multimorbilidad , Calidad de Vida , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/diagnósticoRESUMEN
Short-chain fatty acids (SCFAs) are an important link in the maintenance and normalization of some important body functions. Recently, the metabolic component of the SCFAs effects has also been actively studied; the effect on body weight, insulin resistance and glycemia is of particular interest in the context of the prevention and treatment of carbohydrate metabolism disorders. In this regard, it is relevant to study the characteristics of SCFAs' production in patients with impaired carbohydrate metabolism, mainly with type 2 diabetes mellitus (T2DM). The purpose of the research was to study the modern data on the synthesis peculiarities of SCFAs in healthy people and patients with impaired carbohydrate metabolism. Material and methods. The data of domestic and foreign literature presented in PubMed, Google Scholar, ResearchGate, Elsevier, eLibrary, CyberLeninka databases, published mainly over the past 10 years, have been analyzed. Results. According to the concept of the philometabolic nucleus, bacteria of certain species, which are of the greatest importance compared to the rest, are responsible for the synthesis of specific SCFAs. The gut microbiota (GM) has the property of plasticity - the ability to change its composition under the influence of various factors. Most studies describe the effect of GM and its metabolites on the carbohydrate metabolism, but an equally important aspect of this process is the effect of carbohydrate metabolism disorders on GM and its functional activity. In case of disorders of carbohydrate metabolism, some altered components of homeostasis negatively affect GM and its production of SCFAs. As a result, the total amount and variety of SCFAs decrease, which exacerbate the imbalance in relation to carbohydrate metabolism. There is evidence that in patients with T2DM, the concentration of butyrate, which has a positive effect on insulin resistance, body weight, fasting glycemia and postprandial glycemia, decreases. The concentration of propionate and acetate, which didn't show such a pronounced positive effect in studies on carbohydrate metabolism, on the contrary, increases. Conclusion. The production of SCFAs by GM representatives depends on many factors, such as nutrition, physical activity, medication intake and the presence of chronic diseases. Numerous studies have confirmed the difference in the characteristics of the production of SCFAs in patients with T2DM and healthy people. The study of the peculiarities of GM metabolism in patients with T2DM is a tool in understanding the basics of therapy and lifestyle correction in both patients with T2DM and healthy people in order to prevent disorders of carbohydrate metabolism.
Asunto(s)
Diabetes Mellitus Tipo 2 , Microbioma Gastrointestinal , Resistencia a la Insulina , Humanos , Diabetes Mellitus Tipo 2/metabolismo , Ácidos Grasos Volátiles/metabolismo , Peso CorporalRESUMEN
Sleep disorders are becoming increasingly important due to the high comorbidity with other diseases and a significant impact on the patient's quality of life. Insomnia is the most common sleep disorder both in the general population and in patients with multimorbid pathology. Its prevalence in the general population is 6-15%, while in patients with somatic diseases it increases up to 20-40% and can reach 90% in patients with comorbid mental disorders. Another problem is the development of drug-induced insomnia. Insomnia has negative impact on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and a worse quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so it is extremely important to identify and correct these disorders in the early stages, therefore recommendations for the diagnosis of insomnia in polymorbid patients are proposed. Modern methods of treating acute and chronic insomnia and features of insomnia treatment in polymorbid patients are also discussed.