Obstructive Sleep Apnea in Diabetes

Hassan Chami, MD MSc
Pulmonary Critical Care & Sleep Medicine
Assistant Professor, AUB
Adjunct Assistant Professor, Boston University School of Medicine

Obstructive sleep apnea is a common and treatable yet under-diagnosed condition estimated to affect 2% of women and 4% of men. Obstructive sleep apnea is characterized by recurrent upper airway closure during sleep resulting in frequent brain awakenings (called arousals) and drops in oxygen level in the blood. Although patients do not usually feel these events, the recurrent brain awakenings disrupt sleep and leave the patient fatigued and sleepy during the day. Indeed, obstructive sleep apnea usually manifests with snoring and excessive daytime sleepiness. Although, some patients may have no symptoms while some patients complain of choking during sleep. At times it is the patient’s bed partner who witness that the patient stops breathing during sleep.

In addition to the associated symptoms, obstructive sleep apnea is also associated with significant adverse health events including hypertension, cerebrovascular and cardiovascular disease and increased risk of car accidents. Risk factors for obstructive sleep apnea include obesity, male sex, age and menopause in addition to some craniofacial features such as small jaw and enlarged tonsils in children.

Obstructive sleep apnea is common in patients with diabetes especially, among obese type 2 diabetics in whom the prevalence of obstructive sleep apnea was reported to be up to 86%. The severity of obstructive sleep apnea was associated with poor blood sugar control after accounting for other factors that could impact blood sugar. Several population studies have documented simultaneous occurrence of obstructive sleep apnea, insulin resistance and diabetes, and one prospective study showed an increased risk of developing diabetes in obstructive sleep apnea patients, independent of other risk factors.

Continuous positive airway pressure (CPAP) is the most effective therapy for obstructive sleep apnea. Several studies suggest that CPAP therapy results in improved blood sugar control in patients with coexistent diabetes and obstructive sleep apnea.

Furthermore, since both obstructive sleep apnea and diabetes are risk factors for cardiovascular disease; the coexistence of diabetes and obstructive sleep apnea may compound their deleterious effect on the cardiovascular system. Obstructive sleep apnea is a treatable condition, thus addressing it may decrease the cardiovascular risk in patients with coexistent obstructive sleep apnea and diabetes. Therefore, it is important to increase the awareness about the risk of obstructive sleep apnea diabetics, and to evaluate for the presence of obstructive sleep apnea in diabetics by screening for the presence of snoring and excessive daytime sleepiness or choking during sleep. If these symptoms were present, an overnight sleep study (polysomnography) would be indicated for diagnosing and treating obstructive sleep apnea.

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