Diabetes

Sleep apnea and type 2 diabetes populations exhibit significant overlap; 48% of patients with type 2 diabetes suffer from moderate or severe sleep apnea1.

Sleep apnea and type 2 diabetes share a number of common risk factors. Obesity is one contributing factor to both conditions; however, studies have shown that sleep apnea is independently associated with glucose intolerance and insulin resistance.2

Common Risk Factors for Sleep Apnea & Type 2 Diabetes

  • Excessive weight/central abdominal obesity
  • Physical inactivity
  • Age
  • Ethnicity
  • Family history

Sleep Apnea and Type 2 Diabetes: Interacting Conditions

A growing body of evidence indicates that sleep apnea is associated with impaired fasting glucose, insulin resistance, and type 2 diabetes.

  • Epidemiological research suggests that sleep apnea, like sleep deprivation, has adverse effects on glucose tolerance and insulin resistance, and may be causally related to type 2 diabetes independent of BMI and obesity.3
  • Clinical studies have shown that the degree of increase in glucose levels and insulin resistance correlates with the severity of sleep apnea independent of obesity.1,4,5,6

Glycemic Control through Sleep Apnea Treatment

Studies suggest that effective treatment of sleep apnea with continuous positive airway pressure (CPAP) may improve glycemic control.

Published findings include:

  • CPAP therapy significantly improved insulin sensitivity in 40 patients with sleep apnea. This improvement was observed within 2 days of treatment and sustained over 3 months.7
  • In patients with type 2 diabetes, postprandial glucose levels were significantly reduced after ~3 months of CPAP therapy to treat their sleep apnea. Reduction in HbA1c levels were also observed.8
  • Continuous blood glucose monitoring of type 2 diabetes patients on CPAP therapy demonstrated lower and more stable nocturnal glucose levels.9
  • Insulin responsiveness increased 28% in patients with type 2 diabetes after 4 of CPAP therapy.10

Diabetes Opinion Leaders Highlight the Connection

The International Diabetes Federation (IDF) emphasized the connection between sleep apnea and type 2 diabetes in a recently released Consensus Statement.11 The statement recommends that sleep apnea should be considered in the assessment of all patients with type 2 diabetes and metabolic syndrome.

Specific IDF recommendations include:

  • Patients with type 2 diabetes should be assessed for snoring, observed apnea and daytime somnolence.
  • There should be a low threshold for referral to establish the diagnosis of sleep apnea, owing to the established benefits of therapy.
  • Continuous positive airway pressure is the current best treatment for moderate to severe sleep apnea and should be considered where appropriate.

The IDF also recommends that patients with sleep apnea should be routinely screened for markers of metabolic disturbance and cardiovascular risk.

1 Einhorn D, Stewart DA, Erman MK, Gordon N, Philis-Tsimikas A, Casal E. Endocr Pract. 2007;13:355-362
2 Punjabi NM, et al. Am J Resp Crit Care Med 2002;165:677-82
3 For reviews, see Tasali E, et al. CHEST 2008;133:496-506 and Punjabi N and Polotsky VY. J Appl Physiol 2005;99:1998-2007
4 Meslier N, et al. Eur Resp J 2003;22:156-60
5 Ip MSM, et al. Am J Respir Crit Care Med 2002;165:670-6
6 Tassone F, et al. Clinical Endocrinology 2003;59:374-9
7 Harsch IA, et al. Am J Respir Crit Care Med 2004;169:156-62
8 Babu AR, et al. Arch Intern Med 2005;165:447-52
9 Dawson, et al. J Clin Sleep Med 2008; 4:538 and Pallayova et al. Diab Res Clin Pract 2008:81:e8
10 Brooks B, et al. J Clin Endocrinol Metab 1994;79:1681-5
11 International Diabetes Federation. IDF Consensus Statement on Sleep Apnoea and Type 2 Diabetes 2008.