Sleep Apnea and Diabetes

The following article is from the Doctor's Guide, dated May 6, 1999:
link to Doctor's Guide article

Sleep Apnea Linked To Increased Diabetes Risk

LOS ANGELES, CA -- May 6, 1999 -- Adults who suffer from obstructive sleep apnea are three times more likely to also have diabetes, according to a new UCLA School of Dentistry/Department of Veterans Affairs study published today in the Journal of Oral and Maxillofacial Surgery. Sleep apnea, a serious condition marked by loud snoring, irregular breathing and interrupted oxygen intake, affects an estimated nine million Americans. The culprit? Carrying too many extra pounds.

"The blame falls squarely on excess weight gain," said Dr. Arthur Friedlander, associate professor of oral and maxillofacial surgery at the UCLA School of Dentistry and associate chief of staff at the Veterans Affairs Medical Center in Los Angeles. Surplus weight interferes with insulin's ability to propel sugars from digested food across the cell membrane, robbing the cells of needed carbohydrates. Diabetes results when glucose builds up in the bloodstream and can't be utilised by the body. Being overweight can also lead to obstructive sleep apnea, Friedlander explained.

"When people gain too much weight, fatty deposits build up along the throat and line the breathing passages," he said. "The muscles in this region slacken during sleep, forcing the airway to narrow and often close altogether."

Reclining on one's back magnifies the situation.
"When an overweight person lies down and goes to sleep gravity shoves the fat in the neck backwards,” he said. “This blocks the airway and can bring breathing to a halt."
Friedlander tested the blood sugar of 54 randomly selected male veterans whom doctors had previously diagnosed with obstructive sleep apnea. He discovered that 17 of the 54 patients, or 31 percent, unknowingly suffered from adult-onset diabetes.

Using the same sample, Friedlander also took panoramic X-rays of the men's necks and jaws. The X-rays indicated that 12 of the 54 patients, or 22 percent, revealed calcified plaques in the carotid artery leading to the brain. These plaques block blood flow, significantly increasing patients' risk for stroke. Seven of the 12, or 58 percent, were also diagnosed with diabetes.

In dramatic comparison, the 17 patients diagnosed with diabetes showed nearly twice the incidence of blockage. Seven of the 17 men, or 41 percent, had carotid plaques. Only five of the 54 patients who displayed plaques did not have also diabetes.

If he conducted this study today Friedlander said he would likely find a higher number of diabetic patients. After he completed the study in 1997, the American Diabetes Association lowered its definition for diabetes from 140 to 126 milligrams of sugar per decilitre of blood.

"This is the first time that science has uncovered a link between sleep apnea and diabetes," Friedlander said. "The data suggest that someone afflicted with both diabetes and sleep apnea is more likely to suffer a stroke in the future.

"Persons going to the doctor for a sleep-apnea exam should request that their blood be screened for diabetes, especially if they are overweight."
More than half of the individuals who develop diabetes as adults will need to modify their diet and take daily insulin in order to control the disease, he added.

The following is an article from Medical News Today dated October 30, 2006:
Medical News Today article

Sleep Medicine: Sleep Apnea And Diabetes

Main Category: Sleep / Sleep Disorders News
Article Date: 30 Oct 2006

Sleep Apnea and Diabetes May Be Related

According to new research, obstructive sleep apnea syndrome (OSAS) and diabetes mellitus (DM) may be associated. Using the electronic charts of patients referred for sleep studies over one year, researchers from Quillen College of Medicine in Tennessee identified 127 patients with DM. Data collected included age, gender, and body mass index, as well as the presence of the kidney condition microalbuminuria; microvascular complications, such as retinopathy/neuropathy; or macrovascular complications, such as coronary artery disease and stroke. Overall, OSAS was directly related to microalbuminuria, microvascular, and macrovascular complications. Researchers concluded that, despite being independent diseases, OSAS might directly contribute to DM complications.

Men With Apnea May Be Sleepier Than Women

Men with mild obstructive sleep apnea may have more sleep fragmentation and daytime symptoms than their female counterparts, according to a new study from Marshall University. Researchers assessed the differences in clinical presentation and polysomnographic profile between 31 men and 32 women with mild obstructive sleep apnea. In all, 12 parameters were examined, in which 3 of them showed a significant difference between the sexes. Men had more witnessed apnea, spent more time in stage 1 sleep, and less time in stage 2 sleep, than women. As a result, researchers suggest that physicians may consider a lower continuous positive airway pressure therapy threshold for men.

African-Americans Report Less Sleep Than Caucasians

A new prospective study of morbidly obese patients revealed that African-Americans self-reported less average sleep duration compared with Caucasians. Researchers from Metrohealth Medical Center in Ohio analyzed 251 patients undergoing polysomnography. Sleep questionnaires were administered and self-reported sleep duration was reported. Demographic information, such as age, gender, race, and comorbid conditions were also included. While researchers did not find a relationship between body mass index (BMI) and sleep duration, they did find that despite age, BMI, or caffeine or alcohol intake, African-Americans reported less sleep duration.

Obstructive Sleep Apnea May Increase Complications After Heart Surgery

New research from the Cleveland Clinic Foundation suggests that cardiac surgery patients with obstructive sleep apnea (OSA) are at a higher risk for developing postoperative complications. Researchers compared the incidence of cardiac surgery complications in 37 patients with OSA, identified through the cardiac surgery database, with another database sample absent of OSA. Patients, who underwent open-heart surgery within two years of an OSA diagnosis, were assumed to have had OSA at the time of surgery. Researchers found that the patients with OSA exhibited a higher incidence of encephalopathy, postoperative infection, and increased length of intensive care unit stays. It is suggested that this risk is underestimated due to lack of OSA incidence awareness and that patients may need to be screened for OSA prior to cardiac surgery.

Education Increases Compliance in CPAP Patients

Patient education and mask acclimatization are shown to increase compliance among people who participate in continuous positive airway pressure (CPAP) therapy, says a new study. Researchers from Yale University and Bridgeport Hospital divided 88 CPAP patients into two groups; those who received education and acclimatization prestudy (intervention group) and those who received traditional education only, or poststudy (control group). All patients received humidification and followed-up at one, three, and six months. Compliance data downloaded from the CPAP machine showed only eight percent of patients failed to use CPAP, compared with 31 percent of controls. Researchers concluded that there was more compliance, both in hours per night and nights per week used, in the intervention group.

CPAP Treatment in Commercial Drivers Reduces Employer Health Costs

A new study shows significant savings in health-care expenditures for commercial carriers when their truck drivers' sleep apnea is treated. Between January 2003 and December 2005, researchers from Texas, Wisconsin, and Minnesota analyzed 339 commercial truck drivers with newly diagnosed sleep apnea. All drivers received a continuous positive airway pressure (CPAP) machine for treatment. Data were collected before and after CPAP intervention and included rates of hospital admission, emergency department, office visits, and total health-care spending. Researchers found that after CPAP intervention, there was an average savings of $538, per member per month, or a 57.4 percent reduction in per-member-per-month total health-care costs. In addition, inpatient hospital admissions showed a reduction of 91 percent after CPAP was used. Researchers conclude that companies can enjoy large reductions in corporate health-care by attempting to identify and treat employees with sleep apnea.

external image transpixel.gif