Diabetes and sleep apnoea
Among people with diabetes, the prevalence of sleep apnoea has been reported to be between 58-86%.1-4 Similarly, there is a high prevalence of impaired glucose tolerance and diabetes among people with sleep apnoea (in one study 50% of male sleep apnoea patients had abnormal glucose tolerance, and 30% of them had diabetes).5 Botros et al.6 reported a significantly higher probability of developing T2DM in patients with coinciding OSA than those without OSA. In light of the growing data supporting a significant link between T2DM and OSA, in 2008 the International Diabetes Federation recommended that health professionals ensure that patients presenting with one of these conditions is considered and monitored for the other.7
Obesity is a common and contributing factor to both sleep apnoea and diabetes. However, despite the significance of obesity in both these diseases, studies have shown that sleep apnoea is an additional contributing factor that is independently associated with glucose intolerance and insulin resistance, regardless of obesity.8,9 Insulin resistance is a precursor to diabetes.
CPAP may improve insulin sensitivity and glycemic control in patients with sleep apnoea, particularly for non-obese patients.10,11
Resnick HE, Redline S, Shahar E, et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care 2003;26:702–709
Einhorn D, Stewart DA, Erman MK, et al. Prevalence of sleep apnoea in a population of adults with type 2 diabetes mellitus. Endocr Pract 2007;13:355–362
Aronsohn RS, Whitmore H, Van Cauter E, Tasali E. Impact of untreated obstructive sleep apnoea on glucose control in type 2 diabetes. Am J Respir Crit Care Med 2010;181:507–513
Foster G, Sanders M, Millman R, Zammit G, Borradaile K, Newman A, et al. Obstructive sleep apnoea among obese patients with type 2 diabetes. Diabetes Care 2009; 32:1017-1019
Meslier N, Gagnadoux F, Giraud P, Person C, Ouksel H, Urban T, Racineux JL. Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 2003;22(1):156-60.
Botros N, Concato J, Mohsenin V, Selim B, Doctor K, Yaggi K. Obstructive sleep apnoea as a risk factor for type II diabetes. Am J Med 2009; 122:1122-1127
Shaw JE1, Punjabi NM, Wilding JP, Alberti KG, Zimmet PZ; International Diabetes Federation Taskforce on Epidemiology and Prevention. Sleep-disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Diabetes Res Clin Pract. 2008 Jul;81(1):2-12
Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE; Sleep Heart Health Study Investigators. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol 2004;160(6):521-30.
Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002;165(5):677-82.
Harsch IA, Schahin SP, Radespiel-Troger M, Weintz O, Jahreiss H, Fuchs FS, Wiest GH, Hahn EG, Lohmann T, Konturek PC, Ficker JH. Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patients with obstructive sleep apnoea syndrome. Am J Respir Crit Care Med 2004;169(2):156-62.
Babu AR, Herdegen J, Fogelfeld L, Shott S, Mazzone T. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnoea. Arch Intern Med 2005;165(4):447-52.
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