Diabetes and obstructive sleep apnea (OSA) are serious health problems that can increase mortality and morbidity, decrease quality of life and increase health care costs. Approximately 12 million Americans have OSA, although approximately 80 percent remain undiagnosed. Studies suggest that type 2 diabetes and obstructive sleep apnea commonly coexist and that each condition worsens the other. A recent study found that half of males and 20 percent of females with diabetes had OSA independent of other risk factors including age, race, sex, baseline fasting glucose and body mass index. Sleep loss may be a risk factor for insulin resistance and type 2 diabetes. Also, obstructive sleep apnea has been linked to vision problems in patients with type 2 diabetes. However, it is not clear if sleep-disordered breathing causes the development of diabetes.
In persons with obstructive sleep apnea, the periods of stopped breathing are called “apneas,” and it is usually caused by the collapse of soft tissue in the back of the throat during sleep. Between snores, breathing stops for a period of 10 seconds or longer, and this pattern may repeat itself many times over the course of one night. In severe obstructive apnea, a person can stop breathing one to two times per minute, while at the same time there are wide swings in heart rate and a decrease in oxygen in the blood. Apneas may be interrupted by a brief arousal that does not awaken the person completely, and the person often does not even realize that his or her sleep was disturbed. Not only does it deprive the person of a good night’s sleep, but it may increase the risk for heart disease and triple the risk for high blood pressure. Some studies have linked altered sleep stages with a decrease in growth hormone, which plays a key role in body composition, such as fat and muscle.
Three cardinal symptoms of sleep apnea include snoring, sleepiness and a significant report by another person, who has observed the person sleeping, of sleep apnea episodes. Neck circumference more than 17 inches in men or 16 inches in women may predict obstructive sleep apnea. Other associated symptoms may include dry mouth, sleep-related headaches, poor concentration, memory loss and irritability. Patients with obstructive sleep apnea are not always male, obese, sleepy and middle-aged, so if a patient does not fit this profile his or her symptoms should not be ignored.
Upon referral to a sleep specialist, a sleep study called a polysomnogram may be done to measure activity during sleep and diagnose obstructive sleep apnea. The most common treatment is continuous positive airway pressure (CPAP), in which patients wear a mask over their nose and/or mouth before going to sleep. An air blower forces air through the nose and/or mouth, which keeps the airway open. Treatment is key in managing the condition and reducing the risk of complications.
Studies suggest that diabetes is improved in patients treated with CPAP. Patients have shown significant improvement with insulin sensitivity in two days and have remained stable after three months of treatment. For more information, call the Blount Memorial Diabetes Management Center at 865-977-5767 or the Blount Memorial Sleep Health Center at 865-982-4637.
Lee Ann Duncan is a registered nurse, registered dietitian and diabetes nurse educator for the Blount Memorial Weight Management Center.