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Obstructive Sleep Apnea and Type 2 Diabetes
The International Diabetes Federation (IDF) Taskforce on Epidemiology and Prevention published a seminal article in April 2008 in the journal Diabetes Research and Clinical Practice; vol.8 (i) pages 2-12. For the first time, an independent taskforce outside of sleep medicine has recommended that physicians who treat Type 2 Diabetes should collaborate with sleep specialists in order to evaluate all diabetic patients for sleep disordered breathing (SDB).
Apnea and Type 2 Diabetes Increase Risk of Cardiovascular Disease
Previous research has shown a strong link between SDB, diabetes and cardiovascular disease, although the relationship is complex. What is clear is that patients with diabetes are at a much higher risk for cardiovascular disease, ranging from high blood pressure to heart attack and stroke. According to the IDF, cardiovascular disease is a major cause of death in diabetics, accounting for 50% of all diabetic fatalities.
SDB is often found in individuals with Type 2 Diabetes, hypertension, and obesity. The most common complaint is loud snoring and pauses in breathing which results in increased brain activity, fragmented sleep, drops in blood oxygen (hypoxia), and excessive daytime sleepiness.
Sleep Apnea Causes Impaired Glucose Metabolism
The IDF has proposed a number of causal pathways that may describe how sleep apnea influences insulin resistance. The proposed pathways are described in the figure below. The physiological stress of sleep fragmentation and intermittent hypoxia puts strain on a number of different metabolic pathways, all of which may lead to glucose intolerance and Type 2 Diabetes.
A Potential Mechanism Linking Sleep Apnea to Type 2 Diabetes. Shaw, J.E., et.al (2008) Diabetes Research and Clinical Practice 8(i)
The figure outlines a host of pathways which can be inappropriately activated during sleep as a result of sleep fragmentation and intermittent hypoxia. The over-activation of these pathways leads to dysregulation of Insulin production by Pancreatic Beta (β) Cells – the cause for Type 2 Diabetes.
All Patients with Type 2 Diabetes Should be Evaluated for Sleep Apnea
The IDF has called for immediate action among the diabetes community to raise awareness in clinical practice and research regarding the link between SDB and Type 2 Diabetes.
They suggest all Type 2 Diabetics should be evaluated for symptoms of SDB, such as snoring, observed sleep apnea, and daytime sleepiness.
Multiple Treatments are Already Available for SDB
Treatments for SDB are readily available from accredited sleep medicine programs. Therapeutic options include Continuous Positive Airway Pressure (CPAP), Oral Appliance Therapy (OAT), weight loss, and other specific treatments.