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Can Sleep Apnea Cause Diabetes

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Common Sleep Apnea Symptoms

Reverse Type 2 Diabetes and Sleep Apnea with Functional Medicine – Dr. John Bartemus

Sleep Apnea is not just snoring. It involves periods of time, sometimes a minute or more when a sufferer does not breathe properly. These periods of time can rob the brain of oxygen and can cause poor quality sleep when apnea wakes you. If you have type 2 diabetes and suffer from any of the following, talk to your doctor about a sleep study:

  • frequent or loud snoring.
  • mood swings.

The Relationship Between Diabetes

Sirimon Reutrakul

1Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand

2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

3Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

4Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand

5Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA


1. Introduction

It is well known that OSA, especially moderate-to-severe degree, is strongly associated with hypertension , and hypertensive patients with OSA are at a higher risk for adverse cardiovascular events . Hypertension also plays a crucial role in diabetes-related complications systolic blood pressure has been shown to independently and additively exert effects on micro- and macrovascular complications in T2DM patients, in addition to glycemic control . It is likely that hypertension at least partly mediates the relationship between OSA and diabetes complications.

2. Methods

2.1. Assessment of Baseline Characteristics, Glycemic Control, and Diabetes Complications
2.2. Assessment of OSA
2.3. Statistical Analysis

3. Results

Demographic and glycemic characteristics





Studies Suggesting A Link Between Sleep Apnea And Tinnitus

The most relevant study that tried to examine the link between Sleep Apnea and Tinnitus was a Taiwanese study. In it, almost 22,000 middle aged patients with Tinnitus were studied against a control group of 108,000 people. The study concluded that sleep apnea significantly increased chances of being affected with Tinnitus.

Another study of about 14,000 Hispanic men concluded that hearing impairment was very common amongst people who suffered from Sleep Apnea. In case you did not know, hearing impairment like hearing loss can eventually lead to conditions like Tinnitus. Our brain is confused with the lack of auditory signals resulting out of hearing loss. So, a ringing noise is invented to compensate for that hearing loss.

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Sleep Apnea And Cardiovascular Disease: Role Of Obesity

According to data from the National Center for Health Statistics, about two-thirds of American adults are either overweight or obese . The age-adjusted prevalence of overweight/obesity in ethnic minorities, especially minority women, is higher than in whites in the United States, reaching a critical level of greater than two-thirds of the female minority population. Blacks are at greater risks because they are disproportionately more obese than whites .

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Osa And Type 2 Diabetes

Sleep apnea and diabetes for video chat

The association between OSA and type 2 diabetes was examined either in clinical settings or in epidemiological cohorts. OSA severity was shown to be positively associated with the incidence of type 2 diabetes, independent of adiposity, during 12.8 years of follow up in a subpopulation who were participants of both the Sleep Heart Health Studies and Atherosclerosis Risk in Communities study. Multivariable adjusted hazard ratios and 95% confidence intervals of developing diabetes were 0.94 for mild , 1.28 for moderate and 1.71 for severe OSA , compared with a nonOSA population . The latest metaanalysis of the SHHSAtherosclerosis Risk in Communities study and nine other studies found that the crude and adjusted pooled relative risks were 1.62 and 1.35 , respectively. These 10 studies present convincing evidence that patients with OSA are more likely to develop type 2 diabetes, regardless of their age and body mass index level.

The potential impact of OSA and wellknown risk factors, including adiposity, family history of diabetes and low physical activity, on diabetes risk have been compared, by determination of pooled estimates from different studies: the pooled relative risk of OSA in relation to type 2 diabetes is comparable with that of low physical activity, suggesting that treatment of OSA is crucial for diabetes prevention.

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Impact Of Osa On Glucose Metabolism And Insulin Resistance In Asian Populations

Here, we have reviewed publications regarding the association between OSA and diabetes. Metaanalysis showed that diabetes is more prevalent among OSA patients, and systematic review showed that more than half of diabetes patients suffer from OSA. A common concern regarding these analyses is the effect of ethnicitydependent differences in physical constitution, lifestyle and possibly metabolism. As most of the data reviewed in the present review originated from studies in Western countries, we also focused on some studies carried out in Japan or other Asian nations. One East Asian study was included in the metaanalysis, but there are several others that we have not mentioned. For example, a Japanese crosssectional study of 536 men showed that mild OSA, but not moderate or severe OSA, was associated with a higher prevalence of impaired glucose metabolism, with ORs for impaired glucose metabolism of 2.9 , 1.2 and 1.58 , respectively.

The Circulatory Risk in Communities Study investigated the association between nocturnal intermittent hypoxia as a surrogate marker of OSA and risk of type 2 diabetes in community residents aged 4069 years . After a median followup period of 3.0 years , 210 participants developed diabetes, and the multivariableadjusted HR for developing type 2 diabetes was 1.26 among those with mild nocturnal intermittent hypoxia, and 1.69 among those with moderatetosevere nocturnal intermittent hypoxia .

Does Sleep Apnea Affect Diabetes

There are a number of links between Sleep Apnea and type 2 diabetes. Some of these show one condition affecting or worsening the other. Others point to common risk factors for both or to complications that can be made worse when someone suffers from both diabetes and Sleep Apnea.

First, the two conditions have a risk factor in common: obesity. Excess weight affects how the body processes sugar, making obesity among the top risk factors for type 2 diabetes. Excess weight is also considered a significant risk factor for the development of Obstructive Sleep Apnea .

Obesity, in fact, is considered to be one of the top Sleep Apnea causes. This is because fat deposits that are located around airways can inhibit smooth and easy breathing.

There is also evidence that Sleep Apnea is linked to diabetes development. When people have disturbed sleep, it inhibits their bodys ability to process sugar. The chronic fatigue caused by poor sleep quality has been linked in studies with increases in blood glucose.

Researchers believe that stress associated with poor sleep causes hormonal changes that spur the body to release stored glucose. The link between blood sugar and Sleep Apnea can mean that people who have a risk for type 2 diabetes can see that risk increased by sleep problems.

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Obstructive Sleep Apnea And Coronary Artery Disease: From Pathophysiology To Clinical Implications

Fernando De Torres-Alba

1Acute Cardiac Care Unit, Department of Cardiology, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain

Academic Editor:


Coronary artery disease and obstructive sleep apnea are both complex and significant clinical problems. The pathophysiological mechanisms that link OSA with CAD are complex and can influence the broad spectrum of conditions caused by CAD, from subclinical atherosclerosis to myocardial infarction. OSA remains a significant clinical problem among patients with CAD, and evidence suggesting its role as a risk factor for CAD is growing. Furthermore, increasing data support that CAD prognosis may be influenced by OSA and its treatment by continuous positive airway pressure therapy. However, stronger evidence is needed to definitely answer these questions. This paper focuses on the relationship between OSA and CAD from the pathophysiological effects of OSA in CAD, to the clinical implications of OSA and its treatment in CAD patients.

1. Introduction

Despite the reduction in mortality rates that occurred in the past decades, it still affects 6.4% of adults in any of its forms and constitutes the cause of death of nearly 17% of adult population in the United States . According to data from the Framingham Heart Study, a population-based longitudinal study, nearly one-half of males and one-third of females over 40 years of age will develop some manifestation of CAD .

2. Pathophysiological Effects of OSA in CAD

Both Type 2 Diabetes And Osa Increase Risk Of Cardiovascular Disease

A Link Between Sleep Apnea and Diabetes Confirmed

As both diabetes and OSA lead to cardiovascular disease, clinicians and healthcare professionals should be aware of the association between diabetes and OSA, explains the same 2018 study from Japan.

The study suggests that healthcare professionals should heavily consider treating patients with type 2 diabetes and/or OSA with a CPAP device to reduce the known stress both conditions have on a patients cardiovascular system.

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What Is The Prevalence And Incidence Of Type 2 Diabetes In Osa

Several population and clinic-based studies have assessed the prevalence and incidence of type 2 diabetes in OSA . The majority of these studies have used validated diabetes definitions based on fasting glucose or 2 h post-challenge glucose levels, while a few studies relied on self-reported diabetes and/or antidiabetic medication use. Most, but not all studies , used full polysomnography to diagnose OSA. The majority of studies used statistical adjustments for shared risk factors such as age, sex, body mass index and various other parameters . Overall, the cross-sectional analyses have shown a significantly higher prevalence of diabetes in patients with OSA as compared to those without OSA. The prevalence estimates range from 15 to 30%, depending on the study population, the definition of OSA severity, and the methods used to diagnose type 2 diabetes . A few studies have also reported a significant relationship between increasing severity of OSA and the prevalence of diabetes . In two studies , the higher odds ratio for diabetes in patients with OSA was no longer significant after controlling for confounders. In one study , a higher adjusted odds of self-reported diabetes was found only in the severe OSA group who had excessive sleepiness. In this regard, more research is needed to elucidate the role of sleepiness in adverse metabolic outcomes and to better understand the links between OSA and diabetes in sleepy versus non-sleepy patients.

Sleep Apnea And Diabetes Are Related

Studies show that about 71% of people with diabetes may have sleep apnea. For sleep apnea to have a relationship with diabetes might come as a surprise to the general public, but physicians and scientists have noted some suggestive patterns.

There are many studies published during the last five to ten years showing a strong link between sleep apnea and diabetes, especially type 2 diabetes, says Frédéric Gagnadoux, a professor of medicine at the University of Angers and a respiratory physician who specializes in sleep disordered breathing. A 2012 review of the evidence linking the two conditions estimated that about 71 percent of people with type 2 diabetes may have sleep apnea, based on an average of five studies looking at a total of 1,200 patients^1.

The link goes the other direction also. A 2014 study looked at 6,616 people who participated in the European Sleep Apnea Cohort and looked to see how many had both sleep apnea and type 2 diabetes. 28.9% of those with severe apnea had diabetes, even when the researchers accounted for other risk factors such as obesity^2. In other words, just under a third of people with severe sleep apnea also had type 2 diabetes.

Adjusted mean HbA1c levels among diabetic subjects stratified by OSA severity

This evidence has pushed the American Academy of Sleep Medicine to advise that anyone with type 2 diabetes should get a test for sleep apnea.

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Understanding The Clinical Picture

Sleep-disordered breathing encompasses several characteristic complications . Other symptoms and associated clinical disorders are seen more commonly in those with OSA than would be expected by chance. Sleep apnea can decrease quality of life, says Dr. Einhorn. It can also worsen diabetes and increase the risk of developing diabetes or other serious health problems. While men and women areboth at risk for OSA, older men appear to be at greater risk. Studies indicate that two of every three men with diabetes over the age of 65 have sleep apnea.

How Can Sleep Apnea Treatment Impact Type 2 Diabetes

Sleep Apnea is Dangerous for Diabetes Patients, Can Cause ...

If you have type 2 diabetes and suspect you have sleep apnea, DONT WAIT! As Dr. Einhorn warns, sleep apnea can decrease quality of life . . . It can also worsen diabetes and increase the risk of developing it or other serious health problems. Generally speaking, sleep apnea has detrimental effects on your health, and there isnt a single good reason to leave it untreated and continue to suffer from this disease.

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Patients With Type 1 Diabetes Have A Higher Risk Of Osa

The prevalence of asymptomatic OSA is high in a cohort of patients with type 1 diabetes, determined a 2017 study from Denmark.

Other risk factors for the type 1 diabetes population included being older, overweight, and existing diagnosis of nephropathy .

OSA was present in 32 percent of the patients with normal BMI, in 60 percent of overweight patients, and in 61% of obese patients, explains the study.

Additionally, the study found that patients with type 1 diabetes and OSA showed very few symptoms, particularly very rarely reporting sleepiness compared to patients without OSA. This makes it harder to catch, diagnose, and treat.

Healthcare professionals treating patients with type 1 diabetes should keep in mind that this population should be potentially screened for OSA if they are also over the age of 40, overweight, and have nephropathy.

Sleep Apnea Linked To Insulin Resistance And Type 2 Diabetes

This 2018 report on OSA evaluated dozens of studies on the condition and its implications and connections with other conditions.

It was determined that patients with OSA had an increased risk of developing hypertension, insulin resistance, type 2 diabetes, non-alcoholic fatty liver disease, dyslipidemia, and atherosclerosis.

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Determining How Much Sleep You Need

âThere is no formula for how much sleep you need,â Zafarlotfi says. âIt depends on you.â

Mahowald agrees. âOn average, we need 7.5 hours per night, but your sleep requirement is genetically determined and varies,â he says. âIt can be about four hours on the short end to 10 or 11 on the long end.â

Want to know if you are sleep-deprived? The answer is simple, Mahowald says: âIf you use an alarm clock, you are. If you were getting adequate sleep, your brain would awaken you before the alarm goes off.â

What Are The Symptoms Of Sleep Apnea

Diabetes and Sleep Apnea

Sleep Apnea occurs when an obstruction gets in the way of air entering the lungs.

These short periods of stopping breathing are generally limited to a less than 10 seconds, and can occur often during the night.

Generally, the brain works the sleeping person up when apnea occurs, often with a snore or snort.

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Could You Have An Obstruction

There are different types of sleep apnea, one of which is obstructive sleep apnea , which is when breathing is interrupted by a physical block to airflow. With OSA, snoring is common. The NIH reports that 12 million Americans have OSA, and for people with type 2 diabetes it is a common condition to have.

Research shows that an increase in severity of OSA is correlated with poorer glucose control. If you have diabetes and have the following symptoms, you should talk to your doctor about doing a sleep study to learn if you have sleep apnea:

  • Snoring.
  • Feeling tired or fatigued most of the time.

To diagnose sleep apnea, you can undergo a sleep test called a polysomnogram, which is a test that records body functions while you sleep. The test measures eye movements, electrical brain activity, muscle activity, heart rate, breathing and blood oxygen levels.

Sleep apnea can be treated with CPAP . This is a mask that you wear over the nose and mouth when you sleep. Air pressure from the machine forces air through the nose. This keeps the throat from closing during sleep. Another option to manage your condition is an implantable nerve stimulator, which was recently approved for sleep apnea treatment by the Food and Drug Administration.

If you have diabetes, the bottom line is you want to know ifyou have sleep apnea, because you need to manage the sleep apnea in order tomanage your diabetes. Not to mention, you will feel so much better with a goodnights rest!

How Does Diabetes Affect Sleep

Its estimated that one in two people with type 2 diabetes have sleep problems due to unstable blood sugar levels and accompanying diabetes-related symptoms, High blood sugar and low blood sugar during the night can lead to insomnia and next-day fatigue. As with many chronic conditions, feelings of depression or stress about the disease itself may also keep you awake at night.

When blood sugar levels are high, the kidneys overcompensate by causing you to urinate more often. During the night, these frequent trips to the bathroom lead to disrupted sleep. High blood sugar may also cause headaches, increased thirst, and tiredness that can interfere with falling asleep.

By contrast, going too many hours without eating or taking the wrong balance of diabetes medication can also lead to low blood sugar levels at night. You may have nightmares, break out into a sweat, or feel irritated or confused when you wake up.

Talk to your healthcare provider if you are experiencing fatigue, trouble sleeping, or any other worrying symptoms. They can help analyze the reason and work with you to keep your blood sugar levels more stable.

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