Obstructive sleep apnoea in diabetes: Does it matter?

Abstract

Obstructive sleep apnoea (OSA) is very common in patients with Type 2 diabetes (T2D), which is not surprising considering that obesity is a common risk factor for both conditions. In general population studies, OSA has been shown to be associated with several comorbidities including increased risk of road traffic accidents, T2D, hypertension and lack of nocturnal dipping of blood pressure, hyperlipidaemia, increased inflammation, increased risk of cardiovascular disease and mortality, increased risk of atrial fibrillation, worse quality of life, and erectile dysfunction. However, the impact of OSA on diabetes-related vascular and metabolic outcomes remains unclear. Furthermore, the impact of continuous positive airway pressure (CPAP) treatment in patients with T2D is also unclear. This unclarity regarding the impact of OSA and CPAP in patients with T2D has possibly contributed to the lack of screening for OSA in patients with T2D in the UK despite the high prevalence of OSA in patients with T2D. In this commentary, I provide an overview about OSA with a particular focus on its role and impact in patients with T2D.

Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives

“…Obstructive sleep apnea (OSA) is known to be common in patients with DM and believed to be associated with DPN in patients with T2DM 63,64. While obesity is a major risk factor for OSA, Janovsky et al showed that OSA was common in lean patients with T1DM and that OSA can be associated with CAN 65.…”

(Using questionnaires to detect obstructive sleep apnoe)

“…4 Je známo, že OSA je asociován s vyšší mortalitou a morbiditou z kardiovaskulárních příčin, pacienti mají častěji hypertenzi, poruchy srdečního rytmu, srdeční selhání nebo infarkt myokardu. [5][6][7][8][9][10][11][12][13] V České republice není prevalence OSA v celkové populaci dosud známa.…”

MECHANISMS OF ENDOCRINOLOGY: Mechanisms of disease: the endocrinology of obstructive sleep apnoea

“…In general population studies, OSA has been shown to be associated with various comorbidities, including T2D (9), which is not surprising since obesity is a common risk factor for OSA and T2D (7,65). Several crosssectional studies showed a high prevalence of OSA (mild: 5 ≤ AHI < 15; moderate: 15 ≤ AHI < 30; severe: AHI ≥30) in patients with T2D (8.5-86%, 23.8-70% moderate-tosevere OSA), and a high prevalence of T2D in patients with OSA (15-30%) (7,66). This variation in prevalence estimates is due to different diagnostic methods and criteria used to define OSA and differences in study populations (67,68,69,70,71).…”

“…The impact of OSA on incident T2D is likely to be mediated by the effects of OSA on insulin resistance (IR) and β-cell dysfunction (7). Studies that examined the relationship between OSA and IR had conflicting results, due to variations in the definitions of OSA and IR, but most of the studies showed an association (65).…”

“…These repeated obstructions are associated with recurrent episodes of oxygen desaturation/ re-saturation, cyclical changes in blood pressure (BP), heart rate, sympathetic activity and intrathoracic pressure, brief microarousals and changes to sleep architecture, such as the loss of REM and slow wave sleep (SWS or deep sleep is stage N3 of NREM sleep characterised by high-amplitude slow waves, further decrease in muscle tone, possible eye movement cessation and is a restorative sleep stage decreasing though with age (2)) ( Fig. 1 and Supplementary data) (3,5,7).…”