Obstructive Sleep Apnea and Diabetes

Abstract

OSA is a chronic treatable sleep disorder and a frequent comorbidity in patients with type 2 diabetes. Cardinal features of OSA, including intermittent hypoxemia and sleep fragmentation, have been linked to abnormal glucose metabolism in laboratory-based experiments. OSA has also been linked to the development of incident type 2 diabetes. The relationship between OSA and type 2 diabetes may be bidirectional in nature given that diabetic neuropathy can affect central control of respiration and upper airway neural reflexes, promoting sleep-disordered breathing. Despite the strong association between OSA and type 2 diabetes, the effect of treatment with CPAP on markers of glucose metabolism has been conflicting. Variability with CPAP adherence may be one of the key factors behind these conflicting results. Finally, accumulating data suggest an association between OSA and type 1 diabetes as well as gestational diabetes. This review explores the role of OSA in the pathogenesis of type 2 diabetes, glucose metabolism dysregulation, and the impact of OSA treatment on glucose metabolism. The association between OSA and diabetic complications as well as gestational diabetes is also reviewed.

Prevalence and clinical impact of snoring in older community‐dwelling adults

“…It has already been shown that sleep apnea is associated with hypertension and cardiovascular disease . It is also associated with diabetes, even in an Asian population . Our study added further evidence of these associations in adults aged ≥65 years.…”

The association of sleep disturbances with glycemia and obesity in youth at risk for or with recently diagnosed type 2 diabetes

“…[7][8][9] Although the causal links between sleep disturbances, obesity and glucose dysregulation are not fully understood, experimental studies have improved our understanding of pathophysiologic and mechanistic pathways that underpin this association. [10][11][12] Short-term laboratory-based experiments in young healthy adults have provided convincing evidence that sleep restriction and sleep fragmentation lead to an increase in sympathetic nervous system activity, glucose dysregulation, insulin resistance, alterations in orexigenic and anorexigenic hormones, and excess food intake, ultimately increasing the risk of obesity. [12][13][14][15] Population-based longitudinal studies have also revealed a significant association between sleep duration and obesity in youth.…”

“…From a pathophysiologic standpoint, sleep restriction and fragmentation can increase sympathetic nervous system activity, leading to a decrease in insulin sensitivity . Activation of the hypothalamic‐pituitary‐adrenal axis with resulting elevation of evening cortisol can also decrease insulin sensitivity . However, it is important to note that studies of sleep manipulation have been short in duration and performed predominantly in healthy young adults.…”

“…In obese community‐dwelling children, the prevalence of clinically significant OSA, defined by an apnea‐hypopnea index of ≥5 events per hour of sleep, has been estimated at 13.4% . Multiple studies in adults have reported a significant independent association between OSA and incident type 2 diabetes . However, the association between OSA and metabolic dysfunction has been less consistent in youth, with a recent study suggesting that the association is predominantly determined by adiposity rather than OSA …”

Diabetes sleep treatment trial: Premise, design, and methodology

“…A recent state of the science review of OSA and diabetes 60 included the three studies discussed above with four additional small studies with 23 to 64 participants. This review concluded that the available conflicting evidence regarding the effect of CPAP on glucose metabolism suggests that further study is needed to answer this question.…”