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Obstructive Sleep Apnea May Worsen Diabetes

Diabetic adults with obstructive sleep apnea (OSA) see their type 2 diabetes worsen because it adversely affects their glucose control, according to a new study by the University of Chicago.

The study “demonstrates for the first time that there is a clear, graded, inverse relationship between OSA severity and glucose control in patients with type 2 diabetes,” wrote the lead author, Dr. Renee S. Aronsohn, an instructor of medicine at the University of Chicago.

 

The study, published online in the American Journal of Respiratory and Critical Care Medicine, also confirmed other reports that undiagnosed OSA is very common among patients with type 2 diabetes, indicating that it is largely unrecognized additional medical risk factor in these patients.

 

Aronsohn and colleagues consecutively recruited patients with type 2 diabetes from outpatient clinics to participate in the study. The participants were interviewed to assess their diabetes history, medical history and medications, and level of physical activity. Height and weight measurements were also taken, and each participant’s sleep/wake cycles were tracked for five days using a wrist monitor and self-reported sleep logs. Finally, participants underwent an overnight sleep test for OSA, and glucose control was assessed by obtaining a blood sample.

 

In all, 60 patients were included in the study’s final analysis. More than three-quarters (77%) of participants had OSA, but only five had been previously evaluated for the disease, and none were undergoing treatment. Of the study sample, 38% (23 patients) were classified as having mild OSA, 25% (15) had moderate OSA and the 13% (8) had severe OSA.

 

The researchers found that more severe OSA was associated with poorer glucose control, implying a role more severe diabetes with potentially more complications. Relative to patients without OSA, the presence of mild, moderate or severe OSA significantly increased mean adjusted glycemic values by 1.49%, 1.93%, and 3.69%, respectively. These measurements are comparable to those of widely used hypoglycemic medications, meaning that having OSA may negate the beneficial effects of anti-diabetic drugs.

 

“Our findings have important clinical implications, as they support the hypothesis that reducing the severity of OSA may improve glycemic control,” said Aronsohn. “Thus, effective treatment of OSA may represent a novel and non-pharmacologic intervention in the management of type 2 diabetes.”

 

Commenting on the findings of Aronsohn’s team, Dr. John Heffner, past president of the American Thoracic Society, called on physicians to screen their type 2 diabetes patients for OSA. “At least 80% of their patients, if properly screened and studied, will be found to have OSA, which is a treatable condition,” he said. “Treating their breathing problem might improve their glycemic control and long-term complications from diabetes.”

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