Diabetes

What is the Link Between Diabetes and Sleep Apnea?

The effects of sleep apnea (a breathing disorder that affects sleep) go far beyond leaving you tired/fatigued in the morning hours of the day. For individuals with diabetes, sleep apnea could influence the blood sugar (glucose) levels throughout the day, alter the body’s response to insulin and potentially lead to diabetic complications.

Among the general population, an estimated 6 to 17% of adult individuals experience sleep apnea whereas, among diabetics, the count is much higher with more than 50%  of type 2 diabetics experiencing sleep apnea.

What is Sleep Apnea?

Sleep apnea occurs when an individual transiently stops breathing while being asleep. Common signs of OSA include gaps in breathing, loud snoring, sudden choking or gasping for air, increased somnolence, or falling asleep during the day.OSA deprives the body of oxygen and therefore, can disrupt heart functioning, alter blood pressure (BP), and body metabolism.

Sleep apnea is of three types viz. obstructive, complex, and central of which, obstructive sleep apnea (OSA) is the most commonly reported type. In OSA, the soft tissues (tongue) collapse and fall back on the breathing passage, blocking the airways and interrupting breathing. OSA is commonly associated with obesity but can also occur among non-obese individuals.

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What is the link between type 2 diabetes and sleep apnea?

Researchers have reported a symbiotic association between sleep apnea and type 2 diabetes h such that one condition worsens the other if left unaddressed. Sleep apnea-induced oxygen deprivation (and the resultant increase in carbon dioxide levels) has a can negatively impact on blood sugar levels with increased resistance to insulin (and therefore, increased blood glucose, indicated by higher A1C values ).In addition, the metabolism of glucose is altered. Taken together, OSA is associated with type 2 diabetes development.

Further, obesity is well-established as a comorbidity of type 2 diabetes, and obesity increases the odds of OSA development. In addition, fat deposition such as cholesterol and triglycerides in the neck vasculature could impinge on the airways and excess abdominal fat could compress the chest wall—both situations could lead to airway constriction while sleeping (or lying down). Furthermore, deprivation of oxygen associated with poor sleep quality can increase blood pressure and lead to the deterioration of cardiovascular health.

Management of sleep apnea among diabetics

Effective management of diabetes— maintaining glucose levels within the reference range, weight management, balanced and healthy diets, regular physical exercise, and compliance with prescribed treatment) is a good beginning for managing sleep apnea. Further, allergic or sinus issues that interfere with breathing must be addressed to keep the air sinuses uncongested and open.

Weight reduction could decrease pressure on the chest wall and decrease the odds of fat deposition in the airways. A continuous positive airway pressure (CPAP) machine can be used based on the overnight sleep study reports. In the CPAP machine, an individual wears a mask while sleeping and the hose attached to the mask delivers pressurized air which keeps the airways open and prevents breathing interruptions. Surgery can also be performed which involves the elimination or shrinkage of tissues in the posterior (back) oral cavity (mouth) to prevent airway obstructions during sleep.

Mobile apps and fitness trackers can be used to monitor and record the quality and patterns of sleep. However, such devices are not substitutes for medical professional guidance. The trackers also measure important health parameters such as heart rate and blood pressure. Among fitness trackers, Apple Watch, FitbitOura Ring and Amazon Halo are the most popular options.

References

·       Farabi, S. (2016). Type 1 Diabetes and Sleep. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755454/

·       Senaratna C, et al. (2017). Prevalence of obstructive sleep apnea in the general population: A systematic review. https://pubmed.ncbi.nlm.nih.gov/27568340/

·       Muraki I, et al. (2018). Sleep apnea and type 2 diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123041/

·       Yano Y, et al. (2020). Sleep characteristics and Measurements of Glucose Metabolism in Blacks: The Jackson Heart Study. https://www.ahajournals.org/doi/10.1161/JAHA.119.013209

·       American Diabetes Association Standards of Care (2022). Glycemic Targets: Standards of Medical Care in Diabetes—2022. https://diabetesjournals.org/care/article/45/Supplement_1/S83/138927/6-Glycemic-Targets-Standards-of-Medical-Care-in

Author

Pooja Toshniwal Paharia

Dr. Pooja Toshniwal Paharia is a Consultant Oral and Maxillofacial Physician and Radiologist, M.DS (Oral Medicine and Radiology) from Mumbai. She strongly believes in evidence-based radiodiagnosis and therapeutic regimens for benign, potentially malignant, or malignant lesions and conditions either arising from the oral and maxillofacial structures or manifesting in the associated regions.

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