Dr Paulose

OSA and Type 2 Diabetes

Diabetes and sleep apnea frequently coexist because obesity is a risk factor common to both. Sleep apnea is very common in diabetic populations but typically goes undiagnosed. There is strong evidence to indicate that OSA and the risk of type 2 diabetes are associated which may be largely attributed to the epidemic of obesity.

OSA is a disorder characterized by snoring, partial or complete cessation of breathing during sleep, reductions in blood oxygen levels, severe sleep fragmentation, and excessive day-time sleepiness. It is associated with cardiovascular conditions, causing hypertension, heart disease, and stroke.

Patients with snoring and untreated OSA have a higher risk of both cardiovascular disease and Type 2 Diabetes. Sleep apnea can be associated with recent weight gain. Tiredness can also cause people to eat for stimulation and skip exercise. Over time, these habits result in obesity, which can worsen sleep apnea, leading to a progression in severity of both conditions.

OSA-sleep deprivation from any cause increases blood glucose, blood pressure, and triglycerides. Snoring and OSA causes higher cortisol levels resulting in resistant hypertension. The reasons for this are complex but seem to include increased sympathetic nervous system activity and adrenal cortisol and catecholamine output.

There is increasing epidemiologic evidence suggesting that habitual snoring and OSA have adverse effects on glucose tolerance, insulin resistance, and the risk of diabetes mellitus, that are independent of the degree of obesity.

Intermittent hypoxia and reduced sleep duration due to sleep fragmentation, as occur in OSA, exert adverse effects on glucose metabolism. The interactions among the rising epidemics of obesity, OSA, and type 2 diabetes are likely to be complex and involve multiple pathways. Insulin resistance is the hallmark of type II diabetes. Insulin resistance is strongly associated with visceral obesity. OSA exhibits pathophysiologic mechanisms that may potentially contribute to the development of insulin resistance.

Pregnancy, OSA and DM

Snoring and sleep apnea was associated with a doubling of the incidence of gestational diabetes and a fourfold increase in the risk of pregnancy-induced hypertension. Pregnancy can worsen sleep apnea, especially during the third trimester when a woman’s weight is greatest. That’s why it’s important for a pregnant woman with sleep apnea to be treated with CPAP machine during her pregnancy

Treating sleep apnea with CPAP therapy or by surgery can improve glycemic control and blood pressure.