Doctors Urged to Screen Diabetics for Sleep Apnea

THURSDAY Jan. 8, 2009 -- Here's a wake-up call to the millions of American men and women with type 2 diabetes: Snoring at night or nodding off during the day may be symptoms of obstructive sleep apnea, a potentially life-threatening problem affecting one out of three diabetics.

Based on strong preliminary evidence linking the two disorders, global health experts are encouraging physicians to assess their diabetic patients for sleep apnea symptoms and to screen sleep apnea sufferers for metabolic disease. The recommendation comes from the International Diabetes Federation (IDF) Task Force on Epidemiology and Prevention.

"It is probably too early to see any concrete evidence of changes in practice, but there is little doubt that awareness of the importance of screening people with diabetes and people with sleep apnea for the other condition is rising," said Dr. Jonathan Shaw, associate professor at the International Diabetes Institute in Melbourne, Australia, and lead author of the IDF task force consensus statement, which was issued last June.

Sleep apnea occurs when a person's airway becomes blocked during sleep. It's usually caused by the collapse of soft tissue in the back of the throat during sleep. Between snores, breathing stops for a period of 10 seconds or longer, and this pattern repeats itself multiples times over the course of a night.

Not only does it deprive the person of a good night's sleep, but it may increase the risk for high blood pressure and heart disease, according to the IDF.

Obstructive sleep apnea affects just 2 percent of women and 4 percent of men in the general population, the IDF noted. But it's much more prevalent among diabetics.

In a recent report in the journal Endocrine Practice, researchers examined data from 279 men and woman with type 2 diabetes. Overall, 36 percent had obstructive sleep apnea.

Men with diabetes were particularly vulnerable. Below age 45, they had more than a one-third increased chance of developing sleep apnea, and that risk doubled above age 65. For women below 45, the chances of having sleep apnea were slim: between 5 percent and 8 percent. Females 65 and older, however, had a one-third increased chance of having the sleep disorder, the study found.

Interestingly, being heavier or taking more medicines were not predictors of sleep apnea. The only correlations were age and gender.

"It suggests that once you're diabetic, there's such a powerful disposition to obstructive sleep apnea that the other contributing variables are simply less important," said Dr. Daniel Einhorn, clinical professor of medicine at the University of California, San Diego, and a medical director at the Scripps Whittier Institute for Diabetes in La Jolla, Calif.

Diagnosing sleep apnea is critical, he noted, because treating the sleep disorder can make a huge difference in the patient's diabetes. "Successful treatment of sleep apnea has a greater impact to improve blood sugar than any single thing you can do in a diabetic," Einhorn said.

Previous research has also shown that people with mild to moderate sleep apnea were twice as likely to develop high blood pressure, compared to those without the sleep disorder. Those with severe sleep apnea were three times as likely to have high blood pressure, a risk factor for cardiovascular disease.

Still, experts say further research into the diabetes-sleep apnea connection is necessary.

"We need to understand the mechanisms involved, so we can derive better therapeutic and prevention approaches," said Dr. Paul Zimmet, professor and director of the International Diabetes Institute in Melbourne, Australia.

The most common treatment for obstructive sleep apnea is continuous positive airway pressure, or CPAP. Before sleep, the person places a mask over his or her nose or nose and mouth. It is connected by tubing to a CPAP machine that uses air pressure to keep the airway open, according to the U.S. National Heart, Lung, and Blood Institute.

Typically, before insurers will pay for this therapy, the person's sleep disorder must be documented in a sleep lab study.

Einhorn is currently conducting a follow-up study to assess easier, less expensive and more readily available methods of diagnosing obstructive sleep apnea, such as the use of a portable at-home screening device.

"There's no way that you'll have large-scale screening if everyone has to go through an overnight study at a sleep lab," he said. "It's completely unaffordable."

More information

The International Diabetes Federation has more facts on sleep apnea and diabetes.

Posted: January 2009


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