If you have Type 2 diabetes, you may want to be aware of another condition — sleep apnea. Sleep apnea is a condition where you experience pauses in your breathing during the night when you're sleeping, potentially for a minute or more. Family Medicine published a study in 2013 that showed individuals with type 2 diabetes have an almost 50-50 chance of also having a sleep breathing disorder.
This can be a problem because sleep apnea can make symptoms of diabetes worse and it may even cause diabetes.
Obstructive Sleep Apnea and Diabetes
Obstructive sleep apnea (OSA) is one type of sleep-related breathing disorder where your upper airway collapses leading to a cessation of airflow briefly and repeatedly. The resultant hypoxia (oxygen deficiency) leads to frequent awakenings, which cause sleep fragmentation and excessive daytime sleepiness symptoms. Sleep fragmentation also boosts sympathetic activity, which could raise your blood sugar levels by reducing insulin effectiveness.
Risk factors for developing OSA are:
Male gender: Men seem to develop OSA more than women.
Obesity: Being overweight can increase your risk.
Older age: Being older can increase your risk.
These risk factors are also linked with an increased risk of developing type 2 diabetes. There's growing evidence describing the link between insulin resistance, OSA and the subsequent development of type 2 diabetes.
OSA Causal Factors for Type 2 Diabetes
Patients are interested in know if OSA causes type 2 diabetes and the effect of OSA on diabetes, and various studies help to explain this. Major factors that contribute to developing type 2 diabetes are poor lifestyle habits (limited physical activity, excess dietary intake) and obesity.
A large study researching the conditions has shown an association between how severe an individual's OSA is and their risk of developing type 2 diabetes.
To find whether OSA does increase the risk of diabetes development, researchers looked at 8,678 adults in the study who were suspected of having OSA and underwent a sleep study between the years 1994 and 2010. They measured the severity of each individual's sleep apnea using the apnea-hypopnea index (AHI).
This measurement indicates how many times a person breathes irregularly or stops breathing each hour. The study participants were placed into one of four categories of OSA based on the results. These were:
Mild (5-15 events per hour of sleep)
Moderate (15-30 events per hour of sleep)
Severe (30 or greater events per hour of sleep)
None (less than 5 events per hour of sleep)
They were then followed through May 2011 to determine if they did indeed go on to develop diabetes.
Over the follow-up period, 11.7 percent (1,017 participants) developed Type 2 diabetes. Researchers made adjustments for risk factors known to increase an individual's risk of developing diabetes, including:
After making these adjustments, researchers found individuals with severe OSA had a 30 percent higher risk of developing type 2 diabetes than those without OSA. Also, those who had mild to moderate OSA had a 23 percent increased risk of developing the condition compared to those who didn't have OSA.
Other risk factors for diabetes causes included:
Low oxygen blood levels
REM sleep stage
Sympathetic nervous system activation indicated by a raised heart rate
Researchers were able to show a substantial link between the severity of OSA and the risk of developing diabetes.
Effect of Untreated OSA on Diabetes
Untreated sleep apnea is linked with poor quality of life due to chronic fatigue and poor blood sugar control.
Type 2 diabetes and sleep apnea often coexist because of certain shared risk factors such as obesity.
OSA has been shown to induce a serious increase in insulin resistance, which causes the body to try to compensate by making more and more insulin, eventually burning out the insulin-producing cells. Blood sugar levels are by then out of control.
Two studies found sleep-disordered breathing are linked independently with insulin resistance and glucose intolerance. In this big population-based study, the researchers found people with OSA had higher chances of having lower insulin sensitivity levels (34 percent vs 54 percent) and higher fasting insulin production levels than those without OSA.
Type 2 diabetes can have a weight component. Extra weight in your neck and throat can narrow your airway and make it easier for the tissues to block your breathing.
The prevalence of individuals with both diabetes and obesity in the U.S. population could be as high as 2.9 percent and obesity is believed to be an important risk factor in both diabetes and OSA.
Sleep apnea may also raise levels of blood sugar due to the stress linked with abrupt awakenings during the night and chronic sleep deprivation. When you're stressed, stress hormones are released in your body that may do things like release stored glucose in your liver. Over time, the raised blood sugar levels can lead to insulin resistance.
Clinical guidelines recommend doctors ask their patients who have diabetes whether or not they're experiencing any sleep problems. Doctors should also ask diabetic patients about their quality of sleep and if they snore or not, particularly if they're overweight. If OSA is suspected, a sleep study could be helpful.
These sleep studies were cumbersome when the patients had to stay overnight in the sleep lab to be monitored and be hooked up to wires and sensors. Now there are devices that people can take home and test themselves in their familiar environment. Patients can discuss with their doctors whether they can have an at-home sleep study or if an in-lab study would be more appropriate.
Managing Both Diabetes and OSA
Keeping both OSA and type 2 diabetes under control is critical in reducing the risk of complications. Being able to manage these conditions may also reduce symptoms. Wearing an oral appliance or using a CPAP machine to treat sleep apnea to keep your airway open while you're sleeping is also a critical tool. For diabetes, monitoring and controlling your blood sugar levels through exercise, diet and insulin are just as important.
If you have diabetes, it's essential you watch for sleep apnea symptoms and receive a proper diagnosis so you can begin any necessary treatment. Set up a consultation with your doctor to ask about sleep breathing symptoms. If you are diagnosed, once you start treatment, you can look forward to improvement in your sleep quality. You may even see changes in your blood sugar levels!
Get Treated for Diabetes and Sleep Apnea
To receive an OSA treatment consultation with one of our dental sleep medicine experts, Steve Carstensen, DDS or Carrie Magnuson, DDS in the greater Seattle area, complete our brief form to schedule an appointment. You can also contact us here at Premier Sleep Associates today by calling (425) 698-1732.
We offer patients FDA-approved snoring and sleep apnea oral appliances here at Premier Sleep Associates, and both Dr. Steve and Dr. Carrie are passionate and highly qualified sleep dentists who treat patients with sleep-breathing disorders, such as sleep apnea.