Sleep Apnea News and Research

Is there a connection between sleep apnea and diabetes?

Many of these patients have things in common — hypertension, increased triglycerides, obesity and cardiovascular problems. A large percentage of people who have sleep apnea also have type II diabetes mellitus.

The international diabetes task force has recommended that all patients with type II diabetes or glucose intolerance be screened for sleep apnea.

What percentage of people have sleep apnea?

About 4 percent of women and 8 percent of men have sleep apnea. The recent studies show that about 40 percent of people with sleep apnea have type II diabetes. These are provisional numbers, because no one has formally looked at this.

What percentage of diabetics have sleep apnea?

This has not been formally studied. It is not the standard of care right now to screen all diabetes patients for sleep apnea. The only way you would know is if you have loud snoring, since most diabetes doctors don’t send every patient for a sleep study.

Should be screened for sleep apnea?

Yes, especially if they have symptoms of snoring.

And patients with sleep apnea should be screened for diabetes?

The diabetes test is not a bad screening test. Because it’s cheap, it would be easy to do it. On the other hand, sleep testing is a lot more expensive. If patients don’t have the symptoms, it may not be worthwhile. If they have symptoms, that would make sense.

Is it known how sleep apnea impacts diabetes?

It may be that when you are obese, you tend to get diabetes and sleep apnea. Maybe they are just co-existing factors. This is an area that needs to be studied. They occur frequently together, but this may not be cause and effect.

Does treating diabetes help with sleep apnea?

Not really — unless indirectly, in that treating diabetes may mean a person loses weight.

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According to a study published in the American Journal of Medicine, people who have weight loss surgery should not expect it to cure their obstructive sleep apnea.Dr. David L. Greenburg of Walter Reed Army Medical Center in Washington, DC, along with his team, analyzed twelve studies including over 340 patients who underwent a type of weight loss surgery known as bariatric surgery.

The dozen studies did indicate that patients experienced significant weight loss, and that they also experienced significantly reduced breathing interuptions per hour.

According to the study authors in spite of this “substantial improvement,” the sleep apnea patients still had significant symptoms of apnea, which suggests that the condition could still lead to high blood pressure, heart disease and stroke.

The researchers concluded that “clinicians should have low thresholds” for re-evaluating patients for obstructive sleep apnea after weight loss surgery.

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The most common form of treatment for sleep apnea is a continuous positive airway pressure (CPAP) device. This is a machine with a mask that is worn over the nose and mouth during sleep that forces air into the airway to keep it open. There may be another alternative, though, for people with mild to moderate sleep apnea.

Many people with sleep apnea have what is referred to as “positional” sleep apnea. This refers to apnea episodes that occur when the patient is sleeping on their back, but not when sleeping on their side. It is estimated that 20% of people with moderate sleep apnea (15 to 30 events an hour) and nearly 50% of people with mild (less than 15 events per hour) have positional sleep apnea.

People often don’t make the connection between their loud snoring at night and their complaints of tiredness during the day. According to Samuel Krachman, D. O., professor of medicine and director of the Sleep Disorders Center at Temple University School of Medicine and Hospital, “They think that they’re just tired, not getting enough sleep or just working too hard. But in reality, it’s related to the sleep apnea.”

The new alternative is called Zzoma. The Zzoma, created by former Temple Fellow Joseph G. Crocetti, is a device which is worn around the chest like a belt, with a firm foam pad wrapped in canvas to keep the patient from rolling onto their backs.

Dr. Krachman says that they have been studying the use of the Zzoma in treating patients with mild to moderate sleep apnea and have found that the Zzoma is less obtrusive and easier to use than a CPAP.

“Although CPAP is very effective, the best studies have shown it’s only used correctly 50 percent of the time,” says Dr. Krachman. “That leaves many diagnosed with sleep apnea but not treated.”

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For sufferers of sleep apnea, the impact of the condition on their life can be substantial. The condition results in frequent waking during the night with shortness of breath, severe tiredness during the day and disruption of sleep for their sleep partner.

Current medical guidelines indicate use of continuous positive airway pressure (CPAP), along with weight control and alcohol management. But more recently, the use of upper-airway surgery is becoming more popular as the initial treatment for obstructive sleep apnea (OSA), the most common type of apnea in countries such as Australia and Scandinavia.

Researchers from the University of Adelaide in Australia, led by Dr. Adam Elshaug, report in the British Medical Journal that surgery should not be the first treatment for OSA.

A review of 7 randomized trials found that surgery did not have any impact on symptoms in 5, and where there was quality of life improvements following surgery they rarely lasted beyond 12 to 24 months.

Also, Dr. Elshaug’s team reviewed 48 studies which showed that 62% of the 21,346 patients who had undergone surgery for obstructive sleep apnea suffered persistent, adverse effects, including difficulty swallowing, voice changes, smell and taste disturbances and dry throat.

Over 20% said that they regretted having the surgery in the first place.

According to the study’s authors: “Surgery for obstructive sleep apnoea should be done within controlled clinical trials, Patients should be informed about the trial, as well as the inconsistent results, the associated pain, the potential side effects and potential for relapse.”

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Researchers at the Mayo Clinic in Rochester, Minnesota have determined that people with obstructive sleep apnea, the most common form of sleep-disordered breathing (SDB), are far more likely to die suddenly in their sleep from heart related problems than the general population. They also found that this is the opposite of the general population who are more likely to die from heart-related problems, such as heart attack and cardiac arrest, during the day.

It is generally believed that the risk of sudden cardiac death is lower during sleep periods because of the reduction of stress factors that can trigger heart problems. Based on earlier studies, the likelihood of suddenly dying from cardiac arrest or heart attack is actually the highest between the hours of 6 a.m. and noon.

There are several different forms of SBD, however, this study focused only on people that have obstructive sleep apnea. Estimates range upwards of 25% of North Americans who suffer from obstructive sleep apnea.

The data utilized for this study came from the death certificates of 112 Minnesotans who were tested for sleep apnea and subsequently died suddenly from cardiac causes between July 1987 and July 1983. Of the people who died from cardiac causes between midnight and 6 a.m., 46% were diagnosed with obstructive sleep apnea while only 21% had other diagnoses. This is compared to 16% of the general population who die from cardiac causes during those hours.

The study was published in the New England Journal of Medicine.

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A recent study of 448 older women finds that those with sleep-disordered breathing (SDB), such as obstructive sleep apnea, had a higher incidence of cognitive decline.

The participants of the study, who averaged 83 years of age, underwent an overnight sleep study to determine if they had SDB. They were also given standard tests of memory, attention and other cognitive abilities.

The researchers found that those participants with SDB showed a higher likelihood of cognitive impairment than those without. Further, those with severe breathing problems had more than 3 times the increase in risk of mental impairment.

The link between SBD and mental impairment was predominantly strong in women who carried the gene linked to Alzheimer’s disease.

According to Dr. Adam P. Spira, a research fellow and the University of California San Francisco and lead investigator on the study, the findings do not prove that nighttime breathing problems directly contribute to cognitive decline. He did say, however, that it is “quite plausible”.

The current theory is that SDB results in chronic oxygen depravation with leads to damaged brain cells. Additionally, women who carry the Alzheimer’s gene may be more susceptible to this damage.

Dr. Spira adds that additional research needs to be conducted to determine whether SDB is a predictor of future cognitive decline.

The findings of this study were published in the Journal of the American Geriatrics Society.

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