The article by Pillai et al (2011; summarised alongside) explores the common problem of obstructive sleep apnoea (OSA) and raises a number of questions of immense clinical, and potentially practice-changing, importance.
The observational, cross-sectional study follows 52 consecutive, high-risk people in a diabetes and obesity unit, and neatly links together the three conditions, with glycaemic control deteriorating with increasing severity of OSA.
On the surface, this isn’t particularly surprising as obesity underpins the other two conditions, in particular neck circumference in the case of OSA. However, the discussion section reviews articles by Babu et al (2005) and Coughlin et al (2007) which suggest that HbA1c reductions can be brought about by continuous positive airway pressure (CPAP) therapy. In some ways, however, even this is unremarkable, as energy levels increase and physical activity improves after treatment. Or is it remarkable? Someone on CPAP will no longer sleep through their meals, and will have more opportunity to disobey the energy balance equation by eating in front of the TV instead of sleeping.
The article suggests both a direct and an indirect mechanism of CPAP reducing HbA1c levels and that lifestyle is probably enhanced. But actually that’s neither here nor there, because the main purpose of the article is to highlight OSA to a blindfolded audience. Only 15% of cases are ever diagnosed with only a 1.5% chance of the condition being picked up at consultation (De Silva, 2009). QOF provides no help as screening for it in obese people or those with diabetes isn’t incentivised, and people who often know very well that they have OSA won’t present for fear of losing their driving license.
So the main message is “think about OSA”. Managing it will improve a person’s quality of life, and might help control their diabetes, as well as blood pressure and risk of stroke. OSA is simple to screen for, and managing it can be life-changing for the individual. Diabesity, and even the metabolic syndrome, mean a great deal more than sugar and weight.
To view the summaries of each paper, please download the PDF.
