This site is intended for healthcare professionals only
The coexistence of obesity, obstructive sleep apnoea and type 2 diabetes – three highly prevalent conditions – is a significant risk factor for increased morbidity and mortality. The adverse health and social consequences of this vicious triangle warrant increased clinical awareness and therapeutic attention to raise the standard of practice, and improve clinical outcomes and patient safety. Using a multidisciplinary approach, the present article aims to provide up-to-date discussion on the prevalence and impact of obstructive sleep apnoea in people with coexistent type 2 diabetes and obesity, describe the clinical aspects of management and treatment, and make recommendations to assist healthcare professionals with the management of obese people with type 2 diabetes and obstructive sleep apnoea. In summary, the diagnosis of obstructive sleep apnoea needs to be considered in all obese people with type 2 diabetes. All patients with obesity, obstructive sleep apnoea and type 2 diabetes should have ongoing, long-term management for their chronic disorders. Guidelines have been developed to tailor therapies to patients according to the severity of the disorders, comorbid diseases and patient preference. Successful implementation of these guidelines requires close liaison between primary care and specialist services.
Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine Members (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5: 263–76
American Academy of Sleep Medicine (2005) International classification of sleep disorders: Diagnostic and coding manual. 2nd ed. American Academy of Sleep Medicine Westchester, IL
American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22: 667–89
Aronsohn RS, Whitmore H, Van Cauter E, Tasali E (2010) Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med 181: 507–13
Ashrafian H, le Roux CW, Darzi A et al (2008) Effects of bariatric surgery on cardiovascular function. Circulation 118: 2091–102
Balk EM, Moorthy D, Obadan NO et al (2011). Diagnosis and Treatment of Obstructive Sleep Apnea in Adults. Comparative Effectiveness Review No. 32. Available at: www.ncbi.nlm.nih.gov/books/NBK63560/pdf/TOC.pdf (accessed 13.05.2013)
Botros N, Concato J, Mohsenin V, Selim B (2009) Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med 122: 1122–27
Brownlee M (2005) The pathobiology of diabetic complications: a unifying mechanism. Diabetes 54: 1615–25
Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis JAMA 292: 1724–37
Charuzi I, Lavie P, Peiser J, Peled R (1992) Bariatric surgery in morbidly obese sleep-apnea patients: short- and long-term follow-up. Am J Clin Nutr 55: 594S–6S
Chen L, Magliano DJ, Zimmet PZ (2011) The worldwide epidemiology of type 2 diabetes mellitus – present and future perspectives. Nat Rev Endocrinol 8: 228–36
Collop NA, Tracy SL, Kapur V et al (2011) Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med 7: 531–48
Dawson A, Abel SL, Loving RT et al (2008) CPAP therapy of obstructive sleep apnea in type 2 diabetics improves glycemic control during sleep. J Clin Sleep Med Dec 15: 538–42
Einhorn D, Stewart DA, Erman MK et al (2007) Prevalence of sleep apnea in a population of adults with type 2 diabetes mellitus. Endocr Pract 13: 355–62
Foster GD, Sanders MH, Millman R et al for the Sleep AHEAD Research Group (2009) Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 6: 1017–19
Gay P, Weaver T, Loube D, Iber C (2006) Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 29: 381–401
Gianotti L, Pivetti S, Lanfranco F et al (2002) Concomitant impairment of growth hormone secretion and peripheral sensitivity in obese patients with obstructive sleep apnea syndrome. J Clin Endocrinol Metab 87: 5052–7
Handelsman Y, Mechanick JI, Blonde L et al (2011) American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for developing a diabetes mellitus comprehensive care plan: executive summary. Endocr Pract 17: 287–302
Iftikhar IH, Blankfield RP (2012) Effect of continuous positive airway pressure on hemoglobin A(1c) in patients with obstructive sleep apnea: a systematic review and meta-analysis. Lung 190: 605–11
Kushida CA, Littner MR, Morgenthaler T et al (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28: 499–521
Kushida CA, Littner MR, Hirshkowitz M et al (2006) Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29: 375–80
Lurie A (2011) Obstructive sleep apnea in adults: epidemiology, clinical presentation, and treatment options. Adv Cardiol 46: 1–42
Mannarino MR, Di Filippo F, Pirro M (2012) Obstructive sleep apnea syndrome. Eur J Intern Med 23: 586–93
Marshall NS, Wong KK, Phillips CL et al (2009) Is sleep apnea an independent risk factor for prevalent and incident diabetes in the Busselton Health Study? J Clin Sleep Med 5: 15–20
McGinley BM, Schwartz AR, Schneider H et al (2008) Upper airway neuromuscular compensation during sleep is defective in obstructive sleep apnea. J Appl Physiol 105: 197–205
Muraki I, Tanigawa T, Yamagishi K et al (2010) Nocturnal intermittent hypoxia and the development of type 2 diabetes: the Circulatory Risk in Communities Study (CIRCS). Diabetologia 53: 481–8
National Institutes of Health (1998) Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults–The Evidence Report. Obes Res 6: 51S–209S.
NICE (2006) Clinical guideline 43. Obesity: Guidance on the Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. NICE, London
Oltmanns KM, Gehring H, Rudolf S et al (2004) Hypoxia causes glucose intolerance in humans. Am J Respir Crit Care Med 169: 1231–7
Pallayova M, Donic V, Tomori Z (2008) Beneficial effects of severe sleep apnea therapy on nocturnal glucose control in persons with type 2 diabetes mellitus. Diab Res Clin Pract 81: e8–e11
Patel SR, Larkin EK, Redline S (2008) Shared genetic basis for obstructive sleep apnea and adiposity measures. Int J Obes32: 795–800
Phillips BG, Kato M, Narkiewicz K et al (2000) Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol 279: H234–7
Popko K, Gorska E, Wasik M et al (2007) Frequency of distribution of leptin gene polymorphism in obstructive sleep apnea patients. J Physiol Pharmacol 58: 551–61
Priou P, Le Vaillant M, Meslier N et al (2012) IRSR Sleep Cohort Group. Independent association between obstructive sleep apnea severity and glycated hemoglobin in adults without diabetes. Diabetes Care 35: 1902–6
Punjabi NM, Shahar E, Redline S et al (2004) Sleep-disordered breathing, glucose intolerance, and insulin resistance: The Sleep Heart Health Study. Am J Epidemiol 160: 521–30
Schwartz AR, Patil SP, Squier S et al (2010) Obesity and upper airway control during sleep. J Appl Physiol 108: 430–5
Selmi C, Montano N, Furlan R et al (2007) Inflammation and oxidative stress in obstructive sleep apnea syndrome. Exp Biol Med 232: 1409–13
Stamatakis KA, Punjabi NM (2010) Effects of sleep fragmentation on glucose metabolism in normal subjects. Chest 137: 95–101
Vasu TS, Grewal R, Doghramji K (2012) Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med 8: 199–207
Yamauchi M, Nakano H, Maekawa J et al (2005) Oxidative stress in obstructive sleep apnea. Chest 127: 1674–9
Sign up to all DiabetesontheNet journals
Journals
Sign up to all DiabetesontheNet journals
By clicking ‘Subscribe’, you are agreeing that DiabetesontheNet.com are able to email you periodic newsletters. You may unsubscribe from these at any time. Your info is safe with us and we will never sell or trade your details. For information please review our Privacy Policy.
Are you a healthcare professional? This website is for healthcare professionals only. To continue, please confirm that you are a healthcare professional below.
We use cookies responsibly to ensure that we give you the best experience on our website. If you continue without changing your browser settings, we’ll assume that you are happy to receive all cookies on this website. Read about how we use cookies.
