Obstructive Sleep Apnea Linked to Diabetes
A large study from the University of Toronto shows a link between obstructive sleep apnea (OSA) and diabetes; a finding that authors say confirms earlier evidence of such a relationship demonstrated in smaller studies.
The study, which included 8,678 adults with suspected OSA without diabetes at baseline, “was able to address some of the limitations of earlier studies on the connection between obstructive sleep apnea and diabetes,” said lead author Tetyana Kendzerska, MD, PhD, of the Institute of Health Policy, Management, and Evaluation at the University of Toronto, in a statement.
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Participants underwent a diagnosis sleep study between 1994 and 2010, and were followed through May 2011, using provincial health administrative data to examine the occurrence of diabetes. According to the authors, sleep apnea severity was assessed with the apnea-hypopnea index (AHI), which indicates severity based on the number of apneas and hypopneas per hour of sleep. Patients were classified as not having OSA, or having mild, moderate, or severe OSA.
During the follow-up period, 1,017, or 11.7%, of patients developed diabetes. After adjusting for known risk factors for diabetes such as age, sex, body mass index, neck circumference, smoking, income status, and comorbidities at baseline, patients with an AHI less than 30 had a 30% greater risk of developing diabetes than those with an AHI less than 5. Patients with mild or moderate OSA had a 23% increased risk of developing diabetes. Other risk factors included AHI during rapid eye movement sleep, and measures of the physiologic consequences of OSA, including oxygen desaturation, sleep deprivation, and activation of the sympathetic nervous system.
The researchers note that the study had some limitations, including a lack of data on some potential confounders, including family history of diabetes and race, and the potential misclassification of some subjects due to the limitations of the administrative health data that was used. However, the OSA-related predictors of increased diabetes risk found in the study may allow for early preventive interventions for this patient group, the authors said.
“OSA appears to be a risk factor for diabetes, but one that is highly treatable,” says Richard Leung, MD, PhD, FRCPC, assistant professor in the department of medicine at the University of Toronto, and a co-author of the study.
“Patients who are at risk for diabetes based on traditional risk factors like obesity and family history should probably be screened for sleep apnea,” says Leung.
At the very least, he says, “such patients should be asked a few simple questions such as ‘Do you snore loudly?’ and ‘Has your bed partner ever noticed you stop breathing at night?’ followed by a diagnostic sleep study, if appropriate.”
—Mark McGraw
Reference
Kendzerska T, Gerson A, et al. Obstructive Sleep Apnea and Incident Diabetes: A Historical Cohort Study. Am J Crit Care Med. 2014.