Should Screening for Sleep Apnoea be Recommended among Diabetics?

Diabetes mellitus is a common illness around the world which is a result of long-term elevations of blood sugar. This medical condition occurs when your blood sugar or glucose levels become elevated as a result of either a deficiency in the hormone insulin or resistance of the body cells to insulin. Insulin is a hormone secreted by the pancreas that regulates carbohydrate metabolism. In Type 1 diabetes, there is little to no insulin produced by the pancreas. In Type 2 diabetes the body does not respond to the blood glucose lowering effects of insulin.

Once glucose stays too long in the tissues of the body, it can cause a lot of serious problems such as eye damage, nerve damage, kidney failure, infections and non-healing wounds. Diabetes can also lead to other serious medical illnesses such as hypertension, heart disease and stroke. Pregnant women can also get a type of diabetes known as gestational diabetes. Diabetes is usually diagnosed through fasting blood sugar levels and other blood tests.

It has been said that there is a relationship between obstructive sleep apnoea and diabetes due to insulin resistance and abnormalities in cholesterol metabolism. Obstructive sleep apnoea is a condition characterized by airway collapse due to breathing pauses and reduction of ventilation during sleep. This further leads to hypoxia, sleep fragmentation and impaired cognition during daytime. It is becoming more of a common disorder nowadays and is also associated with obesity. Some studies have also found out that treatment with continuous positive airway pressure shows improvement in insulin resistance. There is also a relationship between obstructive sleep apnoea and other metabolic diseases.

It is surprising that screenings for obstructive sleep apnoea are not usually carried out at primary care clinics and doctors’ offices. Sleep apnoea in diabetes patients needs to be identified because untreated sleep apnoea can give rise to cardiovascular morbidity and mortality and can give rise to other diabetic complications in diabetes patients. Obstructive sleep apnoea along with diabetes can give rise to metabolic and cardiovascular problems.

Obstructive sleep apnoea is said to be associated with glucose tolerance, impaired fasting glucose and fasting blood sugar elevations especially in type 2 diabetics. This is a finding which has been found to be independent of obesity, age, weight and waist circumference. Glucose dysregulation is said to stem from intermittent hypoxia and poor sleep quality in obstructive sleep apnoea. This glucose dysregulation further gives rise to blood sugar levels in diabetics, further enhancing its negative effects. Also, among diabetics, there is weight gain, and vice versa, which can further trigger a vicious cycle of sleep apnoea.

Thus, medical practitioners should screen diabetics for sleep apnoea in their offices. This is to further eliminate the negative effects of obstructive sleep apnoea on our health.

Reference:

Surani S. Are diabetic patients being screened for sleep related breathing disorder? World J Diabetes. 2013 Oct 15;4(5):162-4

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