ReportSleep-disordered breathing and type 2 diabetes: A report from the International Diabetes Federation Taskforce on Epidemiology and Prevention
Introduction
Sleep-disordered breathing (SDB) is commonly found in patients with type 2 diabetes [1]. Recent research demonstrates the likelihood of a relationship between the two conditions independent of obesity [2]. Irrespective of the independence of relationship, the observed association of SDB with type 2 diabetes has important clinical, epidemiological and public health implications. SDB is increasingly considered as a potential therapeutic target for either primary or secondary prevention of cardiovascular disease (CVD). This is particularly relevant in the context of coexisting type 2 diabetes, when patients are already at significant risk of CVD.
While the enormity of the type 2 diabetes epidemic is well recognised, disorders of breathing during sleep are not, in spite of the significant contribution they make to the burden of disease in individuals and the financial burden on communities.
Therefore, the need exists for a global, multidisciplinary approach to raise awareness, improve clinical practice and coordinate research efforts to better understand the links between SDB and type 2 diabetes. The International Diabetes Federation (IDF) Taskforce on Epidemiology and Prevention convened a Working Group in February 2007 to review the subject, resulting in this discussion paper in recognition of the imperative to take action.
Section snippets
Definition
The term SDB encompasses a range of breathing abnormalities that occur during sleep. These include obstructive sleep apnoea (OSA), central sleep apnoea and periodic breathing. This report deals only with OSA, the most common form of SDB. The clinical syndrome of sleep apnoea is defined as the presence of abnormal breathing in sleep along with daytime symptoms, particularly excessive daytime sleepiness [3]. OSA is characterized by repeated episodes of upper airway collapse, leading to apnoeas
Links between OSA and disorders of glucose metabolism
There has long been a recognized association between type 2 diabetes and OSA, and there is emerging evidence that this relationship is likely to be at least partially independent of adiposity [25], [1], [2].
Cross-sectional estimates from clinic populations and population studies suggest that up to 40% of patients with OSA will have diabetes [26], [27], but the incidence of new diabetes in patients with OSA is not known. Likewise, in patients who are known to have diabetes, the prevalence of OSA
Links between OSA and cardiovascular disorders
OSA is associated with a variety of cardiovascular conditions ranging from hypertension to heart failure [69], [70], and OSA has become increasingly considered as a potential therapeutic target for either primary or secondary prevention of CVD.
Benefits of weight loss
Weight loss (either from dietary or surgical intervention) has been associated with improvements in AHI [104]. However, nearly all weight loss studies are observational, with minimal data from controlled trials. Nevertheless, weight loss is a primary treatment strategy for OSA in an overweight or obese patient. As weight is lost, patients may notice reduced symptoms of OSA including more energy, improved social interaction, cognition, and work performance, fewer accidents and decreased erectile
Screening patients with OSA for metabolic disorders
Metabolic disease, including type 2 diabetes, is very common in patients with OSA. Treatment is available that is likely to reduce the risk of micro- and macrovascular complications. The screening tests (waist measurement, blood pressure measurement and fasting lipids and glucose [followed with an OGTT, where appropriate]) are inexpensive and easy to conduct. Monitoring of metabolic parameters is an essential part of the care of patients with OSA.
Screening patients with type 2 diabetes for OSA
Screening questionnaires for OSA have relatively
Conclusions
There is a high prevalence of OSA in people with type 2 diabetes and abnormal glucose metabolism, which may in part be explained by obesity. Conversely, people with OSA have a high prevalence of type 2 diabetes and related metabolic disorders. There is a link between OSA and daytime somnolence, hypertension and CVD. In a group already at high risk of CVD, consideration should be given to a contribution from OSA. Questionnaires and clinical characteristics may identify people with an increased
Recommendations
The IDF calls for immediate action to be taken among the diabetes community to address the areas of awareness, clinical practice and research with respect to OSA and type 2 diabetes.
- 1.
Awareness
All health professionals involved with diabetes or OSA should be educated about the links between the two conditions. Health policy makers and the general public must also be made more aware of OSA and the significant financial and disability burden that it places on both individuals and societies.
- 2.
Clinical
Conflicts of interest
The authors have a competing interest to declare. Jonathan Shaw has received honoraria and travel support for lectures sponsored by Resmed Ltd. Naresh Punjabi has received honoraria and travel support for lectures sponsored by Respironics and Resmed Ltd. John Wilding has received honoraria and travel support for lectures sponsored by Respironics and Resmed Ltd. Paul Zimmet has received travel support from Resmed Ltd.
Acknowledgements
The meeting of the IDF taskforce was funded by The ResMed Foundation. The ResMed Foundation funded Dr Tanya Pelly to act as rapporteur and work with the writing group to prepare the manuscript for publication. Neither ResMed nor The ResMed Foundation had any role in the development, review or approval of the manuscript.
References (119)
- et al.
Epidemiology of sleep-related obstructive breathing
Sleep Med. Rev.
(2000) - et al.
A community study of sleep-disordered breathing in middle-aged Chinese women in Hong Kong: prevalence and gender differences
Chest
(2004) - et al.
A community study of sleep disordered breathing in middle-aged Chinese men in Hong Kong
Chest
(2001) - et al.
Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India
Chest
(2006) - et al.
Obstructive sleep apnea and the metabolic syndrome in community-based Chinese adults in Hong Kong
Respir. Med.
(2006) - et al.
Impact of sleep debt on metabolic and endocrine function
Lancet
(1999) - et al.
Role of hypoxemia in sleep apnea-induced sympathoexcitation
J. Auton. Nerv. Syst.
(1996) - et al.
Relationship of arousals from sleep to sympathetic nervous system activity and BP in obstructive sleep apnea
Chest
(1999) - et al.
Sleep oxygen desaturation and circulating leptin in obstructive sleep apnea–hypopnea syndrome
Chest
(2005) - et al.
Sleep-disordered breathing and myocardial ischemia in patients with coronary artery disease
Chest
(2000)
Gas exchange and hemodynamics during sleep
Med. Clin. North Am.
Obstructive sleep apnoea syndrome—an oxidative stress disorder
Sleep Med. Rev.
Effects of nasal continuous positive airway pressure on soluble cell adhesion molecules in patients with obstructive sleep apnea syndrome
Am. J. Med.
The effects of nasal continuous positive airway pressure on platelet activation in obstructive sleep apnea syndrome
Chest
Hemostatic alterations in patients with obstructive sleep apnea and the implications for cardiovascular disease
Chest
Prevalence of obstructive sleep apnoea in men with type 2 diabetes
Thorax
Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study
Am. J. Epidemiol.
The AASM manual for snoring of sleep and associated events: rules, terminology and technical specifications
A new method for measuring daytime sleepiness: the Epworth sleepiness scale
Sleep
Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome
Ann. Intern. Med.
Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study
Ann. Intern. Med.
The occurrence of sleep-disordered breathing among middle-aged adults
N. Engl. J. Med.
Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study
Arch. Intern. Med.
Sleep-disordered breathing in African-American elderly
Am. J. Respir. Crit. Care Med.
Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity
Arch. Intern. Med.
Prevalence of sleep-disordered breathing in ages 40–64 years: a population-based survey
Sleep
Racial differences in sleep-disordered breathing in African-Americans and Caucasians
Am. J. Respir. Crit. Care Med.
Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men
Am. J. Respir. Crit. Care Med.
Prevalence of sleep-disordered breathing in middle-aged Korean men and women
Am. J. Respir. Crit. Care Med.
The medical cost of undiagnosed sleep apnea
Sleep
Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women
Sleep
Healthcare utilization in women with obstructive sleep apnea syndrome 2 years after diagnosis and treatment
Sleep
The economic cost of sleep disorders
Sleep
Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome
Eur. Heart J.
Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome
Eur. Respir. J.
Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study
J. Intern. Med.
Diabetes and sleep disturbances: findings from the Sleep Heart Health Study
Diabetes Care
The role of habitual snoring and obesity in the development of diabetes: a 10-year follow-up study in a male population
J. Intern. Med.
Snoring as a risk factor for type II diabetes mellitus: a prospective study
Am. J. Epidemiol.
Incidence of diabetes in middle-aged men is related to sleep disturbances
Diabetes Care
High incidence of diabetes in men with sleep complaints or short sleep duration: a 12-year follow-up study of a middle-aged population
Diabetes Care
Sleep disturbances in midlife unrelated to 32-year diabetes incidence: the prospective population study of women in Gothenburg
Diabetes Care
Sleep duration as a risk factor for the development of type 2 diabetes
Diabetes Care
Association of sleep apnea and type II diabetes: a population-based study
Am. J. Respir. Crit. Care Med.
Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus
Arch. Intern. Med.
The effect of continuous positive airway pressure treatment on insulin sensitivity in patients with obstructive sleep apnoea syndrome and type 2 diabetes
Respiration
Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea
Arch. Intern. Med.
The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea
Sleep Breath
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