Sleep and diabetes

Obstructive Sleep Apnoea and Diabetes.

• Obstructive sleep apnoea (OSA) affects approximately 24% of adult men and 9% of women in Australia, although many patients (possibly 80%) remain undiagnosed

• OSA is particularly common in obesity, affecting between 33% and 77% of obese males and between 11% and 46% of obese women

• Similar to diabetes, OSA prevalence and severity correlate with adiposity; untreated OSA is also associated with significant cardiovascular morbidity

• The economic and public health burden of diabetes is enormous, despite the availability of proven lifestyle and medication interventions; diabetes (and pre-diabetes) are associated with increased risk of cardiovascular disease

• Type 2 diabetes is more prevalent among patients with OSA than in those without OSA; this association appears to be independent of shared risk-factors; large-scale studies show that a 58% - 86% prevalence of OSA in type 2 diabetics

• It is estimated that 8% of the population (approximately 1.6 million Australian individuals) have diabetes; with the most conservative estimates of OSA prevalence, this suggests that over 900,000 diabetic Australians suffer from co-morbid OSA, which is very often undiagnosed

• Increasing severity of OSA appears to be associated with poorer glucose control 

• OSA sufferers (particularly those with severe OSA) are more likely to have insulin resistance than those without OSA

• The International Diabetes Federation recommends that all patients with diabetes should be considered for OSA, and vice versa: SNORE Australia offers exactly this: high-quality diagnosis and management advice for all diabetes sufferers

• Most studies show that successful treatment of OSA with CPAP improves HbA1c, and/or insulin sensitivity and/or fasting or post-prandial glucose levels

• CPAP therapy may reduce metabolic syndrome; up to 13% of patients with OSA and diabetes may have reversal of metabolic syndrome as a result of successful OSA treatment with CPAP

• The prevalence of prediabetes, as defined by the presence of either impaired fasting glucose levels or impaired glucose tolerance, has been found to be significantly higher in OSA patients than those without OSA, with estimates ranging between 20% and 37%

• Even mild OSA appears to predispose to adverse metabolic outcomes

• Current evidence from cross-sectional studies strongly supports an independent association between OSA, insulin resistance and glucose intolerance; adiposity may be a causative link

• In addition to improving diabetes, successful correction of OSA with CPAP has been shown to improve diabetic complications as well as cardiovascular sequelae, including diabetic retinopathy and diabetes-related impairment of vision acuity.

Due to the importance of the link between diabetes and obstructive sleep apnoea, SNORE Australia has become a Silver Partner of Diabetes Queensland, who support over 150,000 diabetes sufferers in Queensland.  Our joint aim is to educate patients with diabetes about the importance of correct diagnosis and treatment of OSA, so as to improve patient health, well-being and long-term survival.