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Obstructive Sleep Apnea and Diabetes

Are you a habitual loud snorer? Do you experience excessive daytime sleepiness? Are you overweight or obese? Are you awakened by a choking sensation? If you answer yes to at least two of these questions, you might need to be evaluated for a condition known as obstructive sleep apnea (OSA).

Obstructive sleep apnea is the most common form of sleep disordered breathing. It is a syndrome that is characterized by repetitive upper airway collapse during sleep resulting in a continued breathing effort with diminished or absent airflow. As a result, a person with OSA will have a drop in oxygen level leading to frequent awakenings. The resultant lack of sleep is very stressful to the body thus causing a number of disorders to develop or to worsen.

Related risks
Obstructive sleep apnea has been associated with a number of disorders. Those who have any of the following conditions are therefore considered to be high risk for developing OSA: obesity or overweight, congestive heart failure, atrial fibrillation, refractory or uncontrolled hypertension, type 2 diabetes, stroke and pulmonary hypertension. The high risk driving populations such as the commercial truck/bus drivers also have high risk for OSA. This may explain why there is an increasing incidence of vehicular accidents involving truck and bus drivers.

Moreover, an increased neck circumference (>17 inches for men and > 16 inches for women), large tongue, large or elongated uvula, large tonsils, a body mass index (BMI) >1= to 30 kg/m2 increases the potential to develop OSA.

Obstructive sleep apnea is considered an emerging epidemic. The association between OSA and cardiovascular disease is well-established. Appropriate treatment of OSA has been shown to result in better blood pressure control and prevent decompensation of congestive heart failure.

The diabetes link
Type 2 diabetes is considered a major public health concern not just because of the economic burden of the disease but also because of its high morbidity and mortality. Recently, rapidly accumulating evidence shows that there is a link between OSA and type 2 diabetes. Earlier reports stated that the prevalence of OSA in those with type 2 diabetes is about 23 percent and about 43 percent of those with OSA will eventually have diabetes.

There are a number of proposed causal pathways linking OSA with type 2 diabetes. There is evidence that physiologi tress imposed by episodic hypoxia (a decrease in oxygen level in the blood) and sleep fragmentation has s lot to do with the development of insulin resistance. Needless to say that fatigue and somnolence (sleepiness) may reduce physical activity thus increasing the risk for diabetes. Obesity provides another potential mechanistic link by which OSA may lead to diabetes and vice versa.

Based on current evidence, the risk of OSA in those with type 2 diabetes must be addressed and conversely, evaluation of the presence of impaired glucose tolerance or type 2 diabetes must be done regularly on those with OSA.

Treatment options
As with diabetes, OSA is a chronic disease that requires long term treatment. The treatment of choice is positive airway pressure delivered by machines providing a continuous positive airway pressure or bi-level positive airway pressure or an auto-titrating mode.

The other modalities of treatment include the use of custom made oral appliance or surgery for those with severe obstructing anatomy such as tonsillar enlargement.

It cannot be overemphasized however, that lifestyle modification must be initiated alongside any treatment modality chosen. Those with OSA should actively partner with their health care providers in achieving weight loss by increasing physical activity through exercise and proper diet, as well as avoiding alcohol and sedatives (sleeping pills).

Appropriate treatment decision will be based on the severity of OSA. The diagnosis of OSA must therefore be established objectively by doing a sleep study such as polysomnography.

With appropriate treatment of OSA and adherence to therapy, there is better quality of life not just for those with OSA but also for their spouses or partners. So why wait? Now is the time to report any symptoms of sleep disordered breathing to your health care providers.

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