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Sleep-disordered breathing and type 2 diabetes: A report from the International Diabetes Federation Taskforce on Epidemiology and Prevention

https://doi.org/10.1016/j.diabres.2008.04.025Get rights and content

Abstract

Sleep-disordered breathing (SDB) has been associated with insulin resistance and glucose intolerance, and is frequently found in people with type 2 diabetes. SDB not only causes poor sleep quality and daytime sleepiness, but has clinical consequences, including hypertension and increased risk of cardiovascular disease. In addition to supporting the need for further research into the links between SDB and diabetes, the International Diabetes Federation Taskforce on Epidemiology and Prevention strongly recommends that health professionals working in both type 2 diabetes and SDB adopt clinical practices to ensure that a patient presenting with one condition is considered for the other.

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.

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