Sleep Apnea and Diabetes - The Link
Sleep ApneaYet Another Reason to Lose Weight
Being overweight can not only increase an individual's likelihood of developing obstructive sleep apnea (OSA), but also for developing type 2 diabetes. Excess fat around a sleeper's throat and mouth press down around the airways and block them. When the air is cut off, an extremely loud noise is produced, which often wakes the sleeper. This leads to highly disturbed sleep which may lead to reduced activity levels which can exacerbate type 2 diabetes. Even if a person does not fully awaken, the frequent interruptions of oxygen flow have done their damage.
OSA is not only painful for the patient but for any person having to live with the patient. Unlike most snoring, OSA is noted for its volume. The sudden gagging or choking noises that may not wake up the originator will certainly wake up any house guests or bedroom partners. Some OSA patients are so loud that they can be heard in every room of a house. This stigmatizes the OSA patient, even among family and friends, which may discourage a patient from even trying to lose weight. But becoming obese is an even worse option.
In the October 2009 issue of 'Thorax', details of a large Canadian study showed that despite maintaining an ideal body weight, sleepiness caused by OSA led to the development of type 2 diabetes. OSA doubled and trebled the study participants' risk of developing type 2 diabetes. Over 2,100 Canadian men and women with OSA volunteered for the study. The average age of a volunteer was 50, about ten years before type 2 diabetes sets in. This suggests that even individuals that already have OSA need to pay careful consideration to their diet and exercise habits.
The Good News
The good news is that by losing weight, not only can diabetics better manage their blood sugar condition, but can also lead to a marked reduction in OSA noise. This was the result of 'A Randomized Study on the Effect of Weight Loss on Obstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes.' Gary D. Foster, PhD, et al.; 'Archives of Internal Medicine'; 28 Sept. 2009. The one year study examined 264 volunteers with type 2 diabetes. The group that had weight loss as part of their diabetes management fared the best, some completely losing all traces of OSA. Most of the volunteers were over 60 years old, a time when overweight individuals are at most risk of developing diabetes.
The study authors suggest that all overweight diabetic patients need medical or psychological intervention to not only counsel them about how to go about reaching weight loss goals, but to ensure that they actually achieve those goals. As a diabetic loses weight, he or she should gain more energy to maintain regular exercise.
What Is Obstructive Sleep Apnea?
This is not to say that all types of sleep apnea can benefit from weight loss, only OSA. Sleep apnea can also be caused by a growth or deformity in the throat or soft palate. It is this mass or deformity that causes the sudden blockage of the sleeper's airways. In these cases, only surgery to the affected areas can eliminate the apnea.
But OSA differs in that the sleeper's airways are blocked by external pressure on the airways. During deep sleep, the body's muscles relax. This usually leads to a sleeper's mouth remaining open during the evening. The movement of the jaw remaining open can induce sufficient pressure to trigger a complete airway blockage. If the apnea is mild, then treatment is often conducted with the use of sleep aids such as a dental mouthpiece to keep the mouth from opening during deep sleep.
But over the counter medications or dental aids do not help severe OSA sufferers, who can have as many as 30 blockages to their airways per hour. These patients are often urged to use a continuous positive airway pressure (CPAP) oxygen machine. The patients then have to try and sleep with a face mask to prevent the airway blockages. Not surprisingly, some OSA patients hate the CPAP machine. If they are overweight, then a strict weight loss program may be their only way to obtain a good night's sleep, as well as to halt their progress towards type 2 diabetes.
What about Bariatric Surgery?
One very aggressive weight loss option is bariatric surgery, also known as gastric bypass surgery. But although this drastic form of weight loss can temporarily relieve symptoms of type 2 diabetes and sleep apnea, unless the patient maintains dieting and exercise, the patients often gain the weight again. They may also still have difficulties arising from OSA, or see those difficulties return only months after surgery.
Bariatric surgery also does not reduce OSA. Proponents of bariatric surgery claim that studies conducted on OSA patients were too small to be truly accurate. In a recent study of American veterans at Walter Reed Memorial Hospital, only 4% of the 24 patients that had the surgery had a significant reduction in airway stoppages while they slept one year after the procedure. There seemed to be immediate benefits, but most of those disappeared after a year. ('Persistence in Obstructive Sleep Apnea After Surgical Weight Loss'; CJ Lettieri, et al.; 'Journal of Clinical Sleep Medicine'; 2008.)
Conclusion
OSA is a painful and embarrassing problem that greatly reduces the sufferer's quality of life and increases his or her chances of becoming a type 2 diabetic. Being overweight compounds the problem. There are no shortcuts to managing OSA and type 2 diabetes with weight loss. Bariatric surgery does not provide significant long-term benefits. Only through diligent dieting and weight loss can OSA be successfully managed.
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