Sleep Apnea and Diabetes Are Related

What is Obstructive Sleep Apnea?

Obstructive sleep apnea is a medical condition wherein there are breathing pauses during sleep. There are two breathing interruptions in sleep apnea: apnea and hypopnoea. Apnea is a breathing interruption wherein the   muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway for 10 seconds or more. Hypopnea, on the other hand, is caused by a partial blockage of the airway causing a reduction in airflow of 50% or more.

There are many causes of sleep apnea. One is the collapse of the muscles and the soft tissues of the back of the throat due to excess weight or fat in the neck or other risk factors. These muscles support the tongue, tonsils and soft palate. When there is relaxation of the muscles of the throat, the airways can become totally blocked or narrowed. Oxygen supply in the brain is then interrupted and forces the person to wake up from deep sleep so that the airways may reopen and the person can breathe normally.

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Obstructive sleep apnea can especially affect people who have certain risk factors such as being overweight, being male, being 40 years of age or more, having a large neck, taking sedative medications, having an unusual inner-neck structure, having excess folds in the inner lining of the mouth, alcohol consumption, being menopausal, having a family history of obstructive sleep apnea, diabetes and nasal congestion. Excess weight can increase the bulk of soft tissue in the neck which can then place a strain on the throat muscles. Excess abdominal fat can also lead to breathing difficulties.

Being male as well as being 40 years of age or more can also place you at risk for obstructive sleep apnea. A large neck of greater than 45 cm or 18 inches can also increase the risk for obstructive sleep apnea. Unusual inner neck structures such as an unusually narrow airway, unusually large tonsils or tongue, or a small lower jaw can push the tongue backwards and cause OSA. During menopause, the changes in hormone levels during the menopause may cause the throat muscles to relax and cause obstructive sleep apnea.

At night, people with obstructive sleep apnea may have repeated episodes of apnea and hypopnea. During apnea, the body suffers from lack of oxygen, causing the person to wake up from deep sleep and enter into a lighter phase of sleep or a brief period of wakefulness, in order to restore normal breathing. Repeated episodes of apnoea and hypopnoea can occur. Such events may occur more than once a minute throughout the night. These episodes make the person feel very tired each day while having no memory of breathlessness during the night.

Other sleep apnea symptoms include feeling very sleepy during the day, waking up with a sore or dry throat, poor memory and concentration, headaches (particularly in the morning), irritability and a short temper, anxiety, depression, lack of interest in sex and impotence (inability to get or maintain an erection).

Sleep Apnea and Diabetes Are Related

A large study recently has established the relationship between sleep apnea and diabetes. This study involved more than 8,500 Canadian patients who were followed-up after 67 months. The researchers have demonstrated a link between obstructive sleep apnea (OSA) and the development of diabetes, confirming earlier evidence of such a relationship from smaller studies with shorter follow-up periods. The findings of this study were published in the online issue of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine. The study included 8,678 adults with suspected OSA without diabetes at baseline who underwent a diagnostic sleep study between 1994 and 2010 and were followed through May 2011 using provincial health administrative data to examine the occurrence of diabetes. Sleep apnea severity was assessed with the apnea-hypopnea index (AHI), which indicates severity based on the number of apneas (complete cessation of airflow) and hypopneas (partial cessation of airflow) per hour of sleep. Patients were classified as not having OSA (AHI < 5), or having mild (AHI 5-14.9), moderate (AHI 15-30) or severe (AHI>30) OSA. About 11.7% of these patients developed diabetes.

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