Here is a wake-up call to the millions of American men and women with type 2 diabetes: Snoring at night or nodding off during the day may be symptoms of obstructive sleep apnea.
Sleep apnea is a potentially life-threatening problem affecting one out of three people with diabetes.
Based on evidence linking the two disorders, health experts are encouraging physicians to assess their diabetic patients for sleep apnea symptoms and to screen sleep apnea sufferers for metabolic disease.
The recommendation comes from the International Diabetes Federation (IDF)Task Force on Epidemiology and Prevention.
"It is probably too early to see any concrete evidence of changes in practice, but there is little doubt that awareness of the importance of screening people with diabetes and people with sleep apnea for the other condition is rising," says Dr. Jonathan Shaw, lead author of the IDF task force and associate professor at the International Diabetes Institute in Melbourne, Australia.
Sleep apnea occurs when a person's airway becomes blocked during sleep.
It is usually caused by the collapse of soft tissue in the back of the throat during sleep. Between snores, breathing stops for a period of 10 seconds or longer, and this pattern may repeat itself multiple times over the course of a night.
Not only does it deprive the person of a good night's sleep, but it may increase the risk for high blood pressure and heart disease.
Obstructive sleep apnea affects just 2 percent of women and 4 percent of men in the general population, the IDF notes. But, it is much more prevalent among people with diabetes.
In a recent report in the journal Endocrine Practice, researchers examined data from 279 men and woman with type 2 diabetes. Overall, 36 percent had obstructive sleep apnea.
Men with diabetes were particularly vulnerable. Men younger than age 45 had more than a one-third increased chance of developing sleep apnea. After age 65, the risk doubled.
For women younger than 45, the chances of having sleep apnea were slim: between 5 percent and 8 percent. Females 65 and older, however, had a one-third increased chance of having the sleep disorder, the study found.
Interestingly, being heavier or taking more medicines were not predictors of sleep apnea. The only correlations were age and gender.
"It suggests that once you're diabetic, there's such a powerful disposition to obstructive sleep apnea that the other contributing variables are simply less important," says Dr. Daniel Einhorn, clinical professor of medicine at the University of California, San Diego, and a medical director at the Scripps Institute for Diabetes in La Jolla, California.
He adds that diagnosing and treating sleep apnea is critical to successfully managing a person's diabetes.
"Successful treatment of sleep apnea has a greater impact to improve blood sugar than any single thing you can do in a diabetic," says Dr. Einhorn.
Previous research has also shown that people with mild to moderate sleep apnea were twice as likely to develop high blood pressure, compared to those without the sleep disorder.
Those with severe sleep apnea were three times as likely to have high blood pressure.
Still, experts say further research into the diabetes-sleep apnea connection is necessary.
"We need to understand the mechanisms involved, so we can derive better therapeutic and prevention approaches," says Dr. Paul Zimmet, director of the International Diabetes Institute.
The most common treatment for obstructive sleep apnea is continuous positive airway pressure, or CPAP.
Before sleep, the person places a mask over his or her nose or nose and mouth. It is connected by tubing to a CPAP machine that uses air pressure to keep the airway open, according to the National Heart, Lung, and Blood Institute (NHLBI).
Typically, before insurers will pay for this therapy, the person's sleep disorder must be documented in a sleep lab study.
These studies are expensive and would prohibit any large-scale screening, says Dr. Einhorn.
He is currently conducting a follow-up study to assess easier, less expensive, and more readily available methods of diagnosing obstructive sleep apnea, such as a portable at-home screening device.
Always consult your physician for more information.
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Sleep apnea is characterized by a number of involuntary breathing pauses or "apneic events" during a single night's sleep - sometimes as many as 20 to 30 or more events per hour.
These events are almost always accompanied by snoring between apnea episodes (although not everyone who snores has sleep apnea).
Sleep apnea may also be noted by choking sensations. The frequent interruptions of deep, restorative sleep often lead to early morning headaches and excessive daytime sleepiness.
During the apneic event, the person is unable to breathe in oxygen and to exhale carbon dioxide, resulting in low levels of oxygen and increased levels of carbon dioxide in the blood.
The reduction in oxygen and increase in carbon dioxide alert the brain to resume breathing and cause an arousal.
With each arousal, a signal is sent from the brain to the upper airway muscles to open the airway; breathing is resumed, often with a loud snort or gasp.
Frequent arousals, although necessary for breathing to restart, prevent a person from getting enough restorative, deep sleep.
Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep.
Apnea occurs when the throat muscles and tongue relax during sleep and partially block the opening of the airway.
It can occur when the muscles of the soft palate at the base of the tongue and the uvula relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether.
Diagnosis of sleep apnea is not simple because there can be many different causes.
Primary care physicians, pulmonologists, neurologists, or other physicians with specialty training in sleep disorders may be involved in making a definitive diagnosis and initiating treatment.
Tests are available for evaluating a person for sleep apnea, including:
polysomnography - a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels.
Multiple Sleep Latency Test (MSLT) - a test that measures the speed of falling asleep. People without sleep problems usually take an average of 10 to 20 minutes to fall asleep.
Individuals who fall asleep in less than five minutes are likely to require some type of treatment for sleep disorders.
Diagnostic tests usually are performed in a sleep center, but new technology may allow some sleep studies to be conducted in the patient's home.
Always consult your physician for more information.