Understanding Sleep Apnea’s Toll
Sleep apnea—temporary lapses of breath during slumber—can ruin anyone’s beauty sleep, but people with diabetes have more to worry about: Apnea concurrent with diabetes raises the risk of death from heart attacks and strokes.
Why should that be? A new study has found that in people with sleep apnea, nighttime blood glucose fluctuates more dramatically than in people without the apnea. Previous research has suggested that such glucose variability worsens diabetic complications.
The researchers in the new study also looked at what effect Continuous Positive Airway Pressure (CPAP), the gold standard for treating moderate and severe sleep apnea, has on blood glucose. The CPAP unit, which includes a mask fitted over the face, keeps the airway open during sleep, thereby preventing apnea. Maria Pallayova, PhD, a research associate at the PJ Safarik University in Kosice, Slovakia and her colleagues found that nocturnal glucose variability lessened with the use of CPAP. Plus, people just felt better, she adds: “They usually say in the morning they feel newborn after a night on CPAP.”
This study was published online in Diabetes Research and Clinical Practice, Apr. 24, 2008.
Comments
The Diabetes and Sleep Apnea Connection
This research again confirms what many physicians are now realizing - that Type 2 Diabetes patients need to be tested routinely for Obstructive Sleep Apnea. Sadly, while a majority of physicians surveyed are aware of this connection, very few are actually putting this knowledge into practice. Most diabetic patients have not been informed about the possibility of OSA being a factor in their diabetes condition.
While most research in this area has focused on the use of CPAP, long term studies consistently show that patient tolerance of CPAP is poor, less than 25% in many cases. What has not been brought up in many articles is the much better compliance with Oral Appliance Therapy (OAT) for the treatment of OSA. While oral appliances may be slightly less effective than CPAP, because patients are much more able to wear them, the overall success rate is much higher with OAT.
Part of the reason many physicians may hesitant to discuss the problem of OSA with their diabetes patients because they know the poor compliance with CPAP use if OSA is diagnosed. Who wants to have to "fight" with their patients over something else. Look at the frustration diabetic patients already create in not complying with their treatment recommendations.
What would happen if physicians knew that a much more comfortable option to CPAP, well researched, FDA approved, and now recommended as the first treatment option for mild/moderate OSA by the American Academy of Sleep Medicine, was available? Wouldn't physicians be much more willing to routinely prescribe a sleep study and OSA care is they knew this?
With a bit of research, physicians in almost all communities should be able to locate a dentist, almost always a member of the American Academy of Dental Sleep Medicine (AASM) and sometimes a member of the AASM, in their area who can work with their diabetes patients who have OSA.
Controlling the patient's OSA will decrease nocturnal blood sugar fluctuations, making diabetes control that much easier!
Dr. Tom Armstrong
Member, American Academy of Sleep Medicine
Member, American Adademy of Dental Sleep Medicine
www.bakersfieldsmiles.com
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