ST. LOUIS – Sleep apnea assessment and treatment should be considered an integral part of diabetes management, Susan M. LaRue, R.D., said at the annual meeting of the American Association of Diabetes Educators.
“Sleep apnea is highly prevalent in people with diabetes, people with hypertension and obesity, all of which we see in huge numbers in our patient population,” said Ms. LaRue, a certified diabetes educator with Amylin Pharmaceuticals.
Because sleep apnea is so common among people with diabetes–concomitant with obesity and hypertension–the Scripps' Whittier Institute for Diabetes, La Jolla, Calif., has instituted a “best practice” in which every patient is screened for OSA.
In a study published by Whittier's Dr. Daniel Einhorn and his associates, 72% of 279 adults with type 2 diabetes were found to have some degree of sleep apnea, defined as an apnea-hypopnea index (AHI) of five events or more per hour. Over a third of the patients (36%) had an AHI of at least 15 events per hour, which was associated with a doubling of the risk for the development of hypertension after adjustment for comorbidities (Endocrine Practice 2007;13:355-62).
That study and the symposium in which Ms. LaRue spoke were both sponsored by the ResMed Corp., which manufactures continuous positive airway pressure (CPAP) devices for treatment of OSA.
Diabetes is among several cardiovascular-related conditions that are strongly associated with OSA. Data suggest that OSA is present in about 80% of individuals with drug-resistant hypertension (35% of all hypertension) and in 50% of those with atrial fibrillation.
The mechanism for the association is not known, but theories focus on the increased sympathetic nervous activity resulting from repeated apneas, said Ms. LaRue, formerly with the Whittier Institute.
Treatment with CPAP not only reduces apneic episodes and improves sleep quality, but also appears to improve the cardiovascular and metabolic abnormalities. In a German study of 60 patients with moderate to severe OSA, those given “therapeutic” levels of CPAP for an average of 9 weeks had a 95% reduction in apneas and hypopneas and a decrease in mean arterial blood pressure of 9.9 mm Hg.
That level of decline would be predicted to reduce coronary heart disease event risk by 37% and stroke risk by 56%, the investigators said (Circulation 2003;107:68-73).