UIC research shows sleep apnea increases risks in Type 2 diabetes patients

People with Type 2 diabetes who have moderate-to-severe sleep apnea and hypertension are three times more likely to experience diabetes-related complications, including neuropathy, retinopathy and coronary artery disease, according to a new study in the Journal of Diabetes Research.

Dr. Sirimon Reutrakul (Photo: Jenny Fontaine)

The researchers, led by Dr. Sirimon Reutrakul, associate professor of endocrinology, diabetes and metabolism in the University of Illinois at Chicago College of Medicine, found that the increase in complications among this population may be influenced by the presence of hypertension, which is also associated with both Type 2 diabetes and sleep apnea.

Sleep apnea is a breathing disorder that affects about 30 million individuals in the United States and is linked to numerous health problems, including insulin resistance, Type 2 diabetes and hypertension. In sleep apnea, breathing is interrupted. These pauses can last several seconds and can occur 30 times or more in an hour.

The common treatment for sleep apnea is a continuous positive airway pressure device, or CPAP, that is worn during sleep and forces air into the lungs to prevent breathing pauses. But long-term adherence to the device is poor and many patients simply stop using it.

Type 2 diabetes affects roughly 9.4 percent of Americans and more than 366 million people worldwide. People with Type 2 diabetes don’t produce enough insulin or are resistant to its effects. They must closely monitor their blood glucose throughout the day and, when medication fails, inject insulin.

The researchers wanted to explore the relationship between sleep apnea and diabetes-related complications in people with Type 2 diabetes and see if they could determine the role of hypertension in the development of these complications.

A total of 131 patients with Type 2 diabetes were screened for obstructive sleep apnea. Seventy-five percent of participants had sleep apnea, and about 40 percent had moderate-to-severe sleep apnea. About half of participants had at least one diabetes-related complication, and 70 percent had hypertension.

The researchers found that compared with participants with mild or no sleep apnea, those with moderate-to-severe sleep apnea and hypertension were three times more likely to have diabetes-related complications.

Reutrakul explained that hypertension, a known consequence of sleep apnea, could have negative effects on tissues of the body by restricting blood flow and oxygen through the constriction of vessels, as well as oxidative stress. “These effects could be major contributing factors to diabetes-related complications like neuropathy.”

“Treating sleep apnea in people with Type 2 diabetes could help significantly reduce the risk for diabetes-related complications, but more and larger-scale studies are needed to determine if using a CPAP device can reduce the risk of these complications,” Reutrakul said. “We also didn’t tease out differences in complication rates by the degree of hypertension. Further studies could look to see if worsening hypertension among this population was linked to higher complication rates.”

Dr. Nantaporn Siwasaranond, Dr. Hataikarn Nimitphong, Areesa Manodpitipong, Sunee Saetung and Ammarin Thakkinstian of Ramathibodi Hospital, Bangkok and Dr. Naricha Chirakalwasan of King Chulalongkorn Memorial Hospital, Bangkok, are co-authors on the paper.

The research was supported by a grant from the Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, and the Endocrine Society of Thailand.