Chest
Volume 133, Issue 2, February 2008, Pages 496-506
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Recent Advances in Chest Medicine
Obstructive Sleep Apnea and Type 2 Diabetes: Interacting Epidemics

https://doi.org/10.1378/chest.07-0828Get rights and content

Type 2 diabetes is a major public health concern with high morbidity, mortality, and health-care costs. Recent reports have indicated that the majority of patients with type 2 diabetes also have obstructive sleep apnea (OSA). There is compelling evidence that OSA is a significant risk factor for cardiovascular disease and mortality. Rapidly accumulating data from both epidemiologic and clinical studies suggest that OSA is also independently associated with alterations in glucose metabolism and places patients at an increased risk of the development of type 2 diabetes. Experimental studies in humans and animals have demonstrated that intermittent hypoxia and reduced sleep duration due to sleep fragmentation, as occur in OSA, exert adverse effects on glucose metabolism. Based on the current evidence, clinicians need to address the risk of OSA in patients with type 2 diabetes and, conversely, evaluate the presence of type 2 diabetes in patients with OSA. Clearly, there is a need for further research, using well-designed studies and long-term follow-up, to fully demonstrate a causal role for OSA in the development and severity of type 2 diabetes. In particular, future studies must carefully consider the confounding effects of central obesity in examining the link between OSA and alterations in glucose metabolism. The interactions among the rising epidemics of obesity, OSA, and type 2 diabetes are likely to be complex and involve multiple pathways. A better understanding of the relationship between OSA and type 2 diabetes may have important public health implications.

Section snippets

Evidence From Population-Based Studies

A growing number of epidemiologic studies, originating from various geographic regions and involving diverse study populations, have suggested the existence of an independent link between markers of severity of OSA and an increased risk of type 2 diabetes. The association between OSA and altered glucose metabolism is well supported by a large set of cross-sectional studies, but there are still very few longitudinal studies, which may indicate a direction of causality. In some studies, the

Evidence From Clinic-Based Studies

Clinic-based studies examining the association between OSA and glucose metabolism have consistently used laboratory polysomnography to define the presence and the severity of OSA (Table 322232425262728293031868788). In the largest clinic-based sample to date, Meslier et al22 studied 595 men who were referred to a sleep laboratory for suspected OSA. The cross-sectional data from polysomnography and 2-h OGTTs revealed that type 2 diabetes was present in 30.1% of OSA patients and 13.9% of

Effects of Continuous Positive Airway Pressure Treatment on Glucose Metabolism

Numerous studies have examined the effects of continuous positive airway pressure (CPAP) treatment on glucose metabolism both in diabetic and nondiabetic populations. There is accumulating evidence suggesting that metabolic abnormalities can be partially corrected by CPAP treatment, which supports the concept of a causal link between OSA and altered glucose control. In one study, Harsch et al32 performed a hyperinsulinemic euglycemic clamp evaluation in 40 nondiabetic patients with

Potential Mechanisms Linking OSA to Alterations in Glucose Metabolism

The pathophysiologic mechanisms leading to alterations in glucose metabolism in OSA patients are likely to be multiple. High sympathetic nervous system activity, intermittent hypoxia, sleep fragmentation and sleep loss, dysregulation of the hypothalamic-pituitary axis, endothelial dysfunction, and alterations in cytokine and adipokine release have all been proposed as potential mechanisms for abnormal glucose metabolism in OSA patients. In the following sections, we will briefly discuss the

Future Directions

There is compelling evidence that OSA represents a significant risk factor for cardiovascular disease and mortality.707172 Rapidly accumulating data from several population and clinic-based studies summarized in this article also indicate that there is an independent association between OSA and altered glucose metabolism, suggesting that OSA might be a novel risk factor for the development of type 2 diabetes. Nevertheless, it should be recognized that obesity, in particular visceral adiposity,

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    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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