Sleep Apnea & Diabetes

By Joanne Pallotta
BIDMC Correspondent
For years, Boston-native Lawrence Brown stopped breathing 33 times an hour every night and his oxygen level dropped dangerously low until Dr. Sanjay Patel of the Pulmonary, Critical Care and Sleep Division at Beth Israel Deaconess Medical Center diagnosed him with Obstructive Sleep Apnea (OSA) just over a year ago.  “I would be sleepy during the day.  I would be sleepy at a red light,” declared the 56-year-old.  The condition posed an extreme threat to his health because Mr. Brown lives with several serious conditions, including Type 2 Diabetes.
Obstructive Sleep Apnea
Obstructive Sleep Apnea (OSA) is a condition in which a person’s throat closes off during sleep, preventing someone from being able to breathe normally.  OSA is one of the most common sleep disorders, affecting some 18 million Americans, according to the National Institutes of Health.  Loud snoring is a telltale sign.  There may also be choking, coughing, and constant movement.  Many people who suffer from OSA notice that they wake up in the middle of the night, have difficulty falling asleep, or feel tired during the day.  OSA has been linked to other, more serious conditions, including heart disease, stroke, and diabetes.
Risks of Sleep Apnea & Diabetes
Many diabetics blame symptoms like lack of energy and constant fatigue on their condition, but they may have undiagnosed OSA.
“About 85% of patients with Type 2 Diabetes have some form of sleep apnea,” says Dr. Patel.  “About 40% to 50% of these patients have what we call moderate to severe sleep apnea.”
OSA tends to be more common in men.  Dr. Patel suggests it might have something to do with the shape of a man’s throat or airway.  Also, he says female hormones like estrogen seem to prevent the condition in some women.  “Overall, 4% of women and 9% of men suffer from sleep apnea.”
Dr. Patel says there are studies suggesting that OSA may further complicate the effects of diabetes on eyesight and neuropathy in the feet through the release of free radicals that can cause damage.  “By causing low oxygen levels at night, sleep apnea can worsen the injury that diabetes causes to nerves in the feet as well as the blood vessels in the eyes.” Dr. Patel says treating OSA may lower the risk of complications from diabetes.
If Sleep Apnea is Suspected
A patient should be tested with an overnight sleep exam.  This can be done in a sleep lab where a person’s brain and muscle activity, as well as his or her eye movements, heart rate, breathing, airflow and blood oxygen levels, are recorded while they sleep.  For many patients, a simpler test in their own home that just measures breathing and oxygen levels may be good enough.  If sleep apnea is determined, then a course of treatment is pursued.
Successful Treatments
There are successful treatments to minimize, or even cure, the effects of OSA.  Mr. Brown received a CPAP (Continuous Positive Airway Pressure) machine which he wears every night.  He credits the device with eliminating his sleep apnea and helping him control his diabetes.  “I take long-acting insulin when I go to bed.  The fact that I can actually sleep comfortably helps the insulin work better.” He says he doesn’t miss a night.
Other treatment options include dental appliances, which are worn on the teeth at night in a similar fashion to retainers, as well as surgical treatments which can cure sleep apnea in some patients.  Dr. Patel says maintaining a proper weight is also key.
“If we treat the sleep apnea we can improve the quality of life for these patients.”
Mr. Brown touts the health benefits of sleep without interruption.  “You’re extending your life when you use these machines because you’re getting a better quality of sleep.”
Beth Israel Deaconess HealthCare
Beth Israel Deaconess Medical Center’s new Sleep Medicine Clinic at Chestnut Hill will open in August.  The spacious location provides evaluation and management of conditions such as sleep apnea, insomnia, narcolepsy, restless leg syndrome, circadian rhythm disturbances, parasomnias, and periodic limb movements.  The facility will also arrange for home sleep testing and sleep laboratory testing for sleep apnea and other sleep disorders.
For more information on the Chestnut Hill location and the full range of  sleep-related conditions BIDMC treats: