Sleep apnea associated with risk of type 2 diabetes & cardiovascular diseases: RSSDI consensus

In making these findings, RSSDI collaborated with sleep specialists across India to study and develop clinical practice recommendations

A recent consensus by the Research Society for the Study of Diabetes in India (RSSDI) highlights the importance of screening for obstructive sleep apnea (OSA) in patients with type 2 diabetes mellitus (T2DM). The report reveals that over 50% of patients diagnosed with T2DM suffer from sleep disturbances, many of which may require treatment^[1]. Additionally, the report states that cardiovascular disease is a shared clinical consequence of OSA and T2DM,^[2] further suggesting the importance of screening, diagnosis, and treatment in T2DM patients for OSA.

In making these findings, RSSDI collaborated with sleep specialists across India to study and develop clinical practice recommendations. The consensus identifies the association of OSA with T2DM and the need for a collaborative approach between diabetologists and sleep specialists to manage such patients^[3]. 

The consensus also stated, “Implementation of screening, diagnosis, and treatment of OSA in patients with T2DM at initial stages could potentially alleviate the risk of cardiovascular disease and substantially improve their quality of life.”

 The consensus found the impacts on sleep vary across gender and geographies:

• Research studies consistently reported a higher prevalence of OSA in T2DM among men than in women^[4]
• The prevalence of OSA in patients with T2DM among the urban population is higher compared with the rural population^[5]

 The consensus also suggested that:

• The presence and severity of untreated OSA is independently associated with poor glycemic control in patients with T2DM^[6][7]
• While there are varying results on the effect of CPAP therapy on glycemic control in T2DM patients (owing to small sample size and lack of control subjects), CPAP continues to be the gold standard and first line of therapy for OSA due to its favourable effects on sleep quality and quantity.^[8]

Dr Sibasish Dey, Head, Medical Affairs, Asia, and Latin America, ResMed said, “According to a 2019 report by The Lancet, nearly a billion people suffer from mild to severe OSA across the world.[9] These same people can be more likely to develop T2DM. As the 2021 RSDDI consensus highlights, existing scientific literature shows that both the presence and severity of untreated OSA is independently associated with poor glycemic control (increased HbA1c levels) in patients with T2DM[10]. Hence, as recommended by RSSDI, timely screening, diagnosis and medical intervention are integral for OSA and type 2 diabetes patients.”

He added, “moreover, overweight individuals exhibiting signs and symptoms of OSA, such as habitual snoring, witnessed apnea and daytime sleepiness, should consider screening for the co-existence of T2DM.”

India, with over 77 million adults that suffer from T2DM, is ranked second in the world for incidence of T2DM and the estimated number of affected individuals is projected to rise to 134.2 million by 2045. One simple process to screen for OSA is the STOP-Bang questionnaire (gold standard preliminary screening questionnaire by American Academy Sleep Society), a cost-effective and validated tool to help identify patients more suitable for diagnostic tests.

The treatment options for OSA in patients with T2DM who are at cardiovascular risk include lifestyle modification and medical management, which could include devices such as home CPAP therapy[12].

The preparation of the consensus was supported by ResMed India.

References

^[1]https://pubmed.ncbi.nlm.nih.gov/29453905/#:~:text=OSA%20patients%20are%20more%20likely,disorders%20has%20also%20been%20reported.

^[2] Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687–98. https://doi.org/10.1016/S2213- 2600(19)30198-5.

^[3] RSSDI clinical practice recommendations for screening, diagnosis, and treatment in type 2 diabetes mellitus with obstructive sleep apnea | SpringerLink

^[4] Viswanathan V, Ramalingam IP, Ramakrishnan N. High prevalence of obstructive sleep apnea among people with type 2 diabetes mellitus in a tertiary care center. J Assoc Physicians India. 2017;65(11):38–42.

^[5] Bhimwal RKMM, Jangid R, Bhati RL. To study the prevalence of obstructive sleep apnoea in type 2 diabetes patients in Western Rajasthan, India. Int J Adv Med. 2017;4(4):894–902. https://doi. org/10.18203/2349-3933.ijam20172569.

^[6] Kent BD, Grote L, Ryan S, Pepin JL, Bonsignore MR, Tkacova R, et al. Diabetes mellitus prevalence and control in sleep-disordered breathing: the European Sleep Apnea Cohort (ESADA) study. Chest. 2014;146(4):982–90. https://doi.org/10.1378/chest.13- 2403.

^[7] Aronsohn RS, Whitmore H, Van Cauter E, Tasali E. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med. 2010;181(5):507–13. https://doi.org/10.1164/rccm.200909-1423OC

^[8] RSSDI clinical practice recommendations for screening, diagnosis, and treatment in type 2 diabetes mellitus with obstructive sleep apnea | SpringerLink

^[9] https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(19)30198-5/fulltext

^[10] RSSDI clinical practice recommendations for screening, diagnosis, and treatment in type 2 diabetes mellitus with obstructive sleep apnea | SpringerLink

^[12] Tietjens JR, Claman D, Kezirian EJ, De Marco T, Mirzayan A, Sadroonri B, et al. Obstructive sleep apnea in cardiovascular disease: a review of the literature and proposed multidisciplinary clinical management strategy. J Am Heart Assoc. 2019;8(1): e010440. https://doi.org/10.1161/JAHA.118.010440.