Nearly 5% of adults with type 2 diabetes and obesity may have obstructive sleep apnea, which is more prevalent among those with obesity regardless of diabetes status compared with the general population, according to findings published in Diabetic Medicine.
Simon de Lusignan
Simon de Lusignan, BSc, MBBS, professor of primary care and clinical informatics and chair and head of the department of health care management at the University of Surrey in the U.K., told Endocrine Today that to address this issue there is a need for “more intensive treatment strategies to assist with weight reduction in all obesity groups, including those classified as overweight as well as those classified with degrees of obesity.”
De Lusignan and colleagues reviewed data from 1,275,461 adults registered in the Royal College of General Practitioners Research and Surveillance Centre network as of Dec. 31, 2016. Using these data, the researchers confirmed whether participants had type 2 diabetes (n = 84,394; mean age, 66.5 years; 44.4% women), type 1 diabetes (n = 5,443; mean age, 42.6 years; 45.2% women) or no diabetes (n = 1,179,730; mean age, 46.2 years, 51.4% women).
Participants were also categorized into six separate weight classes. Those considered underweight had a BMI of less than 18.5 kg/m2, those with normal weight had a BMI between 18.5 kg/m2 and 24.9 kg/m2 and those with overweight had a BMI between 25 kg/m2 and 29.9 kg/m2; three obesity classes were also included, with ranges of 30 kg/m2 to 34.9 kg/m2 (class 1), 35 kg/m2 to 39.9 kg/m2 (class 2) and 40 kg/m2 or more (class 3).
The researchers found that 0.7% of the entire cohort had obstructive sleep apnea and that the condition was most prevalent in those with type 2 diabetes and class 3 obesity compared with all other diabetes and weight classes (OR = 9.6; 95% CI,8.95-10.32). In addition, participants with type 2 diabetes and obesity of any kind had higher prevalence of sleep apnea than those of other weight classes (OR = 4.7; 95% CI, 4.48-4.89). Sleep apnea prevalence was also higher for those with type 1 diabetes and obesity (OR = 1.6; 95% CI, 0.96-2.32) and those with obesity and no diabetes (OR = 1.7; 95% CI, 1.62-1.73) compared with those with similar diabetes status and lower BMIs.
Among adults with type 2 diabetes, those aged 35 to 54 years (P = .011) and 55 to 74 years (P = .008) had higher risks for obstructive sleep apnea compared with those aged 18 to 34 years. Higher odds for obstructive sleep apnea were also found for men with type 2 diabetes compared with women (OR = 3.07; 95% CI, 2.76-3.38) and those with overweight (OR = 2.22; 95% CI, 1.71-2.93), obesity class 1 (OR = 5.16; 95% CI, 3.99-6.74), obesity class 2 (OR = 10.52; 95% CI, 8.12-13.78) and obesity class 3 (OR = 21.8; 95% CI, 16.71-28.39) compared with those of normal weight (P < .001 for all).
“To help people with [obstructive sleep apnea], the condition first needs to be diagnosed correctly. ... The results of the present study suggest that people with obesity, and particularly those with obesity and type 2 diabetes, should be considered for [obstructive sleep apnea] screening at regular intervals, as they are more likely to have the condition than people without these diseases,” the researchers wrote. “Health care professionals need to be aware of the increased risk [for obstructive sleep apnea] in people within all overweight categories and not just those in the high obesity range.”
“Earlier use of newer weight-reducing medications as well as specific treatment for OSA need to be included as part of routine diabetes care,” de Lusignan said. – by Phil Neuffer
Disclosure: De Lusignan reports research funding from AstraZeneca, Eli Lilly, GlaxoSmithKline and Takeda. Please see the study for all other authors’ relevant financial disclosures.