January 24, 2020
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Obstructive sleep apnea may be part of ‘pathway’ to type 2 diabetes regardless of severity, BMI

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Adults with obstructive sleep apnea, or OSA, may be more likely to develop type 2 diabetes than those without OSA, according to findings published in the Journal of Diabetes.

“Intermittent hypoxia and sleep fragmentation are pathophysiologic features of OSA and are likely in the pathway leading to type 2 diabetes,” Dongsheng Hu, MD, PhD, of the department of epidemiology and health statistics at the College of Public Health, Zhengzhou University in China, and colleagues wrote. “The possible intermediary pathways by which intermittent hypoxia and sleep fragmentation affect glucose metabolisms include increased sympathetic activity, altered hypothalamic-pituitary-adrenal axis, increased oxidative stress, activation of inflammatory pathways and altered levels of circulating adipokines.”

Hu and colleagues determined the RR of type 2 diabetes in adults with and without OSA in a pooled analysis of 16 cohort studies. The studies spanned 10.5 years of median follow-up time, and altogether, type 2 diabetes was identified in 19,355 of the 338,912 participants.

Participants with OSA had higher RR for type 2 diabetes than those without OSA (RR = 1.4; 95% CI, 1.32-1.48), and this held true for those with between five and 14.9 events of apnea/hypopnea per hour or mild sleep apnea (RR = 1.16; 95% CI, 1.01-1.34), according to the researchers.

 
Adults with obstructive sleep apnea, or OSA, may be more likely to develop type 2 diabetes than those without OSA.
Source: Adobe Stock

Participants with OSA also had higher RR for type 2 diabetes when the researchers included only studies that adjusted for BMI and/or body fat percentage (RR = 1.44; 95% CI, 1.35-1.56), “which further proves that OSA increases the risk for type 2 diabetes not merely through the common risk factor of obesity.”

In addition, for every additional five events of apnea/hypopnea per hour, there was an 8% rise in type 2 diabetes risk for those with OSA (RR = 1.08; 95% CI, 1.01-1.14).

“This meta-analysis provides strong evidence for a linear dose-response association between OSA and type 2 diabetes,” the researchers wrote. “The risk of type 2 diabetes is increased with increasing OSA severity, which suggests that we should detect and treat OSA early to prevent type 2 diabetes.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.