The high prevalence of obstructive sleep apnea syndrome (OSAS) in patients with both type 1 diabetes (T1D) or type 2 (T2D) justifies screening in this population, according to a review article published in Diabetes and Metabolism.
A panel of French expert endocrinologists and pneumologists conducted a systematic review of the scientific evidence in order to evaluate the epidemiologic association between OSAS and all forms of diabetes, as well as the expected benefits/limitations of OSAS treatment in this population and to offer guidance on screening for OSAS.
The panel found that given the high prevalence of OSAS in patients with either T1D or T2D, screening is justified based on clinical symptoms, and in some cases may be justified in the absence of symptoms. Continuous positive airway pressure treatment will primarily improve OSAS symptoms, which can optimize control of blood pressure in resistant hypertension and microvascular complications.
There was limited evidence to support the hypothesis that treatment of OSAS improved glycated hemoglobin, but treatment did have an impact on night-time blood glucose control and insulin sensitivity. Robust evidence also supported the premise that OSAS treatment reduced 24-hour blood pressure.
Another finding was that the pathophysiologic mechanisms of OSAS and the underlying relationship with diabetes that leads to a greater prevalence are yet unclear. In both T1D and T2D, the greater prevalence of OSAS in patients observed independently of obesity has not yet been defined. In addition, the hypothesis that neuropathy may play its own independent role in the pathophysiology of OSAS in patients with either T1D or T2D also remains to be investigated.
Borel A-Laure, Tamisier R, Bohme P, et al. Obstructive sleep apnoea syndrome in patients living with diabetes: which patients should be screened? [published online September 3, 2018]. Diabetes Metab. doi:10.1016/j.diabet.2018.08.006