# Apnea & Diabetes Link



## Cat (Apr 24, 2007)

I've tossed around a medical theory for a little over four years. Time and time again, I see it proven in friends and family members. My theory is this...

I believe that fat people have a higher incidence of type II diabetes due to their propensity for sleep apnea. There's long been research that showed that fat pear shaped people are less likely to suffer from several diseases than their apple shaped sisters. I've also heard that people who carry their weight on their chest, around their necks, etc are more likely to suffer from apnea.

I'm theorizing that the lower blood oxygen levels at night due to apnea may have an adverse effect upon the pancreas's long term health. Maybe the pancreas needs all the oxygen it can get during the body's rejuvenation period? Dunno, I'm not a medical professional nor do I play one on TV. I do strongly believe that sleep apnea will show itself to be a strong link to diseases regardless of the level of obesity. Oxygen obviously plays a huge role in our overall health. If 1/3 of the day one lives with limited oxygen levels, you can bet they will suffer poor health regardless of being fat or thin. 

So, the number of people I know that have been simultaneously diagnosed with these two conditions has grown tremendously over the last few years. While I realized that many fat people avoid going to the doctor may have multiple issues diagnosed at one time due to an accumulation of conditions upon aging, I think it actually goes further than that. Some of the people who have had this double diagnosis aren't fat or even close to being ~obese~. 

What if diabetes and other diseases that are currently ~linked~ in studies to being fat are actually linked to apnea? Would this make any difference in the way that obesity is treated? If doctors saw a fat person would they immediately have them do a "sleep study"? 

When I first posted about the apnea/diabetes connection, a doctor friend of mine sent me information from the a JAMA publication (if I'm remembering the origin correctly) regarding a study that had touched on this very connection and yet as far as I've heard, there hasn't been any more studies done. To me, it seems to be an obvious connection that should be studied further. So many studies are focused on adipose tissue ~somehow~ causing diabetes rather than looking at the basic physiological need for oxygen. 

Dunno. What do you think?


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## Zandoz (Apr 24, 2007)

Well, I do not know what to think of this. I to was diagnosed with diabetes within months of my sleep apnea diagnosis...and the diabetes diagnosis came when I was in the hospital for an unidentified virus that left me unable to breath even while awake. At the time, the diabetes was attributed to the massive doses of steroids that they gave me trying to kick that bug...but I can see it being entirely possible that it was in part triggered or at least greatly helped along by the oxygen deprivation caused by that bug.


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## Scrubbed_In (Apr 24, 2007)

You bring up very interesting points and I agree that there is at least a correlative relation if not causative. I got curious and noodled around in some online journal databases a bit to see what I could find... there are a few studies floating around out there:

Arias, M., Alonso-Fernández, A., García-Río, F. (2006). Stroke, Obstructive Sleep Apnea, and Disorders of Glucose Metabolism. _Archives of Internal Medicine_. Vol. 166 (13), 1418-1419

Babu, A., Herdegen, J. Fogelfeld, L., Shott, S., Mazzone, T. (2005). Type 2 Diabetes, Glycemic Control, and Continuous Positive Airway Pressure in Obstructive Sleep Apnea. _Archives of Internal Medicine_. 165 (4), 447-452.

Obstructive sleep apnea is independently associated with insulin resistance. (2002). _American Journal of Respiratory & Critical Care Medicine_. 165 (5): 670-676.

I haven't read these nor can I attest to the quality of them, but I thought it was interesting that such research has been conducted.

I'd be interested to hear what others might think or have experienced as far as a link between the two.




Cat said:


> I've tossed around a medical theory for a little over four years. Time and time again, I see it proven in friends and family members. My theory is this...
> 
> I believe that fat people have a higher incidence of type II diabetes due to their propensity for sleep apnea. There's long been research that showed that fat pear shaped people are less likely to suffer from several diseases than their apple shaped sisters. I've also heard that people who carry their weight on their chest, around their necks, etc are more likely to suffer from apnea.
> 
> ...


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## Cat (Apr 24, 2007)

Oooh...good to hear that there have been some new studies since the 2002 one! Thanks Scrubbed_in!

Sorry to hear of your troubles, Zandoz. When my mom was diagnosed with type ii 18 years ago, they attributed it too, to the steroids used to treat her emphysema.


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## AnnMarie (Apr 24, 2007)

This is very interesting news to me right now, the steroid aspect. 

I don't have apnea, nor am I diabetic (was just at the Dr. today making sure). 

I have blood work once a year, and about ... 1.6 years ago? I started taking an inhaled steroid daily for my asthma. It has been a wonder drug, and taken my multiple-per-day use of albuterol down to maybe 1-2 times a month. 

However, my last blood work was done in December and my sugar had creeped up by about 15 points from my last blood year (year prior). I was shocked as I've done nothing different, but I also know that it could just be a matter of time, etc. My BS is not high, but the jump in a year made my doctor a little worried. 

So, back I went today (4 months later) and with a new FBS done yesterday. I'm down 13 points from the last test, and he's satisfied with that, so I'll have a full blood work panel as regular in the fall and see where we are. 

Not sure if I'm making the connection here, but I'm now wondering if my steroid inhaler is part of the jump that I saw... it would sort of make sense for me, being a very controlled jump, at a small level (not like I have 250-300 levels to indicate full on untreated diabetes). 

Anyway, I just did a quick "steroids and diabetes" search and there is quite a bit of info. It seems most articles attribute this issue to oral steroids (pill), or injected, and suggest that nasal (and I'm assuming that includes aerated like my Advair is) is not quite nearly as bioreactive. 

Anyway, very interesting topic. 

And Cat, I personally agree with you regarding apnea... I think when untreated it ravages the body with all sorts of systemic breakdowns. If I thought for a second I had it (don't) I'd get it treated asap. I am almost completely convinced that my father's heart arrhythmia is a result of years of untreated apnea. Thank God, now... he's on a CPAP.


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## Miss Vickie (Apr 24, 2007)

Interesting theory, Cat, and it does make a certain amount of sense. Cortisol is a stress hormone, which is raised by, at least in part, lack of sleep. Cortisol also has all kinds of nasty effects on the body, including hyperglycemia.

Here's an interesting wikipedia article about it. It's a good place to start. I'd definitely like to see it studied more, particularly the effects of stress on Cortisol levels and the subsequent effect on fat deposition.


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## Scrubbed_In (Apr 24, 2007)

AnnMarie said:


> This is very interesting news to me right now, the steroid aspect.
> 
> Anyway, I just did a quick "steroids and diabetes" search and there is quite a bit of info. It seems most articles attribute this issue to oral steroids (pill), or injected, and suggest that nasal (and I'm assuming that includes aerated like my Advair is) is not quite nearly as bioreactive.



You are quite right! Most of the issues with steroids are linked with oral steroids such as prednisone. This is not to say that a small dose of prednisone over a short period of time is going to make you diabetic or cause you to gain weight. Long term steroids are a bad thing generally, though sometimes are indicated in patient treatment. There are many side effects to long term steroid usage including steroid induced diabetes and steroid induced osteoporosis. But again, that's long term use. Nasal sprays are generally pretty harmless... and really effective (in general)!

Just some more thoughts....


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## Scrubbed_In (Apr 24, 2007)

Cat said:


> Oooh...good to hear that there have been some new studies since the 2002 one! Thanks Scrubbed_in!



Happy to help


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## Zandoz (Apr 24, 2007)

AnnMarie said:


> This is very interesting news to me right now, the steroid aspect.
> 
> I don't have apnea, nor am I diabetic (was just at the Dr. today making sure).
> 
> ...



My bout with the steroids back then was both inhaled and pill form...may have been injections to, but I was too out of it to remember much detail. But I do remember them saying I had been given massive doses because the shape I was in when admitted (Pulse-ox in low 80s), and the staff being very frantic to get me admitted and medicated. A day or so later my glucose levels were running around 500, and a couple days later it had not dropped below 300. This when when I was told it was probably due to the steroids, and that sometimes folk's levels never return to normal after massive doses.


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## Paul (Apr 24, 2007)

I agree with you Cat. I did a Google serach with the terms "*Apnea and Diabetes*". Many articles came up with this connection. Take a look. Some concluded as you did that apnea is the cause of diabetes. Others claim the either a fat person is prone to both apnea and diabetes and weight is the cause, or less commonly that apnea can interfere with the body's metabolism causing weight gain and diabetes. But what about the large number of persons with both s;eep apnea and diabetes who are not obese? I believe your theory has merit. Please keep us posted if you find out more about this subject since my wife Kathleen is beginning to complain about my snoring when I sleep which may indicate apnea.


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## saucywench (Apr 24, 2007)

*American Journal of Respiratory and Critical Care Medicine Vol 172. pp. 1590-1595, (2005)*
*© 2005 American Thoracic Society*
*doi: 10.1164/rccm.200504-637OC*

*Original Article*

*Association of Sleep Apnea and Type II Diabetes *

*A Population-based Study *

*Kevin J. Reichmuth, Diane Austin, James B. Skatrud and Terry Young *

[SIZE=-1]Department of Medicine, University of Wisconsin Medical School; and Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin [/SIZE]
[SIZE=-1]Correspondence and requests for reprints should be addressed to Kevin J. Reichmuth, M.D., University of Wisconsin Hospital and Clinics, Section of Pulmonary/Critical Care Medicine, 600 Highland Avenue, Madison, WI 53792-9988. E-mail: [email protected] [/SIZE]
_Rationale:_ Cross-sectional association has been reported between sleep-disordered breathing (SDB) and insulin resistance, but no prospective studies have been performed to determine whether SDB is causal in the development of diabetes. 
_Objectives:_ The purpose of our study was to investigate the prevalence and incidence of type II diabetes in subjects with SDB and whether an independent relationship exists between them. 
_Methods:_ A cross-sectional and longitudinal analysis was performed in 1,387 participants of the Wisconsin Sleep Cohort. Full polysomnography was used to characterize SDB. Diabetes was defined in two ways: (_1_) physician-diagnosis alone or (_2_) for those with glucose measurements, either fasting glucose <IMG alt=">=" src="http://ajrccm.atsjournals.org/math/ges.gif" border=0> 126 mg/dl or physician diagnosis. 
_Measurements and Main Results:_ There was a greater prevalence of diabetes in subjects with increasing levels of SDB. A total of 14.7% of subjects with an apneahypopnea index (AHI) of 15 or more had a diagnosis of diabetes compared with 2.8% of subjects with an AHI of less than 5. The odds ratio for having a physician diagnoses of diabetes mellitus with an AHI of 15 or greater versus an AHI of less than 5 was 2.30 (95% confidence interval, 1.284.11; p = 0.005) after adjustment for age, sex, and body habitus. The odds ratio for developing diabetes mellitus within 4 yr with an AHI of 15 or more compared with an AHI of less than 5 was 1.62 (95% confidence interval, 0.673.65; p = 0.24) when adjusting for age, sex, and body habitus. 
_Conclusions:_ Diabetes is more prevalent in SDB and this relationship is independent of other risk factors. However, it is not clear that SDB is causal in the development of diabetes. 
*Key Words:* diabetes  incidence  prevalence  sleep apnea


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## rainyday (Apr 26, 2007)

Cat, I love that you're taking anecdotal experience and looking for connections. I think we should all be doing that and looking for patterns that might lead to new information for our community.

Just to add to your anecdotal info base: I'm peary and not diabetic (I get checked regularly because it runs in my family). I have sleep apnea but I've slept with a CPAP for about ten years. (AM, I use Advair too.)


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## Cat (Apr 26, 2007)

Thanks for all of the info, ya'll!

Rainy, it really is just anecdotal. I worry sometimes that scientists don't look to basic connections rather than try to villainize obesity. 

Rainy, you're the first person that I know so far that has a cpap and no diabetes. I'm sure there are others...out...there...somewhere. You are not alone! ;-) I'm going to set up a non-scientific online survey to see how many others there are. 

Come to think of it, maybe the connection isn't between apnea and diabetes...but maybe it's ME? You know, I could be soooo sweet (ha!) that I'm giving friends and family members diabetes. ;-)


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## Sandie S-R (Apr 26, 2007)

AnnMarie said:


> This is very interesting news to me right now, the steroid aspect.
> 
> I don't have apnea, nor am I diabetic (was just at the Dr. today making sure).
> 
> ...



Just thought I would mention that steriods are awful on your blood sugar numbers. I have diabetes (well controlled with glucophage), and was diagnosed 7 years ago after several boughts of very bad bronchitis (I also have light asthma) where the Dr had me on prednisone. He clearly thought the prednisone helped to kick in the diabetes. I do not have sleep apnea.

Be careful with the steriods.


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## LillyBBBW (Apr 26, 2007)

Cat said:


> Thanks for all of the info, ya'll!
> 
> Rainy, it really is just anecdotal. I worry sometimes that scientists don't look to basic connections rather than try to villainize obesity.
> 
> ...



Throw me into the pile of people with apnea who don't have diabetes... yet. I've been totally expecting it to arrive someday. I was daignosed with apnea within the last week or so and haven't even gotten my CPAP yet. Both my dad and mom have diabetes which runs in the family and I'd bet dimes to donuts they both have OSA as well given the way they've snored for years. It's possible I'm getting my CPAP in the nick of time. I also have mild asthma, was given an inhaler but I refuse to use it. Too much hassle. 

Also I'd like to second what Miss Vickie said in her post about OSA being linked with an overproduction of Cortisol which my doctor mentioned in my initial appointment with him. He seemed to think that after regular use of the CPAP I may notice some weightloss.


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## Tad (Apr 26, 2007)

I mean, it sounds so straight forward: you don't produce enough insulin (or you are overly resistant to using it combined with somewhat limited production).

But one recent piece of research found that, in mice at least, 'type 1' style diabetes may actually be fundamentally a nervous system disorder. I don't have the details available anymore, but essentially maybe the insulin producing islets which were thought to be malfunctioning were basically OK, but being shut down by an inflamation of nerve cells around them. A compound (derived from hot peppers if I recall correctly) that reduces nerve cell inflamation cleared up the condition in those mice. 

A long way from tying it to type II diabetes in humans, but just saying that the root cause is far from clear. So it is entirely possible that something to do with sleep apnea could help trigger it.

-Ed


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## rainyday (Apr 26, 2007)

Cat said:


> Rainy, you're the first person that I know so far that has a cpap and no diabetes.


I never thought about it before, but maybe catching the apnea fairly early on and using the CPAP has helped me keep it at bay. 

I appreciate the steroid info. I've been given prednisone before when bronchitis has kicked up my asthma bad, and I sure will be hesitant from here on out to accept that unless it's absolutely necessary.


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## rainyday (Apr 26, 2007)

edx said:


> A compound (derived from hot peppers if I recall correctly) that reduces nerve cell inflamation cleared up the condition in those mice.


Ed, was the pepper compound pepperine?


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## saucywench (Apr 26, 2007)

Nondiabetic and a CPAP user for 5 1/2 years.


Cat said:


> Thanks for all of the info, ya'll!
> 
> Rainy, it really is just anecdotal. I worry sometimes that scientists don't look to basic connections rather than try to villainize obesity.
> 
> ...


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## Happy FA (Apr 26, 2007)

I've been a CPAP user for about 11 years and was recently diagnosed with diabetes. No steroid use in recent memory and apnea has been well controlled with compliant use every night. I suspect that it's a matter of genetics, diabetes runs in the family and eating habits/weight which were implicated. 

I've been retested several times since I originally got the Cpap and oxygen deficit while sleeping with the cpap has never been an issue.

So, not sure where that falls into the mix.

One thing that is certainly true is that the fatter you are, the more likely you are to have sleep apnea. While you can get sleep apnea even if you're bone thin and not have sleep apnea even if you're extraordinarily fat, that's very much a factor of the size of your airway. If you're blessed with a very wide airway you're much less likely to ever develop obstructive sleep apnea. If you're stuck with a dinky pipe as you either gain weight or age(so the tissues in your throat lose tone as you get older and hang more) eventually you'll start developing sleep apnea. 

Similarly, the higher your weight the more likely that you are to develop diabetes if you're susceptible to it. Some people never develop it no matter what they eat or what they weigh. Others develop it regardless of what they eat or how little they weigh. But, again, it seems that the increase in weight seems to cause those predisposed to develop diabetes(type 2) to become insulin resistant and then diabetic.

While the two may be related, it doesn't have to be so. Also, because both seem to be related to increasing weight(and aging), those susceptible to one may well be susceptible to the other. 

Of course, failure to treat sleep apnea definitely stresses the body big time, with the body pumping huge amounts of adrenalin into the body over and over again to wake up and get air in each night. That stress could certainly push someone susceptible to diabetes over the edge.

Anyhow, just my thoughts.


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## BigBeautifulMe (Apr 26, 2007)

Also a CPAP user, normal blood sugar.


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## Observer (May 22, 2007)

Cat, you may not be a "medical professional," but you're one perceptive lady.

A study just completed by the Yale University School of Medicine, and referenced here, endorses the idea of a diabetes/sleep apnea link.
The six year study released this week concludes that "sleep apnea made a person 3.5-times more likely to develop diabetes." The cause? Activation of the body's flight or fight mechanism.

Sleep apnea has been similarly implicated as a causative actor in stroke and heart disease, but that is another thread.


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