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Question: How are sleep apnea and other sleep disturbancesrelated to diabetes?
Answer: Sleep disorders are common in adults with type 2diabetes.1 One studyfound that one-third of adults with type 2 diabetes had sleep apnea, whichincluded 20% of the women in the study and almost 50% of themen.2
We Americans sleep an average of 90 minutes less per night than ourgrandparents did, and the trend in diminished sleep parallels the growingobesity epidemic. Some suggest that decreased sleep time affects our foodchoices and the amounts of food we consume. In turn, increasing obesity andage make sleep disturbances such as sleep apnea more common and severe,especially in individuals with type 2diabetes.3,4
Sleep deprivation from any cause leads to increases in blood glucose(especially postprandial glucose), blood pressure, triglycerides, visceralfat, and inflammatory cytokines, as well as a decrease in HDL cholesterol andworsening of insulinresistance.4,5Treating sleep deprivation rapidly reverses these metabolicabnormalities.6 Inindividuals with type 2 diabetes and obstructive sleep apnea, treatment withcontinuous positive airway pressure reduced glycated hemoglobin (A1C) by>1% and postprandial glucose by 75mg/dl.7
The reasons for these negative consequences of sleep deprivation arecomplex, but appear to include increased sympathetic nervous system activityand increased adrenal cortisol and catecholamine output. These occur innondiabetic individuals as well.
The diagnosis of sleep disturbance should be considered in any adult withexcessive daytime drowsiness that is not otherwise explained. There are manycauses of sleep disturbance, including voluntary restriction, insomnia,restless leg syndrome, sleep apnea, jet lag, and shift work. Practitionersusually can diagnose sleep deprivation by taking a patient's history and thatof the bed partner. Loud snoring should lead to suspicion of sleep apnea.
Improving sleep quality may turn out to be as important as improving dietand fitness in individuals with diabetes and in managing the care ofindividuals who are obese or insulin resistant. All of the available evidencesuggests that we should inquire about sleep in our patients and recognize thatmost sleep disturbances can be treated. 
Footnotes
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References
2. Einhorn D, Erman M, Philis-Tsimikas A, et al.: Prevalence andassociation of sleep apnea in a population of adults with type 2 diabetesmellitus (Abstract). Diabetes 54 (Suppl. 1): A582, 2005.
3. Speigel K, Leproult R, Van Cauter E, et al.: Impact of sleep debton metabolic and endocrine function. Lancet 354: 1435–1439, 1999.[Medline]
4. Vgontzas AN, Mastorakos G, Bixler EO, et al.: Sleep deprivationeffects on the activity of the hypothalamic-pituitary-adrenal and growth axes:Potential clinical implications. Clin Endocrinol 51: 205–215, 1999.[Medline]
5. Somers VK, Dyken ME, Clary MP, et al.: Sympathetic neuralmechanisms in obstructive sleep apnea. J Clin Invest 96: 1897–1904, 1995.[Medline]
6. Harsch IA, Schahim SP, Radespiel-Troger M, et al.: Continuouspositive airway pressure treatment rapidly improves insulin sensitivity inpatient with obstructive sleep apnea syndrome. Am J Respir CritCare Med 169:156–162, 2004.
7. Babu AR, Herdegen J, Fogelfeld L, et al.: Type 2 diabetes, glycemiccontrol, and continuous positive airway pressure in obstructive sleep apnea.Arch Intern Med 165:447–452, 2005.
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