A need for lifestyle change: How poor sleep can result in Type 2 diabetes

Delhi: Did you know that there is a link between diabetes control and a good night’s sleep? Many studies presented earlier showed a higher association of sleep apnea and Type 2 diabetes and vise versa. But what is the relationship between the two and how does one follow-up with the other? Obstructive Sleep Apnea - also known as OSA - is a sleep breathing disorder that is characterised by a recurrent upper airway collapse during sleep that hampers a good night’s sleep. One of the more recognizable symptom of individuals with OSA is snoring. - something people until recently would associate with a good night’s sleep. However, this is far from the case. But how snoring affect your health? More importantly, what is the link with sleep apnea? The breath of an individual with OSA stops involuntarily due to over-relaxation of the throat muscles, which obstructs the entry of air into the lungs. This obstruction can happen several times during the night, with patients suffering from severe sleep apnea having more such incidents during a span of a night’s sleep. This, in turn, results in the individual waking up feeling tired, less productive. Prolong obstructive sleep apnea has been associated with conditions such as Type 2 diabetes, as well as cardiovascular diseases, and obesity. A consensus paper by Research Society for the Study of Diabetes in India (RSSDI) highlighted how over 50 percent of patients diagnosed with Type 2 diabetes mellitus (T2DM) suffer from sleep apnea (source). “Implementation of screening, diagnosis, and treatment of OSA in patients with T2DM at initial stages could potentially alleviate the risk of cardiovascular disease and substantially improve their quality of life. The recommendations emphasise the need for collaborative efforts from diabetologists, endocrinologists, and sleep medicine specialists towards systematic screening, diagnosis, and treatment of coexisting T2DM and OSA for enhanced patient care,” the report stated. The report further stressed on the importance of screening for OSA in patients with Type 2 diabetes mellitus (T2DM), although it patients with OSA should also be constantly monitored for Type 2 diabetes as well. The study identifies the association of OSA with T2DM and the need for a collaborative approach between diabetologists and sleep specialists to manage such patients. The consensus also suggested that the presence and severity of untreated OSA is independently associated with poor glycaemic control in patients with T2DM. According to a 2019 report by The Lancet, nearly a billion people suffer from mild to severe OSA across the world. These same people can be more likely to develop T2DM. As the 2021 RSDDI consensus highlights, existing scientific literature shows that both the presence and severity of untreated OSA is independently associated with poor glycemic control (increased HbA1c levels) in patients with T2DM. Hence, as recommended by RSSDI, timely screening, diagnosis and medical intervention are integral for OSA and Type 2 diabetes patients. Moreover, overweight individuals exhibiting signs and symptoms of OSA, such as habitual snoring, witnessed apnoea and daytime sleepiness, should consider screening for the co-existence of T2DM. In India, 7 out of 100 people suffer from Type 2 diabetes mellitus. That is nearly 77 million people. The projected number is expected to almost double by 2045. Therefore, a need to regularly screen your sleep patterns, getting regular physical exercise, optimal diet and your regular diabetes medications are crucial to better control your sugar levels. One simple process to screen for OSA is the STOP-Bang questionnaire, a universally accepted and validated screening tool, which is also cost-effective, helpsto identify patients more suitable for diagnostic tests. The treatment options for OSA in patients with T2DM who are at cardiovascular risk include lifestyle modification and medical management, which could include devices such as home CPAP therapy.