Treatment of Sleep Apnoea ? A substantial gain for diabetic patients – we

Treatment of Sleep Apnoea ? A substantial gain for diabetic patients

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Treatment of Sleep Apnoea ? A substantial gain for diabetic patients

Do you gasp for air or choke during sleep? Have you experienced loud snoring, episodes of breathing cessation during sleep (witnessed by another person), abrupt awakenings accompanied by shortness of breath, waking up with a dry mouth or sore throat, suffering from morning headache, insomnia followed by daytime excessive sleep, attention problems and irritability?

If you have any of these symptoms, chances are that you have Obstructive Sleep Apnoea (OSA) which if left untreated may lead to diabetes or aggravate it. OSA is also associated with high blood pressure (hypertension), abnormal heart rate (arrhythmia), heart diseases or even heart attack and stroke.

Sleep apnoea is found in estimate of 5-10% of the general population at any given time, regardless of race and ethnicity.

Studies have shown that patients suffering from OSA have low oxygen levels, narrowing of arteries and activation of sympathetic system which is a part of autonomic nervous system that regulates the functions of internal organs. Together these trigger the rise in blood pressure and cause subsequent heart problems and diabetes or can even turn fatal.

On the other hand if you have diabetes you may also be suffering from OSA. 23-86% of diabetic patients have been found to have OSA. If you have not investigated or started treatment for OSA there is a high chance that you will lose the benefits of treatment. International diabetes Federation (IDF) recommends screening (checking) every diabetic patient for sleep apnoea. Treatment of diabetics diagnosed with OSA helps improve their blood sugar control and these patients respond better to insulin and other medical treatment. This further decrease the risk of developing complications of diabetes such as nerve damage, kidney damage or any other complications and helps improve the patient?s quality of life.

Quite often obesity is found as a common factor for diabetes and sleep apnoea. However, even thinner people with diabetes may suffer from OSA and those with OSA may have undiagnosed diabetes. The relationship is bidirectional. Thus, it is recommended to screen for if either one of diabetes or OSA is diagnosed.

In studies on diabetic population, the use of continuous positive airway pressure therapy (CPAP) for treatment of OSA has led to significant improvement in HbA1c levels (3 monthly, blood test done to monitor the blood sugar control).

A recently published study by the American Diabetes Association, mentions that in patients with type 2 diabetes uses of CPAP lead to improvements in blood pressure and blood glucose control. They monitored patients for 5 years and found CPAP-treated group had HbA1c levels of 8.2% (66.0 mmol/mol) versus. 12.1% (108.4 mmol/mol) in the control group. The study also noted use of CPAP was cost effective and saved management costs by ?4,141 per patient over 5 years; the cost per QALY gained with CPAP was ?15,337.

&nbsp Table 1: Comparison between the groups treated with CPAP and control
Group treated with CPAP CONTROL (Group not treated with CPAP)
HbA1c(Blood sugar control) Lower values (normal values among female patients at 5 years) Higher values
Blood pressure control Lower BP Higher than CPAP treated group
Obesity No change Increase in obesity
Health-related quality of life?(HRQoL) Better in CPAP treated group
Diabetic retinopathy developed in Lesser patients More patients
Cardiac arrhythmias More common Less common
New symptoms developed during study period in 3% of patients 3% of patients

Thus, the benefits of CPAP treatment among diabetics with OSA are clear from the findings in above study.

In the largest clinic-based study, Marin and colleagues found that treatment of OSA by CPAP is associated with a trend towards fewer fatal and non-fatal cardiovascular events.?

Treatment of OSA is involved with better metabolic control and improved quality of life. ?CPAP used among the diabetic with OSA may help adding number of years to your life with better blood pressure, blood sugar control and improved insulin sensitivity.

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