diabetes

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Medical Xpress reports that women diagnosed with gestational diabetes are nearly seven times more likely to have obstructive sleep apnoea than other pregnant women, according to a recent study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM). Gestational diabetes causes glucose levels in the bloodstream to rise above normal levels. This form of diabetes occurs during pregnancy, typically in the second trimester. Between four and eight of every 100 pregnant women in the United States develop gestational diabetes.

The new study found a link between gestational diabetes and sleep apnoea, which causes brief interruptions in breathing during sleep. If sleep apnea goes untreated, it can raise the risk for stroke, cardiovascular disease and heart attacks.

“It is common for pregnant women to experience sleep disruptions, but the risk of developing obstructive sleep apnea increases substantially in women who have gestational diabetes,” said Sirimon Reutrakul, MD, who conducted the research at Rush University Medical Center in Chicago. “Nearly 75 percent of the participants in our study who had gestational diabetes also suffered from obstructive sleep apnoea.”

In a series of observational case control studies, researchers monitored 45 women for sleep apnoea and other sleep disruptions. The research examined sleep health in 15 pregnant women who had gestational diabetes, 15 pregnant women who did not have the condition and 15 women who were not pregnant and did not have diabetes.

The study found a strong association between obstructive sleep apnoea and gestational diabetes in this group of mostly overweight or obese women. Pregnant women who did not have gestational diabetes were able to get an additional hour of sleep and had less fragmented sleep than women who had gestational diabetes. Past research has shown lost sleep, fragmented sleep and shorter periods spent in deep sleep – all symptoms of sleep apnoea – are likely to raise the risk a person will develop diabetes.

“Based on these findings, women who have gestational diabetes should be considered for evaluation for obstructive sleep apnoea, especially if other risk factors such as hypertension or obesity are present, and women already diagnosed with sleep apnoea should be monitored for signs of gestational diabetes during pregnancy,” Reutrakul said.

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The American Academy of Sleep Medicine (AASM) is advising anyone with Type 2 diabetes or hypertension to be evaluated for sleep apnea by a board-certified sleep medicine physician. The recommendation comes as the group of international clinicians and researchers meets in Baltimore for SLEEP 2013, the foremost gathering of sleep experts annually.

Overwhelming clinical evidence has shown that patients suffering from two very common illnesses – Type 2 diabetes and hypertension – are at much higher risk for obstructive sleep apnea (OSA), a dangerous condition characterized by episodes of complete or partial airway obstruction during sleep. Research also has shown that treating sleep apnea can help in the management of these two disorders.

“Type 2 diabetics and people with hypertension are much more likely to have obstructive sleep apnea than other people, and as a result should immediately discuss their risk for sleep apnea with a sleep specialist,” said M. Safwan Badr, MD, president of AASM. “Diagnosis and treatment of sleep apnea from a board-certified sleep medicine physician will promote improvement in these conditions – including improved insulin sensitivity, blood pressure and cholesterol.”

Type 2 Diabetes and Obstructive Sleep Apnea
According to the Centers for Disease Control and Prevention, 25.6 million Americans aged 20 years or older suffer from diabetes, and Type 2 diabetes accounts for about 90 to 95 percent of all diagnosed cases. Seven in 10 people with Type 2 diabetes also have obstructive sleep apnea, and the severity of the sleep disorder directly impacts diabetes symptoms; the more severe a diabetic’s untreated sleep apnea, the poorer their glucose control.

“Treating sleep apnea in diabetics improves nighttime glucose levels and insulin sensitivity,” said Badr. “Treatment also will provide benefits of improved sleep unrelated to diabetes – including increased alertness during the day and improved memory and cognitive function.”

A recent study from the University of Chicago shows that continuous positive airway pressure (CPAP) treatment of sleep apnea may have as much of an effect as prescribed oral diabetes medications.

“In our study, one week of optimal CPAP use lowered average 24-hour glucose levels and improved post-breakfast glucose response in Type 2 diabetics with obstructive sleep apnea,” said Esra Tasali, MD, lead author of the study and assistant professor of medicine, pulmonary and critical care medicine at the University of Chicago Department of Medicine. “The dawn phenomenon, an early-morning increase in blood sugar in people who have Type 2 diabetes, also was reduced by 45 percent as a result of CPAP therapy.”

Hypertension and Obstructive Sleep Apnea
High blood pressure, known as hypertension, is the most important risk factor for cardiovascular disease and is not limited to diabetes sufferers. A staggering 67 million Americans have high blood pressure, which is about one in every three adults. Between 30 and 40 percent of adults with high blood pressure also have sleep apnea, which is even more prevalent in those with resistant hypertension. Approximately 80 percent of patients that do not respond to hypertensive medications have sleep apnea. Seeking and adhering to sleep apnea treatment is a proven means of decreasing blood pressure.

“Evidence shows that sleep apnea treatment lowers nighttime and daytime blood pressure, with the greatest improvement in patients seeking treatment for moderate to severe sleep apnea,” said Badr. “The higher your blood pressure, the greater your risk of suffering a heart attack or stroke. Reducing your blood pressure lowers your risk of cardiovascular disease and improves your overall health.”

Source: AASM

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The 1Oth Middle  East Update in Otolaryngology – Head and Neck Surgery is the largest meeting of Otolaryngologists in the Middle East. I am delighted to have been invited back to speak for a second time about sleep apnoea, in a region where awareness of the condition is very low, but incidence is on the rise. The event is previewed in this month’s issue of Middle East Hospital magazine:

MEH March 2013 Middle East Otolaryngology article

Find out more here

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Lack of sleep can lead you to eat larger portions of high-calorie foods and increase your long-term risk of weight gain, according to a small new study. Swedish researchers asked 16 normal-weight males to choose their ideal portions of high-calorie meals and snacks. They did this when they had a normal night of about eight hours sleep and again when they went a night without sleep.

The participants chose larger portion sizes after the night with no sleep. They did this both before and after a breakfast, which suggests that sleep deprivation increases food intake regardless of whether a person feels full, said study author Pleunie Hogenkamp, of Uppsala University.

“Bearing in mind that insufficient sleep is a growing problem in modern society, our results may explain why poor sleep habits can affect people’s risk to gain weight in the long run,” Hogenkamp said in a university news release.

The study was published online Feb. 18 in the journal Psychoneuroendocrinology. In a previous study, the same team of researchers found that young, normal-weight men who went a single night without sleep had increased activation of a brain region involved in the desire to eat.

Although the study found an association between lack of sleep and increased appetite for high-calorie foods, it did not prove a cause-and-effect relationship.

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White-collared, globe-trotting executives over the age of 45 need to watch out for sleep apnoea, according to a recent study by the Madras ENT Research Foundation.

“Our estimates show that 24 per cent of men and 9 per cent of women above 45 years in the country suffer from this problem,” says Mohan Kameswaran, Managing Director of the foundation.

Those with obesity, diabetes and a sedentary lifestyle are more prone to sleep apnoea. Smoking, excessive consumption of alcohol and heavy snoring are other risk factors associated with this disorder. It is common among middle-aged working professionals.

“With intense travelling, they have very little time for physical activity and exercise. They do not maintain a good diet. When you are young, your muscle tone is good. But it slows down after 45,” cautions Kameswaran.

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Sleep-disordered breathing — which includes snoring and sleep apnea — isn’t just an adult condition: A new study from Finland shows that as many as one in 10 six-to-eight-year-olds may also have it.

The study, which was conducted by researchers from the University of Eastern Finland, included 512 kids from Finland between ages six and eight. The researchers examined their sleep disturbance status, as well as how their top and bottom rows of teeth fit together and their face shape (craniofacial morphology). Researchers found that being overweight and obese wasn’t linked with sleep-disordered breathing in kids, as it may be with older adults. Rather, craniofacial or dental issues seemed to be at play, according to the European Journal of Pediatrics study.

“If a child has symptoms of sleep-disordered breathing, his or her craniofacial status and dental occlusion need to be examined,” study researcher Tiina Ikävalko, an orthodontic specialist and a clinical lecturer at the university, said in a statement. “On the other hand, children with tonsillar hypertrophy, crossbite and convex facial profile should be examined to assess the quality of their sleep.”

The prevalence of sleep-disordered breathing in kids found in this study is not too different from that previously reported by the American Academy of Otolaryngology-Head and Neck Surgery, which said that snoring is commonplace in about 10 percent of all kids, and obstructive sleep apnea is prevalent in about 2 to 4 percent of kids.

Potential health risks from sleep-disordered breathing in kids include attention problems, bedwetting, increase in insulin resistance, increase in blood pressure, and even a decrease in growth hormone, the American Academy of Otolaryngology-Head and Neck Surgery reported. Since enlarged adenoids and tonsils are a common cause for sleep-disordered breathing in kids, getting these removed could help to treat the condition for some.

See article on Huff Post website and 10 health risks associated with sleep apnoea

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As the clocks turned back and British Summer Time (BST) came to an end, millions across the UK enjoyed the benefit of an extra hour in bed. But for many women, this extra hour provided little relief, with a growing number now being diagnosed with the sleep disorder OSA (Obstructive Sleep Apnoea).

“A good night’s sleep is essential for our health and wellbeing. However, increasing rates of obstructive sleep apnoea amongst women are posing a significant threat to their quality of sleep, and potentially putting them at risk of serious health issues, including heart disease, stroke, depression and diabetes,” commented Judy Harris of the British Lung Foundation, which is campaigning for better awareness, diagnosis and treatment of people affected by OSA.

Traditionally viewed as a man’s disease, a recent study has suggested that among women aged 20-44, up to one quarter now have sleep apnoea, a figure which rises to more than half in women aged between 45 and 54, and 75 per cent in women aged between 55 and 70.

Whilst women have often been viewed as the ‘gatekeepers’ to their families’ health, and are often the first to recognise the signs and symptoms of sleep disorders in their husbands or bed-partners, increasingly they’re experiencing this debilitating disease for themselves, with symptoms including loud snoring, day time tiredness, poor concentration, headaches, depression and anxiety.”

With mounting evidence of sleep apnoea’s links to serious medical conditions, including cardiovascular disease and dementia, it’s vital that we move past the stereotypes that label OSA a ‘man’s disease’ and seek to raise awareness of this potentially deadly disease amongst women in the UK.

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Two studies that link the quality of sleep to the occurrence of erectile dysfunction and other urologic conditions were presented to reporters during the 2011 Annual Meeting of the American Urological Association (AUA).

The studies suggest that men with erectile dysfunction (ED) should be screened for obstructive sleep apnoea (OSA). After adjusting for age and other health conditions, patients with ED were more than twice as likely to have sleep apnoea than their normal counterparts.

This was the largest study to date to demonstrate a relationship between obstructive sleep apnoea and erectile dysfunction. Researchers at Mount Sinai Medical Center in New York evaluated 870 consecutively enrolled men through a cardiac screening program. Patients were screened for obstructive sleep apnea and erectile dysfunction through clinical questionnaires and were asked about their history of cardiovascular disease, blood pressure, diabetes and smoking. The mean age in the study population was 47.3 years, with a mean BMI of 30.2.

Sixty-three percent of patients in the study screened positive for obstructive sleep apnea, 5.6 percent had a history of diabetes, and 29 percent had a smoking history. The likelihood for having OSA increased as the severity of ED increased.

The good news for patients with both OSA and ED is that treatment for sleep apnea through continuous positive airway pressure therapy (CPAP), together with drug therapy, has been shown to improve symptoms of ED.

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Continuing on the diet theme, Sarah Boseley reports in the Guardian today on a new piece of research from Newcastle University. Researchers there have discovered that a very harsh 600 calorie a day diet can reverse type 2 diabetes in some cases. 7 out of 11 participants in the study were free of diabetes after two months of the strict regime. Given the strong links between diabetes and sleep apnoea some further research into the impact (besides the benefits of weight loss) this diet may have on sufferers would be very welcome.

In the UK about two and a half million people have been diagnosed with diabetes, the large majority with type 2, and numbers are rising across much of the world. The condition has to be controlled with drugs and eventually insulin injections. It can cause blindness and end in foot amputation, as well as shortening life.

“To have people free of diabetes after years with the condition is remarkable – and all because of an eight-week diet,” said Roy Taylor, professor at Newcastle University, who led the study. “This is a radical change in understanding type 2 diabetes. It will change how we can explain it to people newly diagnosed with the condition. While it has long been believed that someone with type 2 diabetes will always have the disease, and that it will steadily get worse, we have shown that we can reverse the condition.”

The research, presented today at the American Diabetes Association conference, shows that an extremely low-calorie diet, consisting of diet drinks and non-starchy vegetables, prompts the body to remove the fat clogging the pancreas and preventing it from making insulin. However, as the study’s funders Diabetes UK warn, this diet should only be attempted under the supervision of a medical professional.

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A new study published in the British Medical Journal this month has shown that a very low energy diet can have long-term benefits for sleep apnoea sufferers.

It is already known that obstructive sleep apnoea is associated with several adverse outcomes, including impaired cognitive function, vehicle crashes and occupational injuries, and death.

Randomised controlled trials have recently shown that weight loss improves obstructive sleep apnoea in overweight and obese patients.   The long term effect of weight loss has been studied only in people with mild obstructive sleep apnoea and in older patients with type 2 diabetes.

“Of all people with obstructive sleep apnea, an estimated 60-70% are either overweight or obese,” writes Kari Johansson, PhD student in the Obesity Unit, Department of Medicine at the Karolinska Institute in Stockholm, Sweden, and colleagues. “Given the close association between obstructive sleep apnoea and obesity, weight loss has been advocated as a primary treatment option in obese patients with sleep apnoea…. Despite an improving case for the robust treatment effect of weight loss in obstructive sleep apnoea, concerns remain regarding the long term maintenance of improvements, especially after rapid weight loss with a very low energy diet.”

Study conclusions:

  • The initial improvements in apnoea-hypopnoea index after nine weeks of a very low energy diet (−58%) were largely maintained at the one year follow-up (−47%)

  • At one year, 48% (30/63) no longer required continuous positive airway pressure and 10% (six/63) had total remission of obstructive sleep apnoea

  • Patients who lost the most in weight or had severe sleep apnoea at baseline benefited most

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