Which comes first: the chicken or the egg? It’s an epic question, as epic as: “is sleep apnea a cause or effect?” Doctors often say that sleep apnea and Diabetes co-exist but which one is the cause and which is the effect is still unclear.
Obstructive Sleep Disorder or OSA, known also as sleep apnea, is a sleep disorder characterized by interrupted breathing cycle during sleep. The person stops breathing for at least eight seconds every hour because the soft tissues behind the throat — soft palate, uvula, and sometimes tonsils — relax and/or close leading to airway blockage, thus the term apnea (from the Greek word “apnoia” which means the absence of breathing; Latin word “apnoea”: “a” – not or without and “pnein” – to breathe). The word is “apnea” in the US and commonly “apnoea” in the UK.
So much for etymology, let us delve into the subject more deeply.
Despite the temporary and involuntary breathing cessation, a person with sleep apnea is often clueless of his condition upon waking up. This type of sleep disorder is more likely to develop during early or late adulthood, but infants and children are also at high risk. Obesity is believed to be a major contributing factor because of the extra fat mass accumulated around the cervix. Particularly, the sizes of their tonsils and neck are thicker.
Based on studies, the neck circumference is a strong indicator that a person may have sleep apnea. Men and women who are obese and have a neck circumference of 17 and 16 respectively are more likely to have OSA.
Sleep apnea is also being linked to weight gain because it causes disruption of hormones that stimulates hunger leading to glucose intolerance, high blood pressure, and/or eventually diabetes.
Signs and symptoms
- Excessive sleepiness during the day
- Snoring (however, some people do not snore at all)
- Gasping after breathing pauses
- Mood swings
- Headaches and dryness of the mouth upon waking up
Often, people do not take snoring seriously. Hopefully many of you would after reading this, but sleep apnea poses life-threatening health issues and risks. These include:
- Road accidents due to falling asleep while driving
- Heart diseases and stroke
- Hypertension or high blood pressure
- Metabolic disorders such as Diabetes
So how is sleep apnea and diabetes affecting each other?
Research says that hypoxemia or low blood oxygen levels during the night also affects the level of glycosylated hemoglobin (HbA1c) levels. The HbA1c, if you would remember, is associated with Diabetes.
A study was conducted in 22 sleep laboratories in Europe with over 7000 participants. According to researcher Brian Kent, people with Type 2 Diabetes or have high HbA1c levels are likely to develop cardiovascular diseases, which can lead to death.
Another study from 2007 also says that sleep apnea increases the risk of developing Type 2 Diabetes. Several other studies are being conducted to establish the relationship between these two health conditions. Hopefully we will be able to pinpoint the culprit in 10 years.
This draws us to the conclusion that either Diabetes or sleep apnea is the cause or effect. Sleep apnea may trigger or accelerate the development of Diabetes; both issues can also be present when a person is obese. A diabetic person, who does not have to be obese (e.g., Type 1 diabetics with autonomic neuropathy) may develop sleep apnea in the long run as well due to an impaired autonomic nervous system. This autonomic nervous system partially controls breathing function during sleep.
But, why is it important to know the trigger, you may be asking. For most people treatment matters more than which comes first. Maybe it does not matter anymore for people living with Diabetes for long but it matters to people who are at risk – children, teenagers, and adults. Knowing where it starts will help the medical community address the root cause.
For now, it seems that the bond between Diabetes and sleep apnea is getting stronger. But one thing’s for sure: these conditions are both the effects of obesity. We can start avoiding these diseases by living healthy and encouraging awareness among those who do not have a clue as to what they are dealing with.