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One of the main reasons CPAP therapy is considered a “gold standard” in treating sleep apnea is its additional health benefits. It is not only at least as effective as surgery and oral devices, but it has also been shown to reduce blood pressure and improve one’s mental health.
And now, if new studies are to be believed, there is also evidence that CPAP therapy can help diabetics manage their diabetes more efficiently. Or, to be more precise, it can slow the progression of diabetes before it ever takes hold.
Sleep Apnea & Diabetes
The link between obstructive sleep apnea (OSA) and physical health, especially metabolic health, has been long established. Untreated sleep apnea leads to sleep deprivation, which triggers the sympathetic nervous system’s “fight or flight” mechanism and overwhelms the circulatory and endocrine systems.
In addition to the toll it takes on cardiovascular health (i.e. increased risk for heart attacks), these side effects also put OSA patients at higher risk of developing Type 2 diabetes. Type 2 diabetes is characterized by resistance to insulin, which is needed to convert sugar into usable energy.
A 2007 study at Yale University concluded that OSA sufferers are indeed at risk of developing type 2 diabetes, and this risk is independent of other factors such as lifestyle. Observing 593 patients with sleep disordered breathing, they deemed the risk of developing diabetes to be over 21x the risk in people without sleep apnea. Higher severity (i.e. as measured by AHI, etc.) also correlated with an even greater risk.
Can CPAP Therapy Help?
Despite the association between diabetes and sleep apnea, the effect of CPAP therapy on diabetes management has remained relatively unscrutinized until recently. However, in volume 192, issue 1 of the American Journal of Respiratory and Critical Care Medicine, this is precisely the relation that was studied.
Researchers observed 39 overweight and/or middle-aged participants in a randomized experiment that subjected them to either CPAP therapy or a placebo for 8 hours/night over the course of two weeks. Nightly supervision ensured these participants’ compliance with their treatments, and after the experiment their glucose metabolisms were measured.
The presence of glucose in a diabetic’s blood plasma indicates the quality of their health (higher glucose levels is prevalent in untreated diabetes). Compared with the placebo treatment, CPAP therapy was found to:
- Reduce glucose response
- Improve insulin sensitivity (i.e. reduce insulin resistance)
In addition, the study observed correlations between CPAP treatment and reductions in blood pressure and norepinephrine.
It is important to note that the participants in this study were prediabetic. This means they had begun to exhibit symptoms of diabetes, namely abnormally high blood glucose levels. Nevertheless, they had not been diagnosed with type 2 diabetes.
Thus, CPAP therapy’s direct affect on diabetes is inconclusive. However, it is more conclusive that CPAP therapy can, in fact, slow or even halt the progression of diabetes before it becomes problematic.
In conclusion, it is recommended that patients with high risk for developing diabetes (especially type 2) should also be assessed for sleep apnea (and vice versa). Diabetes still remains — and will likely remain for a long time —a serious public health problem. Yet, the rate of developing diabetes can likely be reduced among the population if they are effectively diagnosed and treated for sleep apnea.