Case Study: Sleep Apnea Diagnosis in a Man With Type 2 ...

Case Study: Sleep Apnea Diagnosis in a Man With Type 2 Diabetes Improved Control

Case Study: Sleep Apnea Diagnosis in a Man With Type 2 Diabetes Improved Control
2006
Emily Cashman, BS, RRT
Diabetes Spectrum

© American Diabetes Association ®, Inc., 2006

Clinical Decision Making

What Is Sleep Apnea?

Diabetes and obstructive sleep apnea (OSA) are common disorders that often coexist. In fact, they are equally prevalent within the U.S. adult population. According to the National Institutes of Health, > 20 million people have OSA and only ~ 10% have been identified. OSA is a disorder characterized by snoring, partial or complete cessation of breathing during sleep, reductions in blood oxygen levels, severe sleep fragmentation, and excessive day-time sleepiness. It is associated with cardiovascular conditions, causing hypertension, heart disease, and stroke. Although the scope of sleep apnea is enormous, sleep apnea continues to be poorly recognized by clinicians.

During sleep apnea, breathing stops (apnea) or gets very shallow (hypopnea). Sometimes the person stops breathing entirely for several seconds, and this can happen hundreds of times a night. A bed partner may hear snoring and then witness gasps followed by a coughing sound, as the person struggles to resume breathing. Both apneas and hypopneas cause sleep arousals; the individual wakes enough to resume breathing but not enough to remember any interruption of sleep. Some arousals simply cause the sleeper to shift into a lighter stage of sleep. In either case, the arousal reduces the quality of sleep.

OSA can affect anyone, including children. However, the population typically associated with the disorder includes overweight adults who snore heavily. Sleep apnea is more common in men, and 50% of type 2 diabetic men also have OSA.

Diagnosis and Treatment

Any practitioner can identify OSA symptoms. Patients are then referred to a sleep specialist, and an overnight polysomnography is conducted in a sleep laboratory or the patient's home. The standard treatment is continuous positive airway pressure (CPAP). The air pressure functions like a splint for the upper airway to prevent apneas from occurring and keep the airway from collapsing. This permits normal breathing to continue during sleep, normal sleep patterns to emerge, sleep to become restorative, and the patient to feel better. The impact is often immediate and dramatic. The success of treatment is measured by the reduction of respiratory disturbance to normal levels, the elimination of symptoms such as fatigue and depression, and improvement in the patient's subjective feeling of well-being. Effective treatment will eliminate snoring and apnea events and has demonstrated decreases in blood pressure and post-prandial glucose levels within 30 days.

OSA is often overlooked and misdiagnosed. Complaints of fatigue and sleepiness are attributed to lifestyle, stress, other medical conditions (such as diabetes), or side effects from medications. Sleep apnea should be investigated when patients present classic symptoms (Table 1).

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