B. Brooks et al., OBSTRUCTIVE SLEEP-APNEA IN OBESE NONINSULIN-DEPENDENT DIABETIC-PATIENTS - EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT ON INSULIN RESPONSIVENESS, The Journal of clinical endocrinology and metabolism, 79(6), 1994, pp. 1681-1685
Patients with noninsulin-dependent diabetes mellitus (NIDDM) ace often
obese and frequently complain of tiredness. These features are also c
haracteristically seen in patients with obstructive sleep apnea (OSA).
Therefore, it was the aim of this study to assess the prevalence of O
SA among a group of obese NIDDM patients who have some clinical featur
es of OSA. The effect of reversal of OSA by nasal continuous positive
airway pressure (CPAP) treatment on insulin responsiveness was also in
vestigated. From a population of 179 NIDDM patients with a body mass i
ndex (BMI) greater than 35 kg/m(2), we performed ambulatory sleep moni
toring on 31 (15 males and 16 females) who admitted to either heavy sn
oring or excessive sleepiness. Results were reviewed by a sleep physic
ian blinded to the clinical status of the patients, and 22 (70%) were
found to have moderate or severe OSA, with mean oxygen desaturation in
dexes of 10.3 +/- 5.3 and 30.7 +/- 13.2 episodes/h, respectively. A su
bgroup of 10 patients (seven males and three females) with a mean BMI
of 42.7 +/- 4.3 kg/m(2) was treated with nightly CPAP for 4 months. Th
ese subjects all had significant OSA, with frequent obstructive apneas
(mean, 47 +/- 31.6 episodes/h) and oxygen desaturation (mean minimum
O-2 saturation, 74 +/- 9.5%), as determined by polysomnography. One pa
tient was excluded from analysis because of infrequent use of CPAP. In
sulin responsiveness in terms of glucose disposal measured by hyperins
ulinemic euglycemic clamps improved from 11.4 +/- 6.2 to 15.1 +/- 4.6
mu mol/kg.min (P < 0.05) during CRAP treatment. These results indicate
that OSA occurs commonly in obese NIDDM patients with excessive sleep
iness or heavy snoring. Treatment of their OSA may improve insulin res
ponsiveness.