Obstructive Sleep Apnoea and Type 1 Diabetes Mellitus: A Neglected
                    Relationship?

Theodoros Panou; Konstantinos Roukas; Konstantina Chadia; Evangelia Nena; Evanthia Gouveri; Nikolaos Papanas; Paschalis Steiropoulos

doi:10.1055/a-2414-5487

Experimental and Clinical Endocrinology & Diabetes, Inhaltsverzeichnis

Exp Clin Endocrinol Diabetes 2025; 133(01): 40-50
DOI: 10.1055/a-2414-5487

Mini-Review

Obstructive Sleep Apnoea and Type 1 Diabetes Mellitus: A Neglected Relationship?

Theodoros Panou

¹Deparment of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Ringgold ID: RIN112220)

²Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece

,

Konstantinos Roukas

¹Deparment of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Ringgold ID: RIN112220)

,

Konstantina Chadia

¹Deparment of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Ringgold ID: RIN112220)

,

Evangelia Nena

³Laboratory of Social Medicine, Democritus University of Thrace – Alexandropoulis Campus, Alexandroupolis, Greece (Ringgold ID: RIN112220)

,

Evanthia Gouveri

²Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece

,

Nikolaos Papanas

²Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece

,

Paschalis Steiropoulos

¹Deparment of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece (Ringgold ID: RIN112220)

› Institutsangaben

Abstract

Obstructive sleep apnoea (OSA) is regarded as a major health condition, progressively affecting an increased number of people around the world. The interplay between OSA and type 2 diabetes mellitus (T2DM) has been extensively studied. However, little is known about the relationship between OSA and type 1 diabetes mellitus (T1DM). This review provides insight into the prevalence of OSA in T1DM and its relationship with diabetic complications. Studies have hitherto yielded contradictory results on the occurrence of OSA in T1DM. Indeed, the risk of OSA in T1DM has ranged from 1 in 10 to more than 1 in 2 T1DM subjects. This high occurrence was confirmed by objective polysomnography as well as widely used subjective questionnaires. Multiple studies revealed the important correlation between OSA and diabetes complications. Both microvascular (nephropathy, neuropathy and retinopathy) and macrovascular complications appear to be associated with OSA occurrence, although some associations were not significant due to inadequate data. In conclusion, T1DM subjects carry a higher risk of undiagnosed OSA. Additional studies are needed to clarify the exact correlation between the two conditions.

Keywords

OSA - T1DM - diabetic complications

Volltext

Referenzen

References
1 Benjafield AV, Ayas NT, Eastwood PR. et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019; 7: 687-698
2 Abbasi A, Gupta SS, Sabharwal N. et al. A comprehensive review of obstructive sleep apnea. Sleep Sci 2021; 14: 142-154
3 Agrafiotis M, Galanou A, Fletsios D. et al. Functional Comorbidity Index and health-related quality of life in patients with obstructive sleep apnea. Adv Respir Med 2022; 90: 9-16
4 Fuhrman C, Fleury B, Nguyên XL. et al. Symptoms of sleep apnea syndrome: High prevalence and underdiagnosis in the French population. Sleep Med 2012; 13: 852-858
5 Pizarro C, Schaefer C, Kimeu I. et al. Underdiagnosis of obstructive sleep apnoea in peripheral arterial disease. Respiration. 89. 214-220
6 Costa LE, Uchôa CH, Harmon RR. et al. Potential underdiagnosis of obstructive sleep apnoea in the cardiology outpatient setting. Heart 2015; 101: 1288-1292
7 Gruenberg E, Cooper J, Zamora T. et al. Beyond CPAP: Modifying upper airway output for the treatment of OSA. Front Neurol 2023; 14: 1202271
8 Lorenzi-Filho G, Almeida FR, Strollo PJ. Treating OSA: Current and emerging therapies beyond CPAP. Respirology 2017; 22: 1500-1507
9 Francis CE, Quinnell T. Mandibular Advancement devices for OSA: An alternative to CPAP?. Pulm Ther 2021; 7: 25-36
10 Ioja S, Chasens ER, Ng J. et al. Obstructive sleep apnea in adults with type 1 and type 2 diabetes: Perspectives from a quality improvement initiative in a university-based diabetes center. BMJ Open Diabetes Res Care 2017; 5: e000433
11 GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the Global Burden of Disease Study 2021. Lancet 2023; 402: 203-234
12 Muraki I, Wada H, Tanigawa T. Sleep apnea and type 2 diabetes. J Diabetes Investig 2018; 9: 991-997
13 Reutrakul S, Mokhlesi B. Obstructive sleep apnea and diabetes: A state of the art review. Chest 2017; 152: 1070-1086
14 Mondini S, Guilleminault C. Abnormal breathing patterns during sleep in diabetes. Ann Neurol 1985; 17: 391-395
15 Janovsky CC, Rolim LC, de Sá JR. et al. Cardiovascular autonomic neuropathy contributes to sleep apnea in young and lean type 1 diabetes mellitus patients. Front Endocrinol (Lausanne) 2014; 5: 119
16 van Dijk M, Donga E, van Dijk JG. et al. Disturbed subjective sleep characteristics in adult patients with long-standing type 1 diabetes mellitus. Diabetologia 2011; 54: 1967-1976
17 Maltese G, Fountoulakis N, Drakatos P. et al. Elevated obstructive sleep apnoea risk score is associated with poor healing of diabetic foot ulcers: A prospective cohort study. Diabet Med 2018; 35: 1494-1498
18 Borel AL, Benhamou PY, Baguet JP. et al. High prevalence of obstructive sleep apnoea syndrome in a Type 1 diabetic adult population: A pilot study. Diabet Med 2010; 27: 1328-1329
19 Vale J, Manuel P, Oliveira E. et al. Obstructive sleep apnea and diabetes mellitus. Rev Port Pneumol 2015; 21: 55-60
20 Manin G, Pons A, Baltzinger P. et al. Obstructive sleep apnoea in people with Type 1 diabetes: Prevalence and association with micro- and macrovascular complications. Diabet Med 2015; 32: 90-96
21 Banghoej AM, Nerild HH, Kristensen PL. et al. Obstructive sleep apnoea is frequent in patients with type 1 diabetes. J Diabetes Complications 2017; 31: 156-161
22 Schober AK, Neurath MF, Harsch IA. Prevalence of sleep apnoea in diabetic patients. Clin Respir J 2011; 5: 165-172
23 Pépin JL, Bailly S, Texereau JB. et al. Prevalence of sleep apnoea in patients with type 1 diabetes and its association with comorbidities and diabetic complications: A French nationwide prospective study. Diabetes Obes Metab 2023; 25: 1624-1631
24 Mattos ACMT, Campos YS, Fiorini VO. et al. Relationship between sleep disturbances, lipid profile and insulin sensitivity in type 1 diabetic patients: A cross-sectional study. Arch Endocrinol Metab 2020; 64: 412-417
25 Alshehri Z, Subramanian A, Adderley NJ. et al. Risk of incident obstructive sleep apnoea in patients with type 1 diabetes: A population-based retrospective cohort study. Diabetologia 2022; 65: 1353-1363
26 Kostkova M, Durdik P, Ciljakova M. et al. Short-term metabolic control and sleep in children and adolescents with type 1 diabetes mellitus. J Diabetes Complications 2018; 32: 580-585
27 Denic-Roberts H, Costacou T, Orchard TJ. Subjective sleep disturbances and glycemic control in adults with long-standing type 1 diabetes: The Pittsburgh's Epidemiology of Diabetes Complications study. Diabetes Res Clin Pract 2016; 119: 1-12
28 Reutrakul S, Thakkinstian A, Anothaisintawee T. et al. Sleep characteristics in type 1 diabetes and associations with glycemic control: Systematic review and meta-analysis. Sleep Med 2016; 23: 26-45
29 American Academy of Sleep Medicine. Obstructive sleep Apnea. Illinois: American Academy of Sleep Medicine; 2008
30 LusicKalcina L, Valic M, Pecotic R. et al. Good and poor sleepers among OSA patients: Sleep quality and overnight polysomnography findings. Neurol Sci 2017; 38: 1299-1306
31 Netzer NC, Stoohs RA, Netzer CM. et al. Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999; 131: 485-491
32 Slowik JM, Sankari A, Collen JF. Obstructive Sleep Apnea. [Updated 2022 Dec 11]. In. StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. Jan- Available from: https://www.ncbi.nlm.nih.gov/books/NBK459252/
33 Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnea: A review. JAMA 2020; 323: 1389-1400
34 Chiu HY, Chen PY, Chuang LP. et al. Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis. Sleep Med Rev 2017; 36: 57-70
35 Jauch-Chara K, Schmid SM, Hallschmid M. et al. Altered neuroendocrine sleep architecture in patients with type 1 diabetes. Diabetes Care 2008; 31: 1183-1188
36 Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol 2005; 99: 1998-200
37 Akset M, Poppe KG, Kleynen P. et al. Endocrine disorders in obstructive sleep apnoea syndrome: A bidirectional relationship. Clin Endocrinol (Oxf) 2023; 98: 3-13
38 Bottini P, Redolfi S, Dottorini ML. et al. Autonomic neuropathy increases the risk of obstructive sleep apnea in obese diabetics. Respiration 2008; 75: 265-271
39 Resnick HE, Redline S, Shahar E. et al. Diabetes and sleep disturbances: Findings from the Sleep Heart Health Study. Diabetes Care 2003; 26: 702-709
40 Song SO, He K, Narla RR. et al. Metabolic consequences of obstructive sleep apnea especially pertaining to diabetes mellitus and insulin sensitivity. Diabetes Metab J 2019; 43: 144-155
41 Shaw JE, Punjabi NM, Naughton MT. et al. The effect of treatment of obstructive sleep apnea on glycemic control in type 2 diabetes. Am J Respir Crit Care Med 2016; 194: 486-492
42 Koh HE, van Vliet S, Cao C. et al. Effect of obstructive sleep apnea on glucose metabolism. Eur J Endocrinol 2022; 186: 457-467
43 Leong WB, Jadhakhan F, Taheri S. et al. The association between obstructive sleep apnea on diabetic kidney disease: A systematic review and meta-analysis. Sleep 2016; 39: 301-308
44 Leong WB, Jadhakhan F, Taheri S. et al. Effect of obstructive sleep apnoea on diabetic retinopathy and maculopathy: A systematic review and meta-analysis. Diabet Med 2016; 33: 158-168
45 Zhu Z, Zhang F, Liu Y. et al. Relationship of obstructive sleep apnoea with diabetic retinopathy: A meta-analysis. Biomed Res Int 2017; 2017: 4737064
46 Gu X, Luo X, Wang X. et al. The correlation between obstructive sleep apnea and diabetic neuropathy: A meta-analysis. Prim Care Diabetes 2018; 12: 460-466
47 Reichmuth KJ, Austin D, Skatrud JB. et al. Association of sleep apnea and type II diabetes: A population-based study. Am J Respir Crit Care Med 2005; 172: 1590-1595
48 Qie R, Zhang D, Liu L. et al. Obstructive sleep apnea and risk of type 2 diabetes mellitus: A systematic review and dose-response meta-analysis of cohort studies. J Diabetes 2020; 12: 455-464
49 Wang X, Bi Y, Zhang Q. et al. Obstructive sleep apnoea and the risk of type 2 diabetes: A meta-analysis of prospective cohort studies. Respirology 2013; 18: 140-146
50 Wang C, Tan J, Miao Y. et al. Obstructive sleep apnea, prediabetes and progression of type 2 diabetes: A systematic review and meta-analysis. J Diabetes Investig 2022; 13: 1396-1411
51 Fredheim JM, Rollheim J, Omland T. et al. Type 2 diabetes and pre-diabetes are associated with obstructive sleep apnea in extremely obese subjects: A cross-sectional study. Cardiovasc Diabetol 2011; 10: 84
52 Lecomte P, Criniere L, Fagot-Campagna A. et al. Underdiagnosis of obstructive sleep apnoea syndrome in patients with type 2 diabetes in France: ENTRED 2007. Diabetes Metab 2013; 39: 139-147
53 Malhotra A, Bednarik J, Chakladar S. et al. Tirzepatide for the treatment of obstructive sleep apnea: Rationale, design, and sample baseline characteristics of the SURMOUNT -OSA phase 3 trial. Contemp Clin Trials 2024; 141: 107516
54 Katsiki N, Steiropoulos P, Papanas N. et al. Diabetes mellitus and chronic obstructive pulmonary disease: An overview. Exp Clin Endocrinol Diabetes 2021; 129: 699-704
55 Bartziokas K, Papaioannou AI, Drakopanagiotakis F. et al. Unraveling the link between insulin resistance and bronchial asthma. Biomedicines 2024; 12: 437
56 Pafili K, Steiropoulos P, Papanas N. The relationship between obstructive sleep apnoea and coronary heart disease. Curr Opin Cardiol 2015; 30: 439-446
57 Nena E, Papanas N, Steiropoulos P. Undetected obstructive sleep apnoea (OSA) in the workforce and reduced work productivity in OSA: We need to improve screening to see the whole picture. Chron Respir Dis 2013; 10: 183