Volume 16, No. 3, Summer 2008
By Gary Sheehan
For some time now, those of us in the Durable Medical Equipment business on Cape Cod have noticed an increased interest in the problems of patients suffering from obstructive sleep apnea (OSA) along with greater community awareness of co-morbidity problems arising from this condition.
In other words, awareness that OSA can lead to extremely serious complications.
Some of these were known, such as a tendency of OSA patients to develop cardiovascular problems like heart attacks or stroke. Now, a new study from the International Diabetes Federation (IDF) Task Force on Epidemiology and Prevention warns that recent research demonstrates that type 2 diabetes and OSA “are closely related, and that both disorders have significant implications on public health and on individuals.”
An IDF task force official added that “although the mechanisms linking OSA with diabetes are not yet fully understood, the consequences of both conditions cannot be ignored. It has been shown that the prevalence of cardiovascular disease increases progressively with the increasing severity of OSA and that people with diabetes and/or OSA face serious cardiovascular problems and earlier death. Undiagnosed OSA may interfere with lifestyle treatment for diabetes.
“IDF therefore strongly recommends that healthcare professionals working in both type 2 diabetes and sleep disorders are educated about the links between the two conditions and encouraged to adopt clinical practices to ensure that a person presenting with one condition is considered for the other.”
Recent estimates suggest that up to 40 percent of people with OSA have type 2 diabetes. OSA is the most common form of sleep-disordered breathing, which has been highlighted as a major public health problem on a level equivalent to that of tobacco smoking. Untreated, it can lead to such life-threatening diseases as diabetes, obesity and cardiovascular disease, in particular hypertension, coronary artery disease, heart failure and atrial fibrillation, as well as traffic and workplace accidents.
Further research is needed in this area in order to strengthen the evidence base between diabetes and OSA, but, as with the other complications, fatigue from inability to get a good night’s sleep is believed to be a factor.
The IDF Task Force statement includes recommendations for screening, treatment and further research. While people with OSA should be routinely screened for metabolic disease and type 2 diabetes, people with diabetes in turn should be screened for OSA, particularly when they present classical symptoms such as witnessed apneas, heavy snoring or daytime sleepiness and poor workplace performance.
Spouses often are the first to notice that there is a problem.
Recommendations for treatment of OSA include weight reduction in overweight and obese people, reduction in alcohol intake and CPAP treatment.
CPAP is an acronym for a device called Continuous Positive Airway Pressure. The OSA patient wears a mask when sleeping and the CPAP provides a continuous flow of oxygen to keep the airways open.
Demand for these CPAP devices has been growing rapidly on the Cape. They’re expensive, but, when ordered by a physician, also covered by Medicare and private insurance companies, who recognize the greater costs involved if the apnea develops into more serious chronic conditions.
Screening can be done at the sleep lab at Falmouth Hospital (508-457-3872) and there is a sleep apnea support group that meets at Cape Cod Hospital (508-398-7554).
(Mr. Sheehan is President/CEO of Cape Medical Supply, Inc., 1-800-339-3322 or gsheehan@capemedical.net,)