Diabetes and Obstructive Sleep Apnea Relationship

As observational studies go, headlines are overstated and causation is not proved. Yet many headlines use the terms linked and tied instead of may increase the risk. The lead researcher, Dr. Tetyana Kendzerska, with the University of Toronto's Institute of Health Policy, Management, and Evaluation says, “Patients with severe sleep apnea had a 30 percent higher risk of developing diabetes than those without sleep apnea.”

The full study, a PDF file,  is garnering many headlines, from HealthDay, to Science Daily and several others. I developed severe obstructive sleep apnea which was finally diagnosed in 2001, approximately two years ahead of the diabetes diagnosis. I knew then that I had OSA for several years prior to that and my wife said that I had snored and had apneas for at least two years prior. The sad part was not getting a doctor to believe my wife until I almost wrecked our car when taking my wife to a doctor appointment.

“Kendzerska cautioned, however, that this was an observational study, and cannot prove that sleep apnea causes diabetes. "We are not able to investigate causality, just an association," she explained”

“Shelby Freedman Harris, director of the Behavioral Sleep Medicine Program and the Sleep-Wake Disorders Center at Montefiore Medical Center in New York City, said, "I definitely think that this is an important study highlighting the need for more sleep apnea awareness, screening and treatment. "Given the large sample size, it further places emphasis on sleep apnea as a predictor of diabetes, and hopefully with earlier intervention, it can greatly impact the health costs for diabetes management as well as improve the outcomes for many patients," she said.”

The most notable limitation of the study was there was no information about family history of diabetes.

A Follow-up on Children with OSA Benefit from CPAP

It is a good feeling when you are asked for information about something, in this case obstructive sleep apnea. I had written about this here. Since this happened, the family and I have exchanged several emails about the progress of their son and how he is doing with his VPAP machine. The parents are happy that no surgery was required and that I have been able to direct them to more web sites about sleep apnea.

In the three weeks their son has been using the VPAP, they have added the mask liners (the son has both the nasal mask and a full-face mask) and report that this has helped dramatically reduce the air leaks and he is using the VPAP every night now. The father reports that the entire family now exercises and the son has lost five pounds in the three weeks since starting. With the snow, they just add snowshoes and keep moving.

I was told that the number of apneas during the sleep study had varied from 76 to 92 apneas per hour. The doctor did find a way to work them in the next day because of the distance for travel. This has to be a doctor with much kindness in his heart. The mother reported that the doctor took his time to explain the two masks to them and the fitting of the masks. When asked about the mask liners, the doctor was unfamiliar with them, but took his time to go to the web site and after research, offered a prescription if they needed it.

Both parents have expressed their happiness that surgery is the last option the doctor wants to consider. They did obtain the VPAP machine and masks from a local supplier approved by their insurance. The doctor had also issued a prescription for a second disk for them to use and mail him the first disk to read the results for the first 30 days. Then he will mail it back to them for them to use when they mail the second disk for reading the next 30 days.

I told them this was normal and the doctor would be looking for the amount of time on a daily basis that the machine was being used and if there happened to be sleep problems. In addition, the insurance company would receive a report from the doctor about the results. If problems showed up, this could indicate a need to adjust the pressure and may require a second visit to the doctor. If the results show normal or near normal, the disk mailing might stop or happen at an infrequent interval, just to monitor the results.

The son even reported that his sister likes to tease him about looking like an alien with his mask on. He said he told her he does not care as he is getting a good night's sleep every night and feels so much better. He also said his grades are improving and he is more alert in school.

We do continue to communicate about questions they have and questions they should ask their doctor or equipment supplier. They are happily surprised about the support they have received from their medical insurance and this is a big plus. Their insurance had questioned both the nasal and full-face mask, but when the doctor explained his reasons, the insurance company did allow both.

This blog is the first of four blogs about sleep apnea this week.

Children with OSA Benefit from CPAP

This was a most timely article as it fit with an email question I received from someone discovering a blog of mine on obstructive sleep apnea surgery. The parent was wondering about why the two doctors he had taken his child to were so insistent on doing surgery. The blog was this one and he was thinking there could be more about this since October 2010. I also gave him this blog from February 2011.

After replying to the email with this article, he emailed me back asking for my phone number. I supplied it and his wife called shortly after. I supplied her with the sites I had and a listing of doctors that handled sleep apnea in their area. She discovered that the nearest sleep study lab was about 60 miles from them, but she has a sister living in the town so that was a huge plus as she would have a place to spend the night.

Both parents had read my blogs and were wondering why the doctors wanting to do the surgery had not informed them about the side effects and problems that could result. We discussed their medical insurance and I suggested they should call there for doctors and what equipment would be covered. I had given them three sleep apnea equipment sites so they could familiarize themselves with some of their options.

Two hours later, I received another phone call saying that two of the different types of equipment would be covered and she was to receive a schedule of how often replacement parts could be obtained through the policy. She found out that the doctor she was now going to call for an appointment was indicated by the medical insurance and they encouraged her to make an appointment.

Today, February 15, I received a call saying that at first it was going to be about two weeks before their appointment. Then they had received a call from the doctor this morning asking them to be there by 3:00 PM for an appointment and if a sleep lab was needed, they had a cancellation for this evening and their son would be using this appointment. The mother said the doctor asked her many questions, but her conversations with me had given her the knowledge to answer them.

She and her husband had taken time last night to count the number of apneas at two different times that their son had for a half hour period. She had counted 39 apneas when she observed her son and her husband counted 44 apneas during his time. She said the doctor was very surprised they had done this, but said this helped him know that the sleep study lab was needed. The doctor did ask her to inform the insurance company that he would be participating in the sleep study lab tonight and have the insurance company call him if they had any questions.

The husband just called me and stated that the doctor had done an evaluation and agreed that the sleep study lab was needed. The doctor had discussed with his wife and son what would happen during the study, and then clearly stated that until after the sleep study lab results were available, he could not make any recommendations. He did list the options which included surgery, but that until he knew that CPAP (continuous positive air pressure), if needed, did not work, he would prefer leaving surgery as a last resort. The father also stated that exercise was also part of the treatment options to have their son lose weight to near normal for his body structure.

I hope that I will hear what the results are, the course of action prescribed, and be able to do a follow-up blog. Here is a second article about the same study, which I had given the parents.