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Diabetes and Obstructive Sleep Apnoea: What’s the Link?

Learn about the possible links between type 2 diabetes and obstructive sleep apnoea to better manage your health.

If you have type 2 diabetes, there is a chance that you might also be suffering from obstructive sleep apnoea (OSA) — a sleep disorder in which the patient experiences pauses in breathing and snores loudly throughout the night.

No firm link has been established, but studies have suggested an association between the two conditions: people with diabetes tend to have OSA and vice versa. Diabetics with OSA also tend to be poorer at controlling their blood sugar levels.

The Connection Between Sleep Apnoea and Type 2 Diabetes

People suffering from either condition should be wary of the possibility of the other developing, doctors from the SingHealth Duke-NUS Sleep Centre have warned.

“We know that a lot of patients with OSA may not know [that] they have OSA, including those with diabetes. If their OSA isn’t treated, their diabetes may not be well controlled,” said Dr Toh Song Tar, Head of the SingHealth Duke-NUS Sleep Centre.

“We have patients whose glucose [levels were] not well controlled, but once their OSA was treated, their blood sugar [level] control improved,” added Dr Toh, who is also Senior Consultant, Department of Otolaryngology, and Director, Sleep Disorders Unit, Singapore General Hospital (SGH).

Your Weight Matters: Obesity and Sleep Apnoea

People who are overweight have a greater chance of developing OSA.

Obesity, A Major Risk Factor for Sleep Apnoea

Obesity is a major risk factor for the development and progression of the sleep disorder because fat tends to be deposited around the neck or tissues of the upper airway, leading to a narrowing of the airway and subsequent development of OSA. Patients with obesity and OSA are pulled out of a deep sleep repeatedly during the night when their airflow is blocked. This automatic response reopens the airway for normal breathing.

“They [suffer from] sleep deprivation, which sets up a whole cascade of endocrine abnormalities that predisposes someone to [taking] in more high-calorie foods. [Binge eating] leads to obesity again and alters the glucose metabolism again,” said Dr Toh.

The body responds to the periodic fall in blood oxygen levels — or intermittent hypoxia — in a number of ways, which together affect glucose metabolism and insulin sensitivity, said Dr Mok Yingjuan, Director, Epidemiology and Public Health, SingHealth Duke-NUS Sleep Centre.

Obesity, A Major Risk Factor for Diabetes

“The existence of a link between OSA and diabetes would not be surprising because both share a common risk factor: obesity,” said Dr Mok, who is also a Consultant at the Department of Respiratory and Critical Care Medicine, Changi General Hospital.

A 10 percent increase in weight has been shown to cause a six-fold increase in the risk of developing OSA, while a weight gain of five kilograms or more significantly increases the risk of developing diabetes, she said, citing various studies conducted overseas.

Sleep Apnoea and Diabetes in Singapore

Singapore has the second-highest proportion of diabetics among developed countries, after the United States.

According to 2015 statistics from the International Diabetes Federation, over 10 percent of people in Singapore aged between 20 and 79 have diabetes. At the same time, data from the Singapore Health Study 2012, a cross-sectional population study conducted on adults aged 21 to 79, estimated that 18 percent of Singapore’s adult population have OSA.

Singapore’s diabetes rate is expected to worsen with more young adults becoming obese. Based on current projections, about 35 percent of adults aged 25 to 36 can expect to be diabetic by the time they are 65.