Skip to main content

Advertisement

SpringerLink
Log in

RSSDI clinical practice recommendations for screening, diagnosis, and treatment in type 2 diabetes mellitus with obstructive sleep apnea

  • Consensus
  • Published:
International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Purpose of the study

Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are closely associated diseases with a significant impact on public health. Both diseases are highly prevalent and the common overlapping risk factors include obesity, old age, and a generally high preponderance in men. A growing body of evidence suggests a bidirectional association between OSA and T2DM; both, in turn, constitute as strong risk factors for cardiovascular diseases, the leading cause of premature deaths and morbidity in India. Several studies have reported a higher prevalence of OSA in Indian patients with T2DM, despite lower levels of obesity. However, OSA remains an underdiagnosed condition in Indian patients with T2DM due to lack of awareness, uncertainty about treatment options, and non-availability of diagnostic facilities.

Methods

This document embodies evidence-based clinical practice recommendations and outlines an optimized care pathway for patients with T2DM and OSA, based on consensus multidisciplinary observations and clinical experiences.

Results and conclusions

Implementation of screening, diagnosis, and treatment of OSA in patients with T2DM at initial stages could potentially alleviate the risk of cardiovascular disease and substantially improve their quality of life. The recommendations emphasize the need for collaborative efforts from diabetologists, endocrinologists, and sleep medicine specialists towards systematic screening, diagnosis, and treatment of coexisting T2DM and OSA for enhanced patient care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. International Diabetes Federation. IDF Diabetes Atlas teB, Belgium: International Diabetes Federation. 2017.

  2. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387–94. https://doi.org/10.1378/chest.14-0970.

    Article  PubMed  Google Scholar 

  3. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687–98. https://doi.org/10.1016/S2213-2600(19)30198-5.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Raju YSSD, Yadati R, Alekhya A. Diabetes mellitus and obstructive sleep apnoea: implications for clinicians. J Clin Sci Res. 2016;5:225–33. https://doi.org/10.15380/2277-5706.JCSR.16.05.003.

    Article  Google Scholar 

  5. Hla KM, Young T, Hagen EW, Stein JH, Finn LA, Nieto FJ, et al. Coronary heart disease incidence in sleep disordered breathing: the Wisconsin Sleep Cohort Study. Sleep. 2015;38(5):677–84. https://doi.org/10.5665/sleep.4654.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gottlieb DJ, Yenokyan G, Newman AB, O'Connor GT, Punjabi NM, Quan SF, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122(4):352–60. https://doi.org/10.1161/CIRCULATIONAHA.109.901801.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hou H, Zhao Y, Yu W, Dong H, Xue X, Ding J, et al. Association of obstructive sleep apnea with hypertension: a systematic review and meta-analysis. J Glob Health. 2018;8(1):010405. https://doi.org/10.7189/jogh.08.010405.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Resnick HE, Redline S, Shahar E, Gilpin A, Newman A, Walter R, et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care. 2003;26(3):702–9. https://doi.org/10.2337/diacare.26.3.702.

    Article  PubMed  Google Scholar 

  9. Huang T, Lin BM, Stampfer MJ, Tworoger SS, Hu FB, Redline S. A population-based study of the bidirectional association between obstructive sleep apnea and type 2 diabetes in three prospective U.S. cohorts. Diabetes Care. 2018;41(10):2111–9. https://doi.org/10.2337/dc18-0675.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Bonsignore MR, Baiamonte P, Mazzuca E, Castrogiovanni A, Marrone O. Obstructive sleep apnea and comorbidities: a dangerous liaison. Multidiscip Respir Med. 2019;14:8. https://doi.org/10.1186/s40248-019-0172-9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pillar G, Shehadeh N. Abdominal fat and sleep apnea: the chicken or the egg? Diabetes Care. 2008;31(Suppl 2):S303–9. https://doi.org/10.2337/dc08-s272.

    Article  PubMed  Google Scholar 

  12. Ioja SCE, 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(1):1–5. https://doi.org/10.1136/bmjdrc-2017-000433.

    Article  Google Scholar 

  13. American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care. 2014;37:S14–80.

    Article  Google Scholar 

  14. Viswanathan V, Ramalingam IP, Ramakrishnan N. High prevalence of obstructive sleep apnea among people with type 2 diabetes mellitus in a tertiary care center. J Assoc Physicians India. 2017;65(11):38–42.

    PubMed  Google Scholar 

  15. Singh APS, Jain J, Singh R. Polysomnographic study in diabetes mellitus in central Indian subjects. J Mahatma Gandhi Inst Med Sci. 2012;17:17–21.

    Google Scholar 

  16. Malik JA, Masoodi SR, Shoib S. Obstructive sleep apnea in type 2 diabetes and impact of continuous positive airway pressure therapy on glycemic control. Indian J Endocrinol Metab. 2017;21(1):106–12. https://doi.org/10.4103/2230-8210.196005.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ekka RSJ, Singh C, Sen MK, Gupta A. Prevalence of obstructive sleep apnea in type 2 diabetes mellitus. 2010;5:18–26.

  18. Bhimwal RKMM, Jangid R, Bhati RL. To study the prevalence of obstructive sleep apnoea in type 2 diabetes patients in Western Rajasthan, India. Int J Adv Med. 2017;4(4):894–902. https://doi.org/10.18203/2349-3933.ijam20172569.

    Article  Google Scholar 

  19. Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, et al. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition). Lung India. 2015;32(4):422–34. https://doi.org/10.4103/0970-2113.159677.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Siwasaranond N, Nimitphong H, Manodpitipong A, Saetung S, Chirakalwasan N, Thakkinstian A, et al. The relationship between diabetes-related complications and obstructive sleep apnea in type 2 diabetes. J Diabetes Res. 2018;2018:9269170. https://doi.org/10.1155/2018/9269170.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Eckert DJ, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):144–53. https://doi.org/10.1513/pats.200707-114MG.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Levy P, Kohler M, McNicholas WT, Barbe F, McEvoy RD, Somers VK, et al. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers. 2015;1:15015. https://doi.org/10.1038/nrdp.2015.15.

    Article  PubMed  Google Scholar 

  23. Laratta CR, Ayas NT, Povitz M, Pendharkar SR. Diagnosis and treatment of obstructive sleep apnea in adults. CMAJ. 2017;189(48):E1481–E8. https://doi.org/10.1503/cmaj.170296.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Semelka M, Wilson J, Floyd R. Diagnosis and treatment of obstructive sleep apnea in adults. Am Fam Physician. 2016;94(5):355–60.

    PubMed  Google Scholar 

  25. Stansbury RC, Strollo PJ. Clinical manifestations of sleep apnea. J Thorac Dis. 2015;7(9):E298–310. https://doi.org/10.3978/j.issn.2072-1439.2015.09.13.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Amra B, Rahmati B, Soltaninejad F, Feizi A. Screening questionnaires for obstructive sleep apnea: an updated systematic review. Oman Med J. 2018;33(3):184–92. https://doi.org/10.5001/omj.2018.36.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE, et al. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160(6):521–30. https://doi.org/10.1093/aje/kwh261.

    Article  PubMed  Google Scholar 

  28. Bhat SUH, DeBari VA, Ahmad M, Polos PG, Chokroverty S. The utility of patient-completed and partner-completed Epworth Sleepiness Scale scores in the evaluation of obstructive sleep apnea. Sleep Breath. 2016;20(4):1347–54. https://doi.org/10.1007/s11325-016-1370-8.

    Article  PubMed  Google Scholar 

  29. Prasad KTSI, Agarwal R, Aggarwal AN, Behera D, Dhooria S. Assessing the likelihood of obstructive sleep apnea: a comparison of nine screening questionnaires. Sleep Breath. 2017;21(4):909–17. https://doi.org/10.1007/s11325-017-1495-4.

    Article  PubMed  Google Scholar 

  30. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540–5. https://doi.org/10.1093/sleep/14.6.540.

    Article  CAS  PubMed  Google Scholar 

  31. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812–21. https://doi.org/10.1097/ALN.0b013e31816d83e4.

    Article  PubMed  Google Scholar 

  32. Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108(5):768–75. https://doi.org/10.1093/bja/aes022.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485–91. https://doi.org/10.7326/0003-4819-131-7-199910050-00002.

    Article  CAS  PubMed  Google Scholar 

  34. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5. https://doi.org/10.1056/NEJM199304293281704.

    Article  CAS  PubMed  Google Scholar 

  35. Force USPST, Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW Jr, et al. Screening for obstructive sleep apnea in adults: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(4):407–14. https://doi.org/10.1001/jama.2016.20325.

    Article  Google Scholar 

  36. Comparative effectiveness of diagnosis and treatment of obstructive sleep apnea in adults. Comparative effectiveness review summary guides for clinicians. AHRQ comparative effectiveness reviews. Rockville (MD) 2007.

  37. Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med. 2005;172(12):1590–5. https://doi.org/10.1164/rccm.200504-637OC.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Marshall NS, Wong KK, Phillips CL, Liu PY, Knuiman MW, Grunstein RR. Is sleep apnea an independent risk factor for prevalent and incident diabetes in the Busselton Health Study? J Clin Sleep Med. 2009;5(1):15–20.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Rajan P, Greenberg H. Obstructive sleep apnea as a risk factor for type 2 diabetes mellitus. Nat Sci Sleep. 2015;7:113–25. https://doi.org/10.2147/NSS.S90835.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Qie R, Zhang D, Liu L, Ren Y, Zhao Y, Liu D, 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. 2019;12:455–64. https://doi.org/10.1111/1753-0407.13017.

    Article  Google Scholar 

  41. Elmasry A, Janson C, Lindberg E, Gislason T, Tageldin MA, Boman G. The role of habitual snoring and obesity in the development of diabetes: a 10-year follow-up study in a male population. J Intern Med. 2000;248(1):13–20. https://doi.org/10.1046/j.1365-2796.2000.00683.x.

    Article  CAS  PubMed  Google Scholar 

  42. Al-Delaimy WK, Manson JE, Willett WC, Stampfer MJ, Hu FB. Snoring as a risk factor for type II diabetes mellitus: a prospective study. Am J Epidemiol. 2002;155(5):387–93. https://doi.org/10.1093/aje/155.5.387.

    Article  PubMed  Google Scholar 

  43. Koren D, O'Sullivan KL, Mokhlesi B. Metabolic and glycemic sequelae of sleep disturbances in children and adults. Curr Diabetes Rep. 2015;15(1):562. https://doi.org/10.1007/s11892-014-0562-5.

    Article  CAS  Google Scholar 

  44. Pugliese G, Barrea L, Laudisio D, Salzano C, Aprano S, Colao A, et al. Sleep apnea, obesity, and disturbed glucose homeostasis: epidemiologic evidence, biologic insights, and therapeutic strategies. Curr Obes Rep. 2020;9(1):30–8. https://doi.org/10.1007/s13679-020-00369-y.

    Article  PubMed  Google Scholar 

  45. Viswanathan V, Ramakrishnan N, Sunaina S, Vigneswari A, Satyavani K. Subjects with type 2 diabetes may have obstructive sleep apnoea even at lower BMI values. Indian J Sleep Med. 2012;7(2):45–7.

    Article  Google Scholar 

  46. Reddy EV, Kadhiravan T, Mishra HK, Sreenivas V, Handa KK, Sinha S, et al. Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: a community-based study. Sleep Med. 2009;10(8):913–8. https://doi.org/10.1016/j.sleep.2008.08.011.

    Article  PubMed  Google Scholar 

  47. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–21. https://doi.org/10.1001/jama.284.23.3015.

    Article  CAS  PubMed  Google Scholar 

  48. Mok Y, Tan CW, Wong HS, How CH, Tan KL, Hsu PP. Obstructive sleep apnoea and Type 2 diabetes mellitus: are they connected? Singap Med J. 2017;58(4):179–83. https://doi.org/10.11622/smedj.2017027.

    Article  Google Scholar 

  49. Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62. https://doi.org/10.1371/journal.pmed.0010062.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, et al. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009;32(6):1017–9. https://doi.org/10.2337/dc08-1776.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Wang X, Greer J, Porter RR, Kaur K, Youngstedt SD. Short-term moderate sleep restriction decreases insulin sensitivity in young healthy adults. Sleep Health. 2016;2(1):63–8. https://doi.org/10.1016/j.sleh.2015.11.004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Khandelwal D, Dutta D, Chittawar S, Kalra S. Sleep disorders in type 2 diabetes. Indian J Endocrinol Metab. 2017;21(5):758–61. https://doi.org/10.4103/ijem.IJEM_156_17.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Mussa BM, Schauman M, Kumar V, Skaria S, Abusnana S. Personalized intervention to improve stress and sleep patterns for glycemic control and weight management in obese Emirati patients with type 2 diabetes: a randomized controlled clinical trial. Diabetes Metab Syndr Obes. 2019;12:991–9. https://doi.org/10.2147/DMSO.S201142.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Foster GD, Borradaile KE, Sanders MH, Millman R, Zammit G, Newman AB, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med. 2009;169(17):1619–26. https://doi.org/10.1001/archinternmed.2009.266.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Mesman RLS, Calleja F, Hendriks G, Morolli B, Misovic B, Devilee P, et al. The functional impact of variants of uncertain significance in BRCA2. Genet Med. 2019;21(2):293–302. https://doi.org/10.1038/s41436-018-0052-2.

    Article  CAS  PubMed  Google Scholar 

  56. Calik MW. Treatments for obstructive sleep apnea. Journal of clinical outcomes management. J Clin Outcomes Manag. 2016;23(4):181–92.

    PubMed  PubMed Central  Google Scholar 

  57. Stasche N. Selective indication for positive airway pressure (PAP) in sleep-related breathing disorders with obstruction. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2006;5:Doc06.

    PubMed  PubMed Central  Google Scholar 

  58. Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F, Kushida CA, et al. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med. 2014;10(2):215–27. https://doi.org/10.5664/jcsm.3460.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Morgenthaler TI, Aurora RN, Brown T, Zak R, Alessi C, Boehlecke B, et al. Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report. Sleep. 2008;31(1):141–7. https://doi.org/10.1093/sleep/31.1.141.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Hoffstein V. Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath 2007;11(1):1–22. https://doi.org/10.1007/s11325-006-0084-8, 1.

  61. Gagnadoux F, Fleury B, Vielle B, Petelle B, Meslier N, N'Guyen XL, et al. Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J. 2009;34(4):914–20. https://doi.org/10.1183/09031936.00148208.

    Article  CAS  PubMed  Google Scholar 

  62. Dieltjens M, Vanderveken O. Oral appliances in obstructive sleep apnea. Healthcare (Basel). 2019;7(4). https://doi.org/10.3390/healthcare7040141.

  63. Zaghi S, Holty JE, Certal V, Abdullatif J, Guilleminault C, Powell NB, et al. Maxillomandibular advancement for treatment of obstructive sleep apnea: a meta-analysis. JAMA Otolaryngol Head Neck Surg. 2016;142(1):58–66. https://doi.org/10.1001/jamaoto.2015.2678.

    Article  PubMed  Google Scholar 

  64. Remmers J, Charkhandeh S, Grosse J, Topor Z, Brant R, Santosham P, et al. Remotely controlled mandibular protrusion during sleep predicts therapeutic success with oral appliances in patients with obstructive sleep apnea. Sleep. 2013;36(10):1517–25,25A. https://doi.org/10.5665/sleep.3048.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Deane SA, Cistulli PA, Ng AT, Zeng B, Petocz P, Darendeliler MA. Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial. Sleep. 2009;32(5):648–53. https://doi.org/10.1093/sleep/32.5.648.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773–827. https://doi.org/10.5664/jcsm.4858.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Li HY, Lee LA, Hsin LJ, Fang TJ, Lin WN, Chen HC, et al. Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea. Biom J. 2019;42(2):84–92. https://doi.org/10.1016/j.bj.2019.02.002.

    Article  Google Scholar 

  68. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444(7121):840–6. https://doi.org/10.1038/nature05482.

    Article  CAS  PubMed  Google Scholar 

  69. Cizza G, de Jonge L, Piaggi P, Mattingly M, Zhao X, Lucassen E, et al. Neck circumference is a predictor of metabolic syndrome and obstructive sleep apnea in short-sleeping obese men and women. Metab Syndr Relat Disord. 2014;12(4):231–41. https://doi.org/10.1089/met.2013.0093.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Jehan S, Myers AK, Zizi F, Pandi-Perumal SR, Jean-Louis G, McFarlane SI. Obesity, obstructive sleep apnea and type 2 diabetes mellitus: epidemiology and pathophysiologic insights. Sleep Med Disord. 2018;2(3):52–8.

    PubMed  PubMed Central  Google Scholar 

  71. Doumit J, Prasad B. Sleep apnea in type 2 diabetes. Diabetes Spectr. 2016;29(1):14–9. https://doi.org/10.2337/diaspect.29.1.14.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Vgontzas AN, Papanicolaou DA, Bixler EO, Kales A, Tyson K, Chrousos GP. Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity. J Clin Endocrinol Metab. 1997;82(5):1313–6. https://doi.org/10.1210/jcem.82.5.3950.

    Article  CAS  PubMed  Google Scholar 

  73. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2005;365(9468):1415–28. https://doi.org/10.1016/S0140-6736(05)66378-7.

    Article  CAS  PubMed  Google Scholar 

  74. Xu S, Wan Y, Xu M, Ming J, Xing Y, An F, et al. The association between obstructive sleep apnea and metabolic syndrome: a systematic review and meta-analysis. BMC Pulm Med. 2015;15:105. https://doi.org/10.1186/s12890-015-0102-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Basoglu OK, Sarac F, Sarac S, Uluer H, Yilmaz C. Metabolic syndrome, insulin resistance, fibrinogen, homocysteine, leptin, and C-reactive protein in obese patients with obstructive sleep apnea syndrome. Ann Thorac Med. 2011;6(3):120–5. https://doi.org/10.4103/1817-1737.82440.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Soin D, Kumar PA, Chahal J, Chawla SPS, Kaur S, Garg R, et al. Evaluation of obstructive sleep apnea in metabolic syndrome. J Family Med Prim Care. 2019;8(5):1580–6. https://doi.org/10.4103/jfmpc.jfmpc_175_19.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Jun J, Polotsky VY. Metabolic consequences of sleep-disordered breathing. ILAR J. 2009;50(3):289–306. https://doi.org/10.1093/ilar.50.3.289.

    Article  CAS  PubMed  Google Scholar 

  78. SM TEaM. Obstructive sleep apnea and metabolic syndrome: alterations in glucose metabolism and inflammation. Proc Am Thorac Soc. 2008;5:207–17. https://doi.org/10.1513/pats.200708-139MG.

    Article  Google Scholar 

  79. Balkau B, Vol S, Loko S, Andriamboavonjy T, Lantieri O, Gusto G, et al. High baseline insulin levels associated with 6-year incident observed sleep apnea. Diabetes Care. 2010;33(5):1044–9. https://doi.org/10.2337/dc09-1901.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T. Progression and regression of sleep-disordered breathing with changes in weight: the sleep heart health study. Arch Intern Med. 2005;165(20):2408–13. https://doi.org/10.1001/archinte.165.20.2408.

    Article  PubMed  Google Scholar 

  81. Licinio J, Wong ML. Sequence and function in pharmacogenomics. Pharm J. 2003;3(3):123. https://doi.org/10.1038/sj.tpj.6500185.

    Article  CAS  Google Scholar 

  82. Tantucci C, Scionti L, Bottini P, Dottorini ML, Puxeddu E, Casucci G, et al. Influence of autonomic neuropathy of different severities on the hypercapnic drive to breathing in diabetic patients. Chest. 1997;112(1):145–53. https://doi.org/10.1378/chest.112.1.145.

    Article  CAS  PubMed  Google Scholar 

  83. Kent BD, Grote L, Ryan S, Pepin JL, Bonsignore MR, Tkacova R, et al. Diabetes mellitus prevalence and control in sleep-disordered breathing: the European Sleep Apnea Cohort (ESADA) study. Chest. 2014;146(4):982–90. https://doi.org/10.1378/chest.13-2403.

    Article  PubMed  Google Scholar 

  84. Papanas N, Steiropoulos P, Nena E, Tzouvelekis A, Maltezos E, Trakada G, et al. HbA1c is associated with severity of obstructive sleep apnea hypopnea syndrome in nondiabetic men. Vasc Health Risk Manag. 2009;5:751–6. https://doi.org/10.2147/vhrm.s7057.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Pillai AWG, Gunathilake W, Idris I. Control in patients with type 2 diabetes prior to continuous positive airway pressure treatment. Diabetes Technol Ther. 2011;13:945–9. https://doi.org/10.1089/dia.2011.0005.

    Article  PubMed  Google Scholar 

  86. Aronsohn RS, Whitmore H, Van Cauter E, Tasali E. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med. 2010;181(5):507–13. https://doi.org/10.1164/rccm.200909-1423OC.

    Article  PubMed  Google Scholar 

  87. Tsai YW, Kann NH, Tung TH, Chao YJ, Lin CJ, Chang KC, et al. Impact of subjective sleep quality on glycemic control in type 2 diabetes mellitus. Fam Pract. 2012;29(1):30–5. https://doi.org/10.1093/fampra/cmr041.

    Article  PubMed  Google Scholar 

  88. Tahrani AA. Obstructive sleep apnoea in diabetes: does it matter? Diab Vasc Dis Res. 2017;14(5):454–62. https://doi.org/10.1177/1479164117714397.

  89. Altaf QA, Dodson P, Ali A, Raymond NT, Wharton H, Fellows H, et al. Obstructive sleep apnea and retinopathy in patients with type 2 diabetes. A longitudinal study. Am J Respir Crit Care Med. 2017;196(7):892–900. https://doi.org/10.1164/rccm.201701-0175OC.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Mason RH, West SD, Kiire CA, Groves DC, Lipinski HJ, Jaycock A, et al. High prevalence of sleep disordered breathing in patients with diabetic macular edema. Retina. 2012;32(9):1791–8. https://doi.org/10.1097/IAE.0b013e318259568b.

    Article  PubMed  Google Scholar 

  91. Fujihara K, Kodama S, Horikawa C, Yoshizawa S, Sugawara A, Hirasawa R, et al. The relationship between diabetic neuropathy and sleep apnea syndrome: a meta-analysis. Sleep Disord. 2013;2013:150371. https://doi.org/10.1155/2013/150371.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Tahrani AA, Ali A, Raymond NT, Begum S, Dubb K, Altaf QA, et al. Obstructive sleep apnea and diabetic nephropathy: a cohort study. Diabetes Care. 2013;36(11):3718–25. https://doi.org/10.2337/dc13-0450.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  93. Seicean S, Strohl KP, Seicean A, Gibby C, Marwick TH. Sleep disordered breathing as a risk of cardiac events in subjects with diabetes mellitus and normal exercise echocardiographic findings. Am J Cardiol. 2013;111(8):1214–20. https://doi.org/10.1016/j.amjcard.2012.12.053.

    Article  PubMed  Google Scholar 

  94. Rivas M, Ratra A, Nugent K. Obstructive sleep apnea and its effects on cardiovascular diseases: a narrative review. Anatol J Cardiol. 2015;15(11):944–50. https://doi.org/10.5152/AnatolJCardiol.2015.6607.

    Article  PubMed  Google Scholar 

  95. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829–36. https://doi.org/10.1001/jama.283.14.1829.

    Article  CAS  PubMed  Google Scholar 

  96. Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med. 1997;157(15):1746–52.

    Article  CAS  PubMed  Google Scholar 

  97. Hla KM, Young T, Finn L, Peppard PE, Szklo-Coxe M, Stubbs M. Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin Sleep Cohort Study. Sleep. 2008;31(6):795–800. https://doi.org/10.1093/sleep/31.6.795.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–41. https://doi.org/10.1056/NEJMoa043104.

    Article  CAS  PubMed  Google Scholar 

  99. Tung P, Levitzky YS, Wang R, Weng J, Quan SF, Gottlieb DJ, et al. Obstructive and central sleep apnea and the risk of incident atrial fibrillation in a community cohort of men and women. J Am Heart Assoc. 2017;6(7). https://doi.org/10.1161/JAHA.116.004500.

  100. Kylintireas I, Craig S, Nethononda R, Kohler M, Francis J, Choudhury R, Stradling J, Neubauer S. Atherosclerosis and arterial stiffness in obstructive sleep apnea--a cardiovascular magnetic resonance study. Atherosclerosis. 2012;222(2):483–489. https://doi.org/10.1016/j.atherosclerosis.2012.03.036.

  101. Kawano Y, Tamura A, Kadota J. Association between the severity of obstructive sleep apnea and the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol. Metabolism. 2012;61(2):186–92. https://doi.org/10.1016/j.metabol.2011.06.004.

    Article  CAS  PubMed  Google Scholar 

  102. Doonan RJ, Scheffler P, Lalli M, Kimoff RJ, Petridou ET, Daskalopoulos ME, et al. Increased arterial stiffness in obstructive sleep apnea: a systematic review. Hypertens Res. 2011;34(1):23–32. https://doi.org/10.1038/hr.2010.200.

    Article  PubMed  Google Scholar 

  103. Selim BJ, Koo BB, Qin L, Jeon S, Won C, Redeker NS, et al. The association between nocturnal cardiac arrhythmias and sleep-disordered breathing: the DREAM study. J Clin Sleep Med. 2016;12(6):829–37. https://doi.org/10.5664/jcsm.5880.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Banno K, Ramsey C, Walld R, Kryger MH. Expenditure on health care in obese women with and without sleep apnea. Sleep. 2009;32(2):247–52. https://doi.org/10.1093/sleep/32.2.247.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Seetho IWWJ. Screening for obstructive sleep apnoea in obesity and diabetes – potential for future approaches. Eur J Clin Investig. 2013;43(6):640–55.

    Article  Google Scholar 

  106. Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163–70.

    CAS  PubMed  Google Scholar 

  107. Edmonds PJ, Gunasekaran K, Edmonds LC. Neck grasp predicts obstructive sleep apnea in type 2 diabetes mellitus. Sleep Disord. 2019;2019:3184382. https://doi.org/10.1155/2019/3184382.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  108. Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263–76.

    Article  PubMed  Google Scholar 

  109. Foroughi M, Razavi H, Malekmohammad M, Adimi Naghan P, Jamaati H. Diagnosis of obstructive sleep apnea syndrome in adults: a brief review of existing data for practice in Iran. Tanaffos. 2016;15(2):70–4.

    PubMed  PubMed Central  Google Scholar 

  110. Weinstock TG, Wang X, Rueschman M, Ismail-Beigi F, Aylor J, Babineau DC, et al. A controlled trial of CPAP therapy on metabolic control in individuals with impaired glucose tolerance and sleep apnea. Sleep. 2012;35(5):617–25B. https://doi.org/10.5665/sleep.1816.

  111. Pamidi S, Wroblewski K, Stepien M, Sharif-Sidi K, Kilkus J, Whitmore H, et al. Eight hours of nightly continuous positive airway pressure treatment of obstructive sleep apnea improves glucose metabolism in patients with Prediabetes. A randomized controlled trial. Am J Respir Crit Care Med. 2015;192(1):96–105. https://doi.org/10.1164/rccm.201408-1564OC.

  112. West SD, Nicoll DJ, Wallace TM, Matthews DR, Stradling JR. Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and type 2 diabetes. Thorax. 2007;62(11):969–74. https://doi.org/10.1136/thx.2006.074351.

  113. Myhill PC, Davis WA, Peters KE, Chubb SA, Hillman D, Davis TM. Effect of continuous positive airway pressure therapy on cardiovascular risk factors in patients with type 2 diabetes and obstructive sleep apnea. J Clin Endocrinol Metab. 2012;97(11):4212–8. https://doi.org/10.1210/jc.2012-2107.

  114. Shaw JE, Punjabi NM, Naughton MT, Willes L, Bergenstal RM, Cistulli PA, 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(4):486–92. https://doi.org/10.1164/rccm.201511-2260OC.

  115. Martinez-Ceron E, Barquiel B, Bezos AM, Casitas R, Galera R, Garcia-Benito C, et al. Effect of continuous positive airway pressure on glycemic control in patients with obstructive sleep apnea and type 2 diabetes. A randomized clinical trial. Am J Respir Crit Care Med. 2016;194(4):476–85. https://doi.org/10.1164/rccm.201510-1942OC.

  116. Mokhlesi B, Grimaldi D, Beccuti G, Abraham V, Whitmore H, Delebecque F, et al. Effect of one week of 8-hour nightly continuous positive airway pressure treatment of obstructive sleep apnea on glycemic control in type 2 diabetes: a proof-of-concept study. Am J Respir Crit Care Med. 2016;194(4):516–9. https://doi.org/10.1164/rccm.201602-0396LE.

  117. Morariu EM, Chasens ER, Strollo PJ Jr, Korytkowski M. Effect of continuous positive airway pressure (CPAP) on glycemic control and variability in type 2 diabetes. Sleep Breath. 2017;21(1):145–7. https://doi.org/10.1007/s11325-016-1388-y.

  118. Lam JCM, Lai AYK, Tam TCC, Yuen MMA, Lam KSL, Ip MSM. CPAP therapy for patients with sleep apnea and type 2 diabetes mellitus improves control of blood pressure. Sleep Breath. 2017;21(2):377–86. https://doi.org/10.1007/s11325-016-1428-7.

  119. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63. https://doi.org/10.1016/S0140-6736(03)15268-3.

    Article  Google Scholar 

  120. Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S, et al. RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020. Indian J Endocrinol Metab. 2020;24(1):1–122. https://doi.org/10.4103/ijem.IJEM_225_20.

    Article  PubMed  PubMed Central  Google Scholar 

  121. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an Ac clinical practice guideline. J Clin Sleep Med. 2017;13(3):479–504. https://doi.org/10.5664/jcsm.6506.

    Article  PubMed  PubMed Central  Google Scholar 

  122. Littner MR, Kushida C, Wise M, Davila DG, Morgenthaler T, Lee-Chiong T, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep. 2005;28(1):113–21. https://doi.org/10.1093/sleep/28.1.113.

    Article  PubMed  Google Scholar 

  123. Levendowski DJ, Zack N, Rao S, Wong K, Gendreau M, Kranzler J, et al. Assessment of the test-retest reliability of laboratory polysomnography. Sleep Breath. 2009;13(2):163–7. https://doi.org/10.1007/s11325-008-0214-6.

    Article  PubMed  Google Scholar 

  124. Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007;3(7):737–47.

    Article  PubMed  Google Scholar 

  125. El Shayeb M, Topfer LA, Stafinski T, Pawluk L, Menon D. Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ. 2014;186(1):E25–51. https://doi.org/10.1503/cmaj.130952.

    Article  PubMed  PubMed Central  Google Scholar 

  126. Calleja JM, Esnaola S, Rubio R, Duran J. Comparison of a cardiorespiratory device versus polysomnography for diagnosis of sleep apnoea. Eur Respir J. 2002;20(6):1505–10. https://doi.org/10.1183/09031936.02.00297402.

    Article  CAS  PubMed  Google Scholar 

  127. Kingshott RN, Gahleitner F, Elphick HE, Gringras P, Farquhar M, Pickering RM, et al. Cardiorespiratory sleep studies at home: experience in research and clinical cohorts. Arch Dis Child. 2019;104(5):476–81. https://doi.org/10.1136/archdischild-2018-315676.

    Article  PubMed  Google Scholar 

  128. Tietjens JR, Claman D, Kezirian EJ, De Marco T, Mirzayan A, Sadroonri B, et al. Obstructive sleep apnea in cardiovascular disease: a review of the literature and proposed multidisciplinary clinical management strategy. J Am Heart Assoc. 2019;8(1):e010440. https://doi.org/10.1161/JAHA.118.010440.

    Article  CAS  PubMed  Google Scholar 

  129. Ashrafian H, Toma T, Rowland SP, Harling L, Tan A, Efthimiou E, et al. Bariatric surgery or non-surgical weight loss for obstructive sleep apnoea? A systematic review and comparison of meta-analyses. Obes Surg. 2015;25(7):1239–50. https://doi.org/10.1007/s11695-014-1533-2.

    Article  PubMed  Google Scholar 

  130. Kuna ST, Reboussin DM, Borradaile KE, Sanders MH, Millman RP, Zammit G, et al. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep. 2013;36(5):641–9A. https://doi.org/10.5665/sleep.2618.

    Article  PubMed  PubMed Central  Google Scholar 

  131. Gaisl T, Haile SR, Thiel S, Osswald M, Kohler M. Efficacy of pharmacotherapy for OSA in adults: a systematic review and network meta-analysis. Sleep Med Rev. 2019;46:74–86. https://doi.org/10.1016/j.smrv.2019.04.009.

    Article  PubMed  Google Scholar 

  132. Ravesloot MJL, White D, Heinzer R, Oksenberg A, Pepin JL. Efficacy of the new generation of devices for positional therapy for patients with positional obstructive sleep apnea: a systematic review of the literature and meta-analysis. J Clin Sleep Med. 2017;13(6):813–24. https://doi.org/10.5664/jcsm.6622.

    Article  PubMed  PubMed Central  Google Scholar 

  133. Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, et al. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol. 2017;69(7):841–58. https://doi.org/10.1016/j.jacc.2016.11.069.

    Article  PubMed  PubMed Central  Google Scholar 

  134. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071–8.

    PubMed  PubMed Central  Google Scholar 

  135. Rabelo Guimaraes Mde L, Hermont AP. Sleep apnea and occupational accidents: are oral appliances the solution? Indian J Occup Environ Med. 2014;18(2):39–47. https://doi.org/10.4103/0019-5278.146887.

    Article  PubMed  Google Scholar 

  136. Sutherland K, Deane SA, Chan AS, Schwab RJ, Ng AT, Darendeliler MA, et al. Comparative effects of two oral appliances on upper airway structure in obstructive sleep apnea. Sleep. 2011;34(4):469–77. https://doi.org/10.1093/sleep/34.4.469.

  137. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):576–84. https://doi.org/10.1542/peds.2012-1671.

Download references

Acknowledgments

The preparation of this article was supported by ResMed India Pvt. Ltd. Priya Ganpathy, MPharm CMPP, provided medical writing assistance and Sangita Patil, PhD CMPP (SIRO Clinpharm Pvt. Ltd), provided additional editorial support. Manasi Date, PhD (SIRO Clinpharm Pvt. Ltd), provided support with literature search and data extraction.

Authorship contributions

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author information

Authors and Affiliations

  1. M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), No. 4, West MadaChruch Road, Royapuram, Chennai, Tamil Nadu, 600013, India

    Vijay Viswanathan

  2. Nithra Institute of Sleep Sciences and Department of Critical Care and Sleep Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India

    Nagarajan Ramakrishnan

  3. Dia Care-Diabetes and Hormone Centre, Ahmedabad, Gujarat, India

    Banshi Saboo

  4. Aegle Clinic Diabetes Care and Ruby Hall Clinic, Pune, Maharashtra, India

    Sanjay Agarwal

Authors
  1. Vijay Viswanathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nagarajan Ramakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Banshi Saboo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sanjay Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vijay Viswanathan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Extended working group: Dr Anuj Maheshwari, Dr. B.M. Makkar, Dr Bikask Bhattacharjee, Dr C R Anand Moses, Dr C H Vasanth Kumar, Dr J K Sharma, Dr L Srinivas Murthy, Dr Pratap Jethwani, Dr Rajeev Chawla, Dr Ravindra Mehta, Dr Sanjay Reddy, Dr Shalini Jaggi, Dr Sudhir Bhandari, Dr Sujoy Ghosh, Dr Sunil Gupta, Dr Suresh Ramasubban, Dr Vijay Panikar

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Viswanathan, V., Ramakrishnan, N., Saboo, B. et al. RSSDI clinical practice recommendations for screening, diagnosis, and treatment in type 2 diabetes mellitus with obstructive sleep apnea. Int J Diabetes Dev Ctries 41, 4–21 (2021). https://doi.org/10.1007/s13410-020-00909-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13410-020-00909-1

Keywords

Search

Navigation