The International Diabetes Federation (IDF) Task Force on Epidemiology and Prevention has warned that recent research demonstrates that type 2 diabetes and obstructive sleep apnea (OSA) are closely related, and that both disorders have significant implications on public health and on individuals. These were the conclusions of a meeting of diabetes and sleep experts who examined the impacts of untreated OSA, the most common form of sleep disordered breathing. The resulting IDF statement was released in a presentation at the American Diabetes Association (ADA) 68th Annual Scientific Sessions and in an article published in Diabetes Research and Clinical Practice1.

"While type 2 diabetes is recognized as a serious global epidemic, the severe health consequences of untreated sleep apnea, especially in people with diabetes, are not. Health policy makers and the general public must be made aware of the link between type 2 diabetes and sleep apnea so that we can begin to address the significant economic burden and debilitating health consequences to both individuals and the community," said Professor Paul Zimmet, Foundation Director of the International Diabetes Institute in Melbourne, Australia and co-chair of the IDF Task Force on Epidemiology and Prevention. "Today's statement is an urgent call to action to the medical community. It is imperative that we better understand the relationship between diabetes and sleep apnea through research and establish appropriate standards of care for managing diabetes and co-morbidities such as sleep apnea."

Recent studies show that OSA is common in people with diabetes: estimates suggest that up to 40% of people with OSA have diabetes2,3. However further research is needed in this area in order to strengthen the evidence base between diabetes and OSA.

Additionally, both conditions have tremendous economic implications. While the annual costs of diabetes alone amount to USD170 billion in the United States4, and to at least ID (International Dollars) 16 billion, 15 billion and 6 billions in Japan, China and India respectively5, he estimated annual medical costs of OSA are much harder to define.

Professor Sir George Alberti, co-chair of the IDF Task Force and former President of IDF said 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 CVD 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.

The IDF Task Force on Epidemiology and Prevention statement includes recommendations for screening, treatment and further research. While people with OSA should be routinely screened for metabolic disease and type 2 diabetes as screening tests are inexpensive and easy to conduct, people with diabetes should be screened for OSA particularly when they present classical symptoms such as witnessed apneas, heavy snoring or daytime sleepiness and poor workplace performance.

Recommendations for treatment of OSA include weight reduction in overweight and obese people, reduction in alcohol intake and CPAP treatment. Although further research is needed, the treatment of OSA may improve glycaemic control and will certainly benefit people as it improves their quality of life, blood pressure control and risk of cardiovascular disease.

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Notes

The International Diabetes Federation (IDF) is an umbrella organization of over 200 member associations in more than 160 countries, representing over 250 million people with diabetes, their families, and their healthcare providers. The mission of IDF is to promote diabetes care, prevention and a cure worldwide. Its main activities include education for people with diabetes and healthcare professionals, public awareness campaigns and the promotion and exchange of information. IDF is a non-governmental organization in official relations with WHO and associated to the United Nations' Department of Public Information. For more information, please visit idf/.

The meeting of diabetes and sleep experts was funded by the ResMed Foundation, a private charitable foundation whose primary mission is to promote research, as well as public and physician awareness about the importance of sleep and respiratory health throughout the world. The Foundation, founded in 2002, is a private charitable 501 (c) (3) foundation organized under United States Law. The Foundation promotes research for publication in appropriate peer-reviewed scientific and medical publications. It was not involved in the writing, review or approval of the IDF consensus statement. More information is available on resmedfoundation/.

About Obstructive Sleep Apnea:

Obstructive sleep apnea is the most common form of sleep-disordered breathing (SDB), which has been highlighted as a major public health problem on a level equivalent to that of tobacco smoking. Untreated SDB 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.

References 1 Shaw JE, Punjabi NM, Wilding JP, Alberti G, Zimmet PZ: Sleep-disordered breathing and type 2 diabetes, Diabetes Res Clinical Pract 81(1), 2008.

2 Meslier N, Gagnadoux F, Giraud P, Person C, Ouksel H, Urban T, Racineux JL: Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J22(1): 156-160, 2003.

3 Elmasry A, Lindberg E, Berne C, Janson C, Gislason T, Awad Tageldin M, Boman G: Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med 249(2): 153-161, 2001.

4 American Diabetes Association, website accessed 16/05/2008

5 Diabetes Atlas, third edition. International Diabetes Federation, 2006 Source: Anne Pierson
International Diabetes Federation