4.11.0.0 Ob­struc­tive Sleep Apnea

Age-‍ad­just­ed rates of ob­struc­tive sleep apnea, a risk fac­tor for car­dio­vas­cu­lar dis­ease, are significant­ly high­er (4- to 10-fold) with obe­si­ty, es­pe­cially with cen­tral obe­si­ty (75). The preva­lence of ob­struc­tive sleep apnea in the pop­u­la­tion with type 2 di­a­betes may be as high as 23%, and the preva­lence of any sleep­-dis­or­dered breath­ing may be as high as 58% (76,77). In obese par­tic­i­pants en­rolled in the Ac­tion for Health in Di­a­betes (Look AHEAD) trial, it ex­ceed­ed 80% (78). Pa­tients with symp­toms sug­ges­tive of ob­struc­tive sleep apnea (e.g., ex­ces­sive day­time sleepi­ness, snor­ing, wit­nessed apnea) should be con­sid­ered for screen­ing (79). Sleep apnea treat­ment (lifestyle modification, con­tin­u­ous pos­i­tive air­way pres­sure, oral ap­pli­ances, and surgery) significant­ly im­proves qual­i­ty of life and blood pres­sure con­trol. The ev­i­dence for a treat­ment ef­fect on glycemic con­trol is mixed (80).