Sleep-disordered breathing, type 2 diabetes and the metabolic syndrome
Abstract
Sleep-disordered breathing (SDB) encompasses a spectrum of conditions that can lead to altered sleep homeostasis. In particular, obstructive sleep apnoea (OSA) is the most common form of SDB and is associated with adverse cardiometabolic manifestations including hypertension, metabolic syndrome and type 2 diabetes, ultimately increasing the risk of cardiovascular disease. The pathophysiological basis of these associations may relate to repeated intermittent hypoxia and fragmented sleep episodes that characterize OSA which drive further mechanisms with adverse metabolic and cardiovascular consequences. The associations of OSA with type 2 diabetes and the metabolic syndrome have been described in studies ranging from epidemiological and observational studies to controlled trials investigating the effects of OSA therapy with continuous positive airway pressure (CPAP). In recent years, there have been rising prevalence rates of diabetes and obesity worldwide. Given the established links between SDB (in particular OSA) with both conditions, understanding the potential influence of OSA on the components of the metabolic syndrome and diabetes and the underlying mechanisms by which such interactions may contribute to metabolic dysregulation are important in order to effectively and holistically manage patients with SDB, type 2 diabetes or the metabolic syndrome. In this article, we review the literature describing the associations, the possible underlying pathophysiological mechanisms linking these conditions and the effects of interventions including CPAP treatment and weight loss.
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Upper airway obstruction caused directly by obesity results in development of sleep disordered breathing, which exists on a spectrum, from snoring with increased upper airways resistance, to obstructive sleep apnoea and obesity hypoventilation syndrome.
“Upper airway obstruction caused directly by obesity results in development of sleep disordered breathing, which exists on a spectrum, from snoring with increased upper airways resistance, to obstructive sleep apnoea and obesity hypoventilation syndrome.102”
From Definition and diagnostic criteria of clinical obesity (2025) · cites this paper as [102]
Recurrent hypoxia and associated activation of the sympathetic nervous system and other stress responses can contribute to higher rates of hypertension, metabolic syndrome, and type 2 diabetes in people with obesity and sleep disordered breathing.
“Recurrent hypoxia and associated activation of the sympathetic nervous system and other stress responses can contribute to higher rates of hypertension, metabolic syndrome, and type 2 diabetes in people with obesity and sleep disordered breathing.102”
From Definition and diagnostic criteria of clinical obesity (2025) · cites this paper as [102]
Cites
Increased Prevalence of Sleep-Disordered Breathing in Adults
Peppard, P. E., Young, T., Barnet, J. H., Palta, M., Hagen, E. W., & Hla, K. M. (2013) · American Journal of Epidemiology · doi:10.1093/aje/kws342 · Cited by 4,618 · see citing works
Sympathetic neural mechanisms in obstructive sleep apnea.
Somers, V. K., Dyken, M. E., Clary, M. P., & Abboud, F. M. (1995) · Journal of Clinical Investigation · doi:10.1172/jci118235 · Cited by 2,527 · see citing works
Longitudinal Study of Moderate Weight Change and Sleep-Disordered Breathing
Peppard, P. E. (2000) · JAMA · doi:10.1001/jama.284.23.3015 · Cited by 2,020 · see citing works
Comment on the provisional report from the WHO consultation
(1999) · Diabetic Medicine · doi:10.1046/j.1464-5491.1999.00059.x · Cited by 1,820 · see citing works
The metabolic consequences of sleep deprivation
Knutson, K. L., Spiegel, K., Penev, P., & Van Cauter, E. (2007) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2007.01.002 · Cited by 1,365 · see citing works
Obstructive Sleep Apnea Is Independently Associated with Insulin Resistance
Ip, M. S. M., Lam, B., Ng, M. M. T., Lam, W. K., Tsang, K. W. T., & Lam, K. S. L. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.165.5.2103001 · Cited by 1,300 · see citing works
Gillies, C. L., Abrams, K. R., Lambert, P. C., Cooper, N. J., Sutton, A. J., Hsu, R. T., & Khunti, K. (2007) · BMJ · doi:10.1136/bmj.39063.689375.55 · Cited by 1,171 · see citing works
Obstructive sleep apnoea syndrome – an oxidative stress disorder
Lavie, L. (2003) · Sleep Medicine Reviews · doi:10.1053/smrv.2002.0261 · Cited by 993 · cited 1× · see citing works
“Hypoxia-inducible factor-1 is upregulated in many tissues during hypoxia and modulate the expression of proteins that mediate adaptive responses to hypoxia, some of which may influence glucose metabolism.(48,76,63) Additionally, reactive oxygen species formation may have an important role in activating inflammatory re…”
BackgroundObesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches
Schwartz, A. R., Patil, S. P., Laffan, A. M., Polotsky, V., Schneider, H., & Smith, P. L. (2008) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200708-137mg · Cited by 730 · cited 3× · see citing works
“The mechanisms causing upper airway obstruction in obesity are only partly understood.(12) Suggested mechanisms include adiposity in the neck leading to increased neck circumference, with pharyngeal airway narrowing and enlargement of tissue in the upper airways such as the lateral pharyngeal wall and posterior tongue.”
BackgroundObstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes
Foster, G. D., Sanders, M. H., Millman, R., Zammit, G., Borradaile, K. E., Newman, A. B., Wadden, T. A., Kelley, D., Wing, R. R., Pi Sunyer, F. X., et al. (2009) · Diabetes Care · doi:10.2337/dc08-1776 · Cited by 600 · see citing works
CPAP, Weight Loss, or Both for Obstructive Sleep Apnea
Chirinos, J. A., Gurubhagavatula, I., Teff, K., Rader, D. J., Wadden, T. A., Townsend, R., Foster, G. D., Maislin, G., Saif, H., Broderick, P., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1306187 · Cited by 523 · see citing works
Babu, A. R., Herdegen, J., Fogelfeld, L., Shott, S., & Mazzone, T. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.4.447 · Cited by 453 · cited 1× · see citing works
“, there were lower fasting and postprandial glucose levels following 3 months of CPAP, with improved glycaemic control in patients with HbA1c > 7%.(122) Nevertheless, these studies were limited by an absence of a placebo treatment group.”
BackgroundObstructive Sleep Apnea and Type 2 Diabetes
Tasali, E., Mokhlesi, B., & Van Cauter, E. (2008) · Chest · doi:10.1378/chest.07-0828 · Cited by 371 · see citing works
Obstructive Sleep Apnea and Metabolic Syndrome: Alterations in Glucose Metabolism and Inflammation
Tasali, E., & Ip, M. S. M. (2008) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200708-139mg · Cited by 365 · see citing works
Effects of acute intermittent hypoxia on glucose metabolism in awake healthy volunteers.
Louis, M., & Punjabi, N. M. (2009) · Journal of Applied Physiology · doi:10.1152/japplphysiol.91523.2008 · Cited by 342 · see citing works
Role of sleep duration in the regulation of glucose metabolism and appetite
Morselli, L., Leproult, R., Balbo, M., & Spiegel, K. (2010) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2010.07.005 · Cited by 283 · cited 2× · see citing works
“Shortened sleep duration from fragmented sleep may be associated with altered glucose regulation and insulin resistance.(52,87) Short sleep duration is associated with impaired glucose regulation and an increased prevalence of diabetes.”
BackgroundVeasey, S. C., Guilleminault, C., Strohl, K. P., Sanders, M. H., Ballard, R. D., & Magalang, U. J. (2006) · SLEEP · doi:10.1093/sleep/29.8.1036 · Cited by 217 · see citing works
Weinstock, T. G., Wang, X., Rueschman, M., Ismail-Beigi, F., Aylor, J., Babineau, D. C., Mehra, R., & Redline, S. (2012) · Sleep · doi:10.5665/sleep.1816 · Cited by 181 · see citing works
Lam, J. C. M., Lam, B., Yao, T. J., Lai, A. Y. K., Ooi, C. G., Tam, S., Lam, K. S. L., & Ip, M. S. M. (2010) · European Respiratory Journal · doi:10.1183/09031936.00047709 · Cited by 170 · see citing works
Meston, N., Davies, R. J. O., Mullins, R., Jenkinson, C., Wass, J. A. H., & Stradling, J. R. (2003) · Journal of Internal Medicine · doi:10.1046/j.1365-2796.2003.01212.x · Cited by 163 · see citing works
Kajaste, S., Brander, P. E., Telakivi, T., Partinen, M., & Mustajoki, P. (2004) · Sleep Medicine · doi:10.1016/j.sleep.2003.07.007 · Cited by 151 · see citing works
Phillips, C. L., Yee, B. J., Marshall, N. S., Liu, P. Y., Sullivan, D. R., & Grunstein, R. R. (2011) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201102-0316oc · Cited by 145 · see citing works
Neuroendocrine alterations in obese patients with sleep apnea syndrome
Lanfranco, F., Motta, G., Minetto, M. A., Baldi, M., Balbo, M., Ghigo, E., Arvat, E., & Maccario, M. (2010) · International Journal of Endocrinology · doi:10.1155/2010/474518 · Cited by 78 · see citing works
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Definition and diagnostic criteria of clinical obesity
Rubino, F., Cummings, D. E., Eckel, R. H., Cohen, R. V., Wilding, J. P. H., Brown, W. A., Stanford, F. C., Batterham, R. L., Farooqi, I. S., Farpour-Lambert, N. J., et al. (2025) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(24)00316-4 · Cited by 1,811 · see citing works
Self-citationBubu, O. M., Andrade, A. G., Umasabor-Bubu, O. Q., Hogan, M. M., Turner, A. D., de Leon, M. J., Ogedegbe, G., Ayappa, I., Jean-Louis G, G., Jackson, M. L., et al. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2019.101250 · Cited by 389 · see citing works
- Authors
- Seetho, I. W., & Wilding, J. P.
- Affiliations
- University of Liverpool (GB)
- Corresponding author
- Wilding, John PH
- ORCID
- Wilding, John PH
- Venue
- Chronic Respiratory Disease
- Publisher
- SAGE Publications
- Published
- 2014-10-03
- Volume
- 11
- Issue
- 4
- Pages
- 257-275
- ISSN
- 1479-9723 (ISSN-L)
- 1479-9731
- OpenAlex
- W2123973341
- Cited by
- 57
- References
- 23
- Citations by year
- 2025: 5 · 2024: 1 · 2023: 8 · 2022: 5 · 2021: 3 · 2020: 5 · 2019: 9 · 2018: 5 · 2017: 3 · 2016: 4 · 2015: 7 · 2014: 2
- FWCI
- 0.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Chronic Respiratory Disease (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Liverpool
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- sleep-disordered breathing, obstructive sleep apnea, type 2 diabetes, metabolic syndrome, intermittent hypoxia, sleep fragmentation, cardiometabolic risk, cardiovascular risk, continuous positive airway pressure, weight loss, obesity
- MeSH terms
- Diabetes Mellitus, Humans, Hypertension, Hypothalamo-Hypophyseal System, Inflammation, Insulin Resistance, Obesity, Pituitary-Adrenal System, Weight Loss, Oxidative Stress, Sleep Apnea, Obstructive, Metabolic Syndrome, Continuous Positive Airway Pressure, Dyslipidemias, Adipokines
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