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Cited by 504Obstructive Sleep Apnea ResearchSleep and related disordersNeuroscience of respiration and sleep

Diabetes and Sleep Disturbances

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Resnick, Helaine E., Redline, Susan, Shahar, Eyal, Gilpin, Adele, Newman, Anne, Walter, Robert, Ewy, Gordon A., Howard, Barbara V. +1 more·2003·Diabetes Care
DOI 10.2337/diacare.26.3.702
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Abstract

OBJECTIVE—To test the hypothesis that diabetes is independently associated with sleep-disordered breathing (SDB), and in particular that diabetes is associated with sleep abnormalities of a central, rather than obstructive, nature. RESEARCH DESIGN AND METHODS—Using baseline data from the Sleep Heart Health Study (SHHS), we related diabetes to 1) the respiratory disturbance index (RDI; number of apneas plus hypopneas per h of sleep); 2) obstructive apnea index (OAI; ≥3 apneas/h of sleep associated with obstruction of the upper airway); 3) percent of sleep time < 90% O2 saturation; 4) central apnea index (CAI; ≥3 apneas [without respiratory effort]/h sleep); 5) occurrence of a periodic breathing (Cheyne Stokes) pattern; and 6) sleep stages. Initial analyses excluding persons with prevalent cardiovascular disease (CVD) were repeated including these participants. RESULTS—Of the 5,874 participants included in this report, 692 (11.8%) reported diabetes or were taking oral hypoglycemic medications or insulin and 1,002 had prevalent CVD. Among the 4,872 persons without CVD, 470 (9.6%) had diabetes. Diabetic participants had worse CVD risk factor profiles than their nondiabetic counterparts, including higher BMI, waist and neck circumferences, triglycerides, higher prevalence of hypertension, and lower HDL cholesterol (P < 0.001, all). Descriptive analyses indicated differences between diabetic and nondiabetic participants in RDI, sleep stages, sleep time <90% O2 saturation, CAI, and periodic breathing (P < 0.05, all). However, multivariable regression analyses that adjusted for age, sex, BMI, race, and neck circumference eliminated these differences for all sleep measures except percent time in rapid eye movement (REM) sleep (19.0% among diabetic vs. 20.1% among nondiabetic subjects, P < 0.001) and prevalence of periodic breathing (odds ratio [OR] for diabetic subjects versus nondiabetic subjects 1.80, 95% CI 1.02–3.15). Additionally, adjusted analyses showed diabetes was associated with nonstatistically significant elevations in the odds of an increased central breathing index (OR 1.42, 95% CI 0.80–2.55). Addition to the analysis of the 1,002 persons with prevalent CVD (including 222 people with diabetes) did not materially change these results. CONCLUSIONS—These data suggest that diabetes is associated with periodic breathing, a respiratory abnormality associated with abnormalities in the central control of ventilation. Some sleep disturbances may result from diabetes through the deleterious effects of diabetes on central control of respiration. The high prevalence of SDB in diabetes, although largely explained by obesity and other confounders, suggests the presence of a potentially treatable risk factor for CVD in the diabetic population.

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  • In patients with type 2 diabetes, the prevalence of obstructive sleep apnea assessed by full-night polysomnography ranges from 58% to 86%.

    “In patients with type 2 diabetes, the prevalence of OSA assessed with full night polysomnography, i.e., the gold standard method for the diagnosis of OSA, ranged from 58% to 86% [2, 45, 52, 134].”

    From Sleep and metabolic function (2012) · cites this paper as [134]

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Research works printed but not linked: 2

  1. Cowie CC, Harris MI: Physical and meta- bolic characteristics of persons with dia- betes. In Diabetes In America (2nd Edition). National Institute of Diabetes, Digestive and Kidney Diseases. National Institutes of Health, Bethesda, MD, 1995 (NIH publ. no. 95-1468)
  2. Imai Y, Abe K, Munakata M, Sakuma H, Hashimoto J, Imai K, Sekino H, Yoshinaga K: Circadian blood pressure variations under different pathophysiologic condi- tions (Review Article). J Hypertens Suppl 8:S125-S132, 1990

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Authors
Resnick, H. E., Redline, S., Shahar, E., Gilpin, A., Newman, A., Walter, R., Ewy, G. A., Howard, B. V., & Punjabi, N. M.
Affiliations
  • MedStar Health Research Institute (US)
  • Rainbow Babies & Children's Hospital (US)
  • University of Minnesota (US)
  • Johns Hopkins University (US)
  • University of Pittsburgh (US)
  • Boston University (US)
  • University of Arizona (US)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2003-03-01
Volume
26
Issue
3
Pages
702-709
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.26.3.702
OpenAlex
W2088456053
Cited by
504
References
46
Citations by year
2026: 8 · 2025: 15 · 2024: 18 · 2023: 22 · 2022: 20 · 2021: 24 · 2020: 18 · 2019: 19 · 2018: 24 · 2017: 26 · 2016: 27 · 2015: 35 · 2014: 27 · 2013: 30 · 2012: 33
FWCI
6.24
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5u01hl053940-05, 5u01hl053934-14)
  • National Heart, Lung, and Blood Institute (U01 HL 53940, U01HL053941, U01HL053938, U01 HL53934, U01HL053937, U01HL053931, U01HL064360, U01HL053916, U01HL063463, U01HL063429)
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
diabetes mellitus, sleep-disordered breathing, central sleep apnea, obstructive sleep apnea, Cheyne-Stokes respiration, REM sleep, sleep oxygen saturation, cardiovascular risk factors, Sleep Heart Health Study, insulin, cardiovascular disease, sleep stages, respiratory disturbance index, obstructive apnea index, central apnea index, neck circumference, body mass index
MeSH terms
Aged, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Risk Factors, Sleep Apnea Syndromes, Prevalence, Multivariate Analysis, Logistic Models, Sleep Apnea, Obstructive

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