Sleep Apnea Treatment with CPAP Helps in Prediabetes, Reduces Heart Problems

With Sushmita Pamidi, MD, and Elena Christofides, MD, FACE

If you have prediabetes and a sleep disorder known as obstructive sleep apnea (OSA), treating this sleep problem aggressively may help you not only sleep better but have improved heart health,1 according to data presented at American Thoracic Society (ATS) 2018 annual meeting in San Diego, California.

The usual treatment, called CPAP, for constant positive airway pressure, uses room air to keep your airway open as you sleep, delivering it through a mask that fits over your nose and mouth while you sleep. The system works by pushing air into the back of the throat to prevent the muscles in the throat to collapse during sleep, hampering breathing. The CPAP system keeps the air flowing so breathing continues uninterrupted in people diagnosed with sleep apnea.

People with prediabetes are at increased risk for obstructive sleep apnea.

Sleep apnea occurs when breathing stops and starts during sleep, and is most often diagnosed because of loud snoring, difficulty staying asleep (insomnia), daytime irritability, or a sense of lingering tiredness upon waking from a night’s sleep.2 This disorder appears to increase the risk of high blood pressure, heart problems, and diabetes and is also commonly diagnosed in people with obesity.3

Obstructive Sleep Apnea is Critical in People with Prediabetes

To see if the treatment helped not only the sleep disorder but also lessened the risk for heart problems, the researchers compared people with prediabetes (a higher than normal blood glucose, but not high enough to be termed diabetes) and OSA (apnea) who wore the CPAP all night for 14 days with a similar group of people who did not receive any treatment for their sleep apnea.1

In a randomized, placebo-controlled study, the researchers evaluated how well the treatment helped to reduce the participants' resting heart rate.1 A higher resting heart rate is linked with an increased risk of getting heart disease and dying, says lead author Sushmita Pamidi, MD, assistant professor of medicine at McGill University in Montreal, Canada along with colleagues from the University of Chicago in Illinois.

The results? "We found that all night CPAP treatment for sleep apnea improves the 24-hour resting heart rate in patients with prediabetes," Dr. Pamidi tells EndocrineWeb.

Average daytime resting heart rates were much lower in those who were treated versus those not treated with CPAP.1 The biggest differences between groups occurred during the second week of the study, according to the researchers. We found similar heart rate lowering effects during the night as during the day in those who used the CPAP system,1 according to Dr. Pamidi. The observed heart rate reduction was similar to the effect found when people take the medications known as beta blockers, prescribed to reduce blood pressure and protect the heart from abnormal rhythms.3

Link Between Prediabetes and Heart Disease Related to Sleep Problems

Dr. Pamidi explains that patients with prediabetes, just as those who have been diagnosed with diabetes, are at a higher risk for cardiovascular disease.2 And individuals with prediabetes often have sleep apnea. Resting heart rate predicts which people have a higher risk of death, whether they have heart disease or not, Dr. Pamidi says.

By lowering the resting heart rate, with CPAP, there may be a potential reduction in heart disease risk,1 says Dr. Pamidi and her colleagues. So it would help not only their sleep disorder but would improve their heart health. However, she says, "it's still too early to say that definitively."

Patients often balk at using CPAP, which requires wearing a mask to sleep at night. So, Dr. Pamidi is hopeful that if patients know about the potential benefits of CPAP to protect their heart, it ''may be an extra incentive for them to use the CPAP all night." She finds that some patients put CPAP on when they go to bed, then remove it during the night, which is not recommended if they want the full benefit of the treatment.

In the study,1 the 39 patients were 45 years old or older, overweight or obese, and had been diagnosed with both prediabetes and sleep apnea. None of the participants had ever used CPAP before.

Accepting CPAP Treatment is a Must for People with Prediabetes  

The study results are ''obvious and expected," says Elena Christofides, MD, FACE, an endocrinologist in private practice in Columbus, Ohio who reviewed the findings for EndocrineWeb.

Obstructive sleep apnea is a serious condition. If sleep apnea goes untreated, Dr. Christofides says, it can lead to pressure on the adrenal glands and increase levels of cortisol, the ''stress hormone." In turn, elevated cortisol can lead to a higher heart rate, and so as she says: "High heart rate equals high cortisol activity, lower heart rate means lower cortisol activity."

She finds that her patients with sleep apnea are often resistant to using the CPAP so her approach is “tough love", she admits, so "I explain to them that without adequate oxygen at night, they lose brain cells, progress quickly to dementia, and are at greater risk for a heart attack, stroke and early death. Basically, I have to scare them into accepting treatment because they won't [use it] otherwise."

When to Suspect Apnea

Common symptoms of sleep apnea are loud snoring, gasping or stopping breathing during sleep, morning headaches, memory loss, irritability and daytime sleepiness.More often than not, the snorer is called out by the bed partner who is the first to identify the problem because the snoring makes it too hard for the good sleeper to get a restful night’s sleep.

If you suspect you have OSA, or you think your bed partner does, it's important to bring it up with your doctor and be tested, and follow the prescribed treatment. 

More About CPAP System

The CPAP machine system is available in several models, but all include a mask with a hose attached to the machine kept by the bedside to deliver a constant stream of room temperature air during sleep. When prescribed to treat OSA, treatment is usually arranged through a company that specializes in the providing the equipment.

If you are diagnosed with sleep apnea, your doctor is likely to suggest CPAP as the first and best treatment. Other options may include surgery, weight management, and other lifestyle changes.4

Dr. Pamidi and Dr. Christofides have no relevant financial conflicts. 

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