Chicken or the Egg? Diabetes or Obstructive Sleep Apnea

Here’s another study that strengthens the connections between the dots in my sleep-breathing paradigm. About 87% of obese type II diabetics were found to have undiagnosed obstructive sleep apnea. Most diabetes studies give the impression that having diabetes can lead to obstructive sleep apnea due to gradual weight gain, but what I propose is that having even very mild sleep-breathing problems can predispose to elevated glucose levels, insulin resistance, and weight gain. I talk about the specific mechanism  in my book, Sleep, Interrupted. What I want to emphasize is the fact that an underlying sleep-breathing condition is what can predispose you to obesity AND diabetes, not the other way around.

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2 thoughts on “Chicken or the Egg? Diabetes or Obstructive Sleep Apnea

  1. I agree with the Chicken or the Egg discussion. I am exactly the type of case you describe.

    I have a long history of allergies, asthma, and possibly childhood sleep apnea [1950’s, we didn’t know about sleep apnea then, but my pediatrician once joked that I must have been ‘born tired’]. As I got into middle age, I felt worse and worse and started gaining weight. I knew I didn’t have the best health habits [who does?], but the weight gain and fatigue seemed like more than should be expected. It took years for a primary care doctor to suspect sleep apnea. I just didn’t have any totally obvious symptoms or ‘numbers’ that were an obvious diagnosis of anything. All my indicators were mild, as you describe, but even though I seemed very high functioning, I never felt great.

    Once I got better control of the allergies AND started on a CPAP machine, everything turned around. I was also prediabetic (IFG) with metabolic syndrome.

    Over the past 2 years I have lost 70 lbs and everything has changed. I have worked with my allergist, sleep doctor, ENT doc [nasal turbinate surgery] and endocrinologist [diabetes clinic approach] in a positive feedback loop to make this happen. While my primary care doctor started me looking into sleep apnea, the ongoing follow-up was not the best and I had to take charge of the coordination.

    Many people I talk to tell me that when I stop ‘dieting’ at my target weight that I’ll just gain it back. I don’t think so. I know how all these conditions work together and I have control of it now.

    It has been tough for me to coordinate my own care. I would like to see primary care doctors take a whole-patient approach to this broader syndrome.

    Dr. Park, I appreciate your creativity and open-mindedness in educating people beyond the narrow scope of the typical medical specialist. You are doing just fine with your blog. Thanks for writing it.

  2. Dr. Park,

    You are doing a great service to humanity by speaking out on this deadly and highly prevalent condition. From personal experience, I believe that my undiagnosed sleep apnea caused weight gain, insulin resistance, and diabetic blood-glucose levels.

    I finally got my sleeping/breathing working well with CPAP and it was easy and quick to lose weight and achieve normal bg levels.

    BTW, I am one of the slim ones with severe OSA.