Metabolic Syndrome Links Sleep Apnea to Diabetes

If you have diabetes, you may have been told it’s associated with obstructive sleep apnea (OSA). Or, it might be the opposite: you may have been told your OSA might lead to the development of diabetes.

Which is it?

The answer is both.1 Welcome to the dangerous intersection in chronic health known as metabolic syndrome.

What is metabolic syndrome?

Harvard physician Dr. Robert Shmerling wrote that “Metabolic syndrome may be the most common and serious condition you’ve never heard of.”2

The condition itself isn’t new, first described in a joint scientific statement by the American Heart Association and National Heart, Lung, and Blood Institute in 2005. Metabolic syndrome exists when 3 of the following 5 health concerns are present:2

  1. Obesity
  2. High triglycerides
  3. Low HDL cholesterol (the “good” cholesterol)
  4. High blood pressure
  5. Elevated blood sugar

Together, these risk factors, if ignored or untreated, appear to promote the development of 2 of our biggest chronic killers, atherosclerosis (hardening of the arteries) and type 2 diabetes.3

Not only is metabolic syndrome not new, it may be inaccurate to call it a condition. It’s why the use of the word syndrome is important. Syndrome, in this case, suggests a collection of interrelated risk factors that originate within the metabolic system.3

Why be concerned now?

Metabolic syndrome has been especially top of mind among physician specialists since COVID-19 emerged. As of this writing, it’s generally understood that people living with the symptoms inherent to metabolic syndrome may be suffering some of COVID-19’s most severe cases and the highest death rates.4

What does this have to do with OSA?

OSA, itself, commonly affects 24 percent of men and at least 9 percent of women in the general population. Alarmingly, as many as 80 percent of all people with OSA remain undiagnosed, according to some research.5 Undiagnosed, more or less, means untreated.

OSA doesn’t exist in a bubble, however. It’s a companion condition (referred to as a comorbidity) to many other chronic health problems. In the case of metabolic syndrome, its very mechanisms, which ultimately lead to the development of cardiovascular disease, mirror those found in obstructive sleep apnea. Meanwhile, having metabolic syndrome raises risk factors for other conditions, OSA among them.2,6

It makes sense: obesity counts as a risk factor for OSA, for instance. The risk for developing metabolic syndrome matches the trajectory for those who eventually develop OSA: growing older increases the risk. Also, the more severe OSA is, the higher the risk for developing metabolic syndrome.7 Other connections between the 2 have yet to be clarified, but the overarching conclusion is this: if you have one of these conditions, you’re more likely to also have the other.

Treatment can make a big difference

But check this out: treating OSA with positive airway pressure (PAP) therapy might actually reverse preexisting metabolic syndrome.8

Research released at the American Thoracic Society 2020 International Conference showed the probability of reversing metabolic syndrome. People using PAP therapy for at least 6 months increased their chances of a reversal of preexisting metabolic syndrome 5-fold. The same research also showed a clinically significant decrease in cardiovascular disease risk.8

Imagine if that 80 percent of undiagnosed people who have OSA discovered and treated their condition with PAP therapy? It’s a safe assumption that a good number of those people also have metabolic syndrome, and that treating their OSA could keep their metabolic syndrome at bay or even send it packing.

Diabetes remains part of this picture

Let’s not forget: type 2 diabetes and OSA also share a key relationship here. On the one hand, OSA creates systemic inflammation and chronic stress responses in the body every night apneas go untreated. The endocrine system must then work overtime to manage the balance between blood sugar and insulin.

This additional effort — at a time when the body, included the hard-working heart, is meant to rest — raises the risks for cardiovascular problems down the road.

Meanwhile, someone with type 2 diabetes may become obese over time as a result of insulin resistance.9 Weight gain is well known to contribute directly to the development of OSA. Then, with both type 2 diabetes and OSA taxing the body — both day and night — the likelihood of heart disease increases.

The way forward

So, which comes first? The OSA? Or the metabolic syndrome? Or the type 2 diabetes?

Researchers continue to unravel this multidimensional puzzle, but suffice it so say, treating OSA, losing weight, and managing diabetes or heart conditions early — or even better, preventing them — may be your best defense against a multitude of chronic health problems.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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