Research Activities, November-December 2013
Sleep-disordered breathing boosts risk of heart disease in patients with asymptomatic type 2 diabetes
Adults with type 2 diabetes mellitus (T2DM) have a two to four times greater risk of heart disease-related mortality than their nondiabetic counterparts. Sleep-disordered breathing (SDB) has been associated with T2DM and impaired glucose tolerance, independent of other coexisting conditions, including obesity.
A recent study found a greater risk of new-onset cardiac disease in asymptomatic patients (with normal exercise results on echocardiogram) with T2DM and SDB than in those without SDB. SDB was associated with a greater risk of incident coronary artery disease (CAD) even after controlling for risk factors, including age, sex, hypertension, smoking, lipid profile, family history of cerebrovascular disease, medical treatment, standard of care-related risk factors, or overweight/obesity. SDB was also associated with more than twice the risk of incident atrial fibrillation (AF) in patients with T2DM. In addition, there was a positive association of SDB with heart failure (HF).
Patients were considered to have SDB if the diagnosis was made using polysomnography or if a comprehensive sleep evaluation identified the patient to be at high risk of SDB but the patient did not undergo polysomnography. All patients were treated at a single, large center in Ohio and were followed for a period of up to 7.8 years. The study included 869 asymptomatic patients with T2DM, of whom 188 had SDB.
The researchers believe that the association of SDB with incident CAD, AF, and HF in patients with T2DM justifies more liberal screening for SDB in patients with T2DM, given that SDB is a potentially modifiable risk factor. This study was supported by AHRQ (T32 HS00059).
See "Sleep disordered breathing as a risk of cardiac events in subjects with diabetes mellitus and normal exercise echocardiographic findings," by Sinziana Seicean, M.D., Kingman P. Strohl, M.D., Andreea Seicean, M.P.H., and others in the American Journal of Cardiology 111, pp. 1214-1220, 2013.