Diabetes, sleep apnea, obesity form lethal combo
Diabetes, sleep apnea, obesity form lethal combo
Patients with all three at high risk of stroke
Type 2 diabetes, sleep apnea, and obesity may be tied into a deadly knot that increases the risk of stroke, say recent research from the University of California at Los Angeles.
While this idea comes as no real surprise to most practitioners, this is the first time the three elements have been linked to the risk of stroke, according to the study’s lead author, Arthur Friedlander, DMD, DDS. Friedlander is chair of dentistry at the U.S. Department of Veterans Affairs of Greater Los Angeles Health Care System and a professor of oral and maxillofacial surgery at the UCLA School of Dentistry.
Given the well-documented link between Type 2 diabetes and obesity and the also well-documented link between obesity and sleep apnea — apparently caused by fat deposits on the neck which place an added burden on the throat — it’s a small leap of logic to combine diabetes, sleep apnea, and obesity to come up with a lethal risk of stroke. In Friedlander’s study of 100 patients, published in the May issue of the Journal of Oral and Maxillofacial Surgery, 58% of the 17 diabetic patients who had sleep apnea also had carotid blockages, signaling a risk of stroke.
Those numbers are small, says Jeff Susman, MD, a family practitioner in Omaha, NE, and professor of family medicine at the University of Nebraska Medical Center, but there’s a message for doctors anyway: Pay attention to the potentially lethal combination of diabetes, obesity, and sleep apnea.
Friedlander and his colleagues speculate that nighttime oxygen depletion caused by sleep apnea and a history of diabetes may contribute to the buildup of plaque on the artery walls.
Sleep apnea, formally known as obstructive sleep apnea syndrome (OSAS), is rare, occurring in 2% of middle-aged women and 4% of middle-aged men. But Friedlander wrote that people with OSAS suffer strokes three to six times more frequently than those without it.
Patients and risks
Patients in Friedlander’s study were generally obese, with Type 2 diabetes that was diagnosed after the age of 40. Not surprisingly, 70% required antilipidemic medications to control elevated cholesterol levels.
And, Friedlander wrote, excessive low-density lipoprotein (LDL) production and excessive rates of LDL oxidation due to the hyperglycemic environment, places such patients at high risk of atherosclerosis because lesions calcify and protrude into the vessel lumen, inhibiting the flow of blood.
This condition promotes the formation of ulcers that act as sites for mural thrombus formation, says Friedlander, thereby increasing the risk for emboli that can plug an intercranial artery, causing a stroke.
Health care professionals should be aware of this linkage, says Friedlander, "So someone who goes to a doctor for a sleep apnea exam should have a screening for diabetes, especially if the patient is obese."
Susman says physicians should ask their diabetic patients about sleep apnea and take it as another signal of impending vascular disease.
"This is probably a reminder for physicians to be alert for sleep apnea, particularly in those individuals who are overweight, with or without diabetes," Susman says. "We can be more vigilant."
[Contact Arthur Friedlander at (310) 268-3196.]
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