A small study presented at the Associated Professional Sleep Societies 26th Annual Meeting in June of this year showed increased carbohydrate craving in those type II diabetics with sleep apnea. These results, despite the small study, elevate the importance of screening for sleep apnea in the population of type II diabetics by primary care doctors and endocrinologists, as this additional disease process could further impair treatment of diabetes, given the significant increase in carbohydrate craving. Studies among the general population have shown that sleep apnea and sleep deprivation may affect carbohydrate craving by hormonal changes in leptin and ghrelin, which were previously discussed in these blogs. However, the impact of sleep apnea on carbohydrate craving among diabetics has not been extensively studied in a real-world setting. Studies have shown that sleep apnea can worsen diabetes but self-reported carbohydrate craving among this group has not been examined, until this research.
The small study involved patients visiting a sleep clinic in New Jersey. There were 55 adults with a mean age of 62.5 years; 43% were men. The researchers assessed the risk for sleep apnea using the validated Berlin questionnaire, which predicts sleep apnea by incorporating body mass index (BMI), hypertension status, and characterization of snoring and daytime sleepiness. They assessed carbohydrate craving using the Likert scale from 1 (highest) to 5 (lowest).
Fifty-four percent of study participants were diabetic, and 82% of these individuals were at high risk for sleep apnea, scoring 2 to 4 on the Berlin questionnaire. Compared with participants without diabetes, the risk for sleep apnea among patients with diabetes was high, the researchers found.
Further, the diabetic patients had almost double the risk for carbohydrate craving as their nondiabetic counterparts (33% vs 14%). The odds of moderate to high carbohydrate craving was more than double in all patients at high risk for sleep apnea (Berlin score, 2 – 4) vs those at low risk (Berlin score, 0 – 1).
In a conference statement, the study’s principal investigator, Dr. Anthony Cannon, described that the current national guidelines on the management of diabetes need to consider sleep apnea as an independent risk factor more vigorously, and that the management of patients with diabetes and or metabolic syndrome based solely on pharmacotherapy, exercise and nutritional modifications without taking into account the risk of sleep apnea may not lead to optimal outcomes for patients suffering from these chronic diseases.
Because sleep apnea frequently remains undiagnosed, a greater awareness amongst physicians and patients about the association between sleep apnea and diabetes through public policy measures may be helpful.