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Sleep Medicine Bulletin

Issue 5 - September 2008

Restless Legs Syndrome and Diabetes: A Vicious Cycle

A study published in the Journal Sleep (vol. 30, No. 7, 2007, p. 866-871) investigated the association between Restless Legs Syndrome (RLS) and Type 2 Diabetes...

We diagnose and treat all sleep disorders in children, adolescents and adults. • Sleep Disordered Breathing • Sleep Apnea • Snoring • Restless Legs Syndrome • Narcolepsy • Parasomnias • Insomnia • Circadian Rhythm Disorders Professional Services: • Comprehensive Evaluations • All Levels of Sleep Testing • Prompt Results • Effective & Immediate Treatment Options • Comprehensive Followup • Personalized Attention & Warm Welcome • PAP Therapy Equipment • Oral Appliance Therapy • Broad Insurance Coverage • Board Certified Sleep Physicians

Wake Up Call for Physicians & Type 2 Diabetes Patients

The International Diabetes Federation Taskforce on Epidemiology and Prevention calls for immediate action among the diabetes community to raise awareness for snoring and sleep apnea...

Sleep in Art & Culture

Iceland's first sculptor, Einar Jonsson (1874-1954), was an expressionist who was inspired by Icelandic folklore and Nordic mythology...

We are nationally accredited by the American Academy of Sleep Medicine, the benchmark for excellence in the field of Sleep Medicine.

Sleep Medicine Program 4265 Johns Creek Pkwy, Suite A Suwanee, Georgia 30024 phone 678 990 3962 fax 678 990 3966 For additional information visit www.fusionsleep.com

Fusion Sleep welcomes your feedback. To enquire regarding references or to provide your comments, please call or e-mail to reception@fusionsleep.com

Sleep Medicine Program


Restless Legs Syndrome and Diabetes: A Vicious Cycle A study published in the Journal Sleep (vol. 30, No. 7, 2007, p. 866-871) investigated the association between Restless Legs Syndrome (RLS) and Type 2 Diabetes. The study, authored by Dr. Giovanni Merlino, MD and colleagues from the University of Udine, Italy, analyzed the characteristics of RLS in diabetic patients and the possible risk factors in the development of RLS in diabetics.

RLS is Characterized by an Uncomfortable Feeling in the Legs RLS is a very common disorder that often occurs in families due to inherited problems with a neurochemical called Dopamine. The symptoms include an uncomfortable feeling in the legs or arms, and/or an irresistible urge to move while at rest. Both adults and children experience RLS, which is associated with a number of other conditions like ADHD and depression. These “difficult-to-describe” symptoms occur more often in the evening or night and may be temporarily relieved by rubbing, movement or massage. RLS may also result from other conditions such as diabetes, neuropathy, kidney disease, iron deficiency or even central nervous system trauma.

RLS Found to be Highly Associated with Type 2 Diabetes The Italian researchers studied one hundred twenty-four consecutive outpatients with diabetes at a university diabetic outpatient clinic and eighty-seven consecutive controls. RLS was diagnosed in close to 18% of the diabetic patients compared to only 5.5% of the controls. They also discovered that RLS was independently associated with Type 2 Diabetes. Multivariate statistical analysis excluded additional confounding variables such as age, gender, body mass index (BMI), levels of triglycerides and presence of polyneuropathy. Even after controlling for these

variables, RLS was still found to be highly associated with Type 2 Diabetes. The authors also studied whether Polyneuropathy – a generalized disorder of the peripheral nerves – is more common in diabetics with or without RLS. They showed that polyneuropathy only partially explains the increased prevalence of RLS in Type 2 Diabetics.

RLS and Diabetes Set Up a Vicious Cycle Many of those afflicted by RLS complain of poor sleep quality with frequent awakenings and difficulty in initiating and maintaining sleep. This chronic sleep deprivation has been shown to be linked to increased risk of cardiovascular disease and mortality. The link between RLS and cardiovascular disease may be related to chronic sleep loss. The documented increase of hypertension, and now diabetes, in RLS could provide an explanation for the increased risk of vascular disease in RLS.

Treating RLS will Improve Diabetes The authors suggest that by treating RLS symptoms in diabetics, the risk of mortality due to vascular disease may be reduced. Although this study demonstrated an increased prevalence of RLS in diabetics, it is also noted in the literature that Restless Legs Syndrome itself may be a cause for Type 2 Diabetes.

A Wake Up Call for Physicians & Type 2 Diabetes Patients The International Diabetes Federation (IDF) Taskforce on Epidemiology and Prevention published a seminal article in April 2008 in the journal Diabetes Research and Clinical Practice; vol.8 (i) pages 2-12. For the first time, an independent taskforce outside of sleep medicine has recommended that physicians who treat Type 2 Diabetes should collaborate with sleep specialists in order to evaluate all diabetic patients for sleep disordered breathing (SDB).

Apnea and Type 2 Diabetes Increase Risk of Cardiovascular Disease Previous research has shown a strong link between SDB, diabetes and cardiovascular disease, although the relationship is complex. What is clear is that patients with diabetes are at a much higher


risk for cardiovascular disease, ranging from high blood pressure to heart attack and stroke. According to the IDF, cardiovascular disease is a major cause of death in diabetics, accounting for 50% of all diabetic fatalities. SDB is often found in individuals with Type 2 Diabetes, hypertension and obesity. The most common complaint is loud snoring and pauses in breathing which results in increased brain activity, fragmented sleep, drops in blood oxygen (hypoxia), and excessive daytime sleepiness.

Sleep Apnea Causes Impaired Glucose Metabolism

Multiple Treatments are Already Available for SDB Treatments for SDB are readily available from accredited sleep medicine programs. Therapeutic options include Continuous Positive Airway Pressure (CPAP), Oral Appliance Therapy (OAT), weight loss and other specific treatments.

Sleep in Art & Culture Iceland’s first sculptor, Einar Jonsson (18741954), was an expressionist who was inspired by Icelandic folklore and Nordic mythology.

The IDF has proposed a number of causal pathways that may describe how sleep apnea influences insulin resistance. The proposed pathways are described in the figure below. The physiological stress of sleep fragmentation and intermittent hypoxia puts strain on a number of different metabolic pathways, all of which may lead to glucose intolerance and Type 2 Diabetes.

A Potential Mechanism Linking Sleep Apnea to Type 2 Diabetes Shaw, J.E., et.al (2008) Diabetes Research and Clinical Practice 8(i)

All Patients with Type 2 Diabetes Should be Evaluated for Sleep Apnea The IDF has called for immediate action among the diabetes community to raise awareness in clinical practice and research regarding the link between SDB and Type 2 Diabetes. They suggest all Type 2 Diabetics should be evaluated for symptoms of SDB, such as snoring, observed sleep apnea and daytime sleepiness.

Sleep (1931-1941). Einar Jonsson

He was born on a farm in southern Iceland on May 11, 1874. He died in Reykjavik on October 18, 1954. Jonsson studied in Copenhagen at the end of the 19th century and built his home and studio in the center of Reykjavik in 1923. Today, his studio, the Einar Jonsson Museum, is dedicated to his life and works. The sculpture “Sleep”, which took 10 years to complete, depicts a central masculine figure sitting, or sleeping, with his head between his knees and his strong hands holding the back of his head. In the forefront is a smaller feminine figure standing watch, which may symbolize the fragile yet protective aspects of sleep.

Copyright © 2007 Fusion Sleep LLC - All Rights Reserved.

The figure outlines a host of pathways which can be inappropriately activated during sleep as a result of sleep fragmentation and intermittent hypoxia. The over-activation of these pathways leads to dysregulation of Insulin production by Pancreatic Beta (!) Cells - the cause for Type 2 Diabetes.


Sleep Medicine Bulletin

Issue 5 - September 2008

Restless Legs Syndrome and Diabetes: A Vicious Cycle

A study published in the Journal Sleep (vol. 30, No. 7, 2007, p. 866-871) investigated the association between Restless Legs Syndrome (RLS) and Type 2 Diabetes...

We diagnose and treat all sleep disorders in children, adolescents and adults. • Sleep Disordered Breathing • Sleep Apnea • Snoring • Restless Legs Syndrome • Narcolepsy • Parasomnias • Insomnia • Circadian Rhythm Disorders Professional Services: • Comprehensive Evaluations • All Levels of Sleep Testing • Prompt Results • Effective & Immediate Treatment Options • Comprehensive Followup • Personalized Attention & Warm Welcome • PAP Therapy Equipment • Oral Appliance Therapy • Broad Insurance Coverage • Board Certified Sleep Physicians

Wake Up Call for Physicians & Type 2 Diabetes Patients

The International Diabetes Federation Taskforce on Epidemiology and Prevention calls for immediate action among the diabetes community to raise awareness for snoring and sleep apnea...

Sleep in Art & Culture

Iceland's first sculptor, Einar Jonsson (1874-1954), was an expressionist who was inspired by Icelandic folklore and Nordic mythology...

We are nationally accredited by the American Academy of Sleep Medicine, the benchmark for excellence in the field of Sleep Medicine.

Sleep Medicine Program 4265 Johns Creek Pkwy, Suite A Suwanee, Georgia 30024 phone 678 990 3962 fax 678 990 3966 For additional information visit www.fusionsleep.com

Fusion Sleep welcomes your feedback. To enquire regarding references or to provide your comments, please call or e-mail to reception@fusionsleep.com

Sleep Medicine Program

Sleep Medicine Bulletin - September 2008  

Restless Legs Syndrome and Diabetes: A Vicious Cycle Wakeup Call for Physicians & Type II Diabetes Patients

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