Dr Ian Neeland Describes Sleep Therapies for Diabetic Vascular Complications

Ian J. Neeland, MD, FACC, FAHA, is co-director of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease for University Hospitals Harrington Heart & Vascular Institute and director of the UH Center for Cardiovascular Prevention, in the Cleveland, Ohio, area. He summarized a talk he gave at the 2021 AHA Scientific Sessions, “Disrupted Sleep in Diabetic Vascular Complications."

Transcript:

Can you please discuss the main points and themes of your presentation: “Disrupted Sleep in Diabetic Vascular Complications?"

Sleep and cardiometabolic disease often go hand in hand. We know [they] actually have bidirectional relationships. So obesity and adiposity—excess fat—can increase fat deposition in upper airway and decrease airway caliber, which can lead to obstructive sleep apnea. In the same vein, sleep apnea—including sleep restriction and chronically shortened sleep duration—are, in turn, linked to worsening obesity and insulin resistance. So there are bidirectional relationships with regard to sleep disorders and obesity and diseases, such as diabetes.

Unfortunately, both are epidemic in the United States. Sleep deficiency overlaps with rising rates of obesity and type 2 diabetes, as has been shown now for several years. In fact, we think about disparities and health disparities, and sleep deficiency is over represented among racial ethnic minorities, leading to help sleep health disparities. It’s a truly important topic and very much on the forefront of taking care of patients with obesity and diabetes really to look at sleep, diagnose sleep disorders, and treat them as best we can to improve all of their comorbidities.

Based on results of recent trials, are there new therapeutic options to promote better sleep for patients with diabetic vascular complications? If so, how are these being implemented? Are there opportunities in both type 1 and type 2 diabetes?

Sleep disorders and sleep deficiency is definitely an emerging field of research and therapeutics. Most of the therapies that we have are aimed at the anatomy and the anatomic problems relate to OSA [obstructed sleep apnea], so things like CPAP [continuous positive airway pressure], or now there's something called an Inspire device, which are really focused on the airway itself.

But no emerging research is looking at what I mentioned before, [which] were these non-anatomic physiologic traits of sleep apnea, where altering one's metabolic milieu may actually improve the sleep apnea itself, regardless of the anatomy.

There are now several research programs underway looking at different therapeutics for obstructive sleep apnea, whether it be SGLT2 inhibitors or other medications that can improve diabetes or cardiovascular disease. Right now, currently on the market, it's still limited to pretty much CPAP and similar devices. But I think in the future, you'll be seeing a lot more overlap between sleep disorders and cardio metabolic disease, and therefore the medications that we [use to] treat one, we could maybe potentially treat the other with. So we'll see. Stay tuned for the future.