Peripheral Neuropathy and Sleep Apnea

Summary:  Obstructive sleep apnea (OSA) is a common, independent, and often-overlooked cause of peripheral neuropathy.  Additionally, in type 2 diabetics, OSA has been shown to significantly increase the odds of developing peripheral neuropathy as well as increase the intensity of neuropathic symptoms.  Treatment of OSA by continuous positive airway pressure (CPAP) may diminish neuropathic symptoms.  Physicians should consider ordering sleep studies on those patients suffering from peripheral neuropathy in which OSA is suspected of being a contributing factor.

OSA is a common disorder characterized by recurrent upper airway obstruction during sleep resulting in intermittent hypoxemia.  Its prevalence increases with age. Lajoie et al. recently reported OSA to have a prevalence of nearly 60% and 40%, respectively, in men and women over 60 years of age.  OSA is an independent risk factor for peripheral neuropathy. In a sample of people with OSA, Ludëmann found 71% had clinical signs of polyneuropathy.

OSA has been shown to be a risk factor for the development of diabetic peripheral neuropathy.  A meta-analysis of the scientific literature indicated that diabetics with peripheral neuropathy had an approximately 2-fold higher prevalence of OSA than diabetics without neuropathy.  A 2012 British study found OSA significantly increases the odds of type 2 diabetic patients developing peripheral neuropathy and that the intensity of neuropathic symptoms correlate with the severity of the hypoxemia caused by the OSA.

Daytime sleepiness is a common symptom of OSA–being present in more than 80% of patients.  Other signs and symptoms of OSA include loud snoring, morning headache, difficulty concentrating, etc.

Dziewas et al., Schmidt et al., and others have shown that treatment of OSA with CPAP may decrease neuropathic symptoms and improved nerve function.

OSA is also associated with decreased cognitive function, stroke, Parkinson’s disease, Alzheimer’s disease, hypertension and cardiovascular disease.  Physicians should consider ordering sleep studies on those patients suffering from peripheral neuropathy in which OSA is suspected of being a contributing factor.

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Dr. Richard H Mann, DABPS, ret
Chief Scientific Officer & Founder, Realm Labs, Makers of Nutrients to Improve the Function of the Nerves in the Feet and Legs.

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