How Diabetes Can Lead to Sleep Apnea

If you have type 2 diabetes and also struggle with obstructive sleep apnea (OSA), you’re not alone—and it’s not a coincidence. Research shows a strong connection between these two conditions. In fact, up to 40% of people with sleep apnea also have diabetes, and many people with diabetes also show signs of undiagnosed sleep apnea.

What the Research Shows

The International Diabetes Federation formed a task force to study this relationship. Their findings showed:

• Up to 24% of men and 9% of women with type 2 diabetes also had OSA.
• This link exists even in people who aren’t overweight, suggesting it’s not just about obesity.
• Sleep apnea can make blood sugar harder to control, while diabetes can contribute to breathing problems during sleep.

The Role of Insulin Resistance and “Syndrome Z”

One of the key links between diabetes and sleep apnea is insulin resistance, which means your body isn’t using insulin properly to manage blood sugar. Insulin resistance is a major part of metabolic syndrome—a cluster of health issues that includes:

• High blood pressure
• High cholesterol
• Obesity
• Type 2 diabetes

OSA shares many of these same features. In fact, when OSA and metabolic syndrome occur together, doctors now refer to this as “Syndrome Z.”

Why This Happens: Inflammation and Hormones

People with diabetes and sleep apnea often have higher levels of inflammatory chemicals in their bodies, such as:

• Interleukin-6 (IL-6)
• Tumor necrosis factor-alpha (TNF-α)

These substances have been linked to:

• Daytime fatigue and sleepiness
• Worsening insulin resistance
• Breathing disturbances during sleep

These effects can occur even in people who are not obese, highlighting the fact that diabetes and sleep apnea are deeply connected through inflammation and metabolism—not just weight.

Population Studies Confirm the Link

Data from a major national health study (NHANES III, 1988–1994) found that the rates of metabolic syndrome and sleep apnea in the U.S. population closely match. This strongly supports the idea that these conditions go hand in hand—and that shared factors like inflammation and insulin resistance play a big role.

What This Means for Veterans

If you have service-connected diabetes mellitus and are also dealing with sleep apnea, it may be more than a coincidence. There is now substantial medical evidence showing that diabetes may directly contribute to the development or worsening of sleep apnea.

This supports the possibility of a VA claim for sleep apnea as secondary to diabetes, especially when backed by a medical opinion or nexus letter.