When insulin has to work hard to keep the sugar at bay the upper airway collapses away.

Obesity is a major risk factor for both obstructive sleep apnoea (OSA) and metabolic disease. As obesity rates continue to rise, so too does the prevalence of OSA and metabolic disorders. Indeed, recent community sample data from over 2000 adults aged 40–85 years in Switzerland indicate that up to 50% of men and almost a quarter of women have apnoea–hypopnoea indices (AHI) within the moderate to severe range (>15 events·h sleep) [1]. Insulin resistance, a strong predictor for the development of type 2 diabetes [2], is being recognised earlier with prevalence rates in children varying between 3 and 44% [3]. Thus, OSA and insulin resistance are major health issues.