Sleep apnea is significantly undiagnosed among obese individuals with type 2 diabetes, according to a study published in the June issue of Diabetes Care. The study, called Sleep AHEAD, found nearly 87% of participants reported symptoms of sleep apnea but were never diagnosed.

The Sleep AHEAD study included 306 obese patients with type 2 diabetes who were enrolled in the Look AHEAD trial, an ongoing 16-site study investigating the long-term health impact of an intensive lifestyle intervention in 5,145 overweight or obese adults with type 2 diabetes.

The researchers found that 86.6% of the participants had sleep apnea but had never been diagnosed. More than 30% of those patients had 16 to 20 pauses in breathing per hour while sleeping, and 22% had more than 30 episodes per hour.

“Doctors who have obese patients with type 2 diabetes need to be aware of the possibility of sleep apnea, even if no symptoms are present, especially in cases where the patient has a high BMI or waist circumference,” said lead author Gary Foster, PhD, from Temple University in a press release from the school.