A randomised controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea

Lam, W.K. Jacky; Lam, Bing; Yao, Tzy‐Jyun; Lai, Agnes Yuen Kwan; Ooi, Clara; Tam, S; Lam, Karen Siu Ling; Ip, Mary S.M.

doi:10.1183/09031936.00047709

Cited by 155 publications

(139 citation statements)

References 40 publications

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“…estimated by the short insulin tolerance test in Asian men with no diabetes (30). In our study, the participants used CPAP continuously (except for rare bathroom breaks) in the laboratory during the entire duration of the time in bed (i.e., from 11:00 P.M. to 7:00 A.M.), which is comparable with approximately 8 hours of nightly objective CPAP adherence downloaded from devices in a clinical setting.…”

Section: Original Articlesupporting

confidence: 49%

“…First, because air pressure is the mechanism of action of CPAP, sham devices may feel different due to a markedly lower mask air pressure compared with the therapeutic device, which may adversely affect its tolerability and acceptance by patients. Indeed, several studies investigating the effects of CPAP on glucose metabolism have reported lower average duration of sham-CPAP adherence as compared with therapeutic CPAP (20,21,29,30). A large randomized controlled multicenter trial (56), comparing the effects of therapeutic versus sham-CPAP, reported significantly lower adherence to sham-CPAP and a lower retention rate in the sham-CPAP group.…”

Section: Original Articlementioning

confidence: 99%

“…Despite this strong association between OSA and alterations in glucose metabolism, there is still controversy as to whether treatment of OSA with continuous positive airway pressure (CPAP) has metabolic benefits (18,19). Prior randomized controlled trials investigating the effects of CPAP on measures of glucose metabolism yielded mostly negative results (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The average duration of CPAP use in these trials ranged from 3.3 to 6.2 hours per night.…”

mentioning

confidence: 99%

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Eight Hours of Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea Improves Glucose Metabolism in Patients with Prediabetes. A Randomized Controlled Trial

Pamidi

Wroblewski²,

Stępień

et al. 2015

Am J Respir Crit Care Med

160

117

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Rationale: Although obstructive sleep apnea (OSA) is associated with impaired glucose tolerance and diabetes, it remains unclear whether OSA treatment with continuous positive airway pressure (CPAP) has metabolic benefits.Objectives: To determine the effect of 8-hour nightly CPAP treatment on glucose metabolism in individuals with prediabetes and OSA.Methods: In a randomized controlled parallel group study, 39 participants were randomly assigned to receive either 8-hour nightly CPAP (n = 26) or oral placebo (n = 13). Sleep was polysomnographically recorded in the laboratory on each night. CPAP adherence was ensured by continuous supervision. Participants continued their daily routine activities outside the laboratory. Glucose metabolism was assessed at baseline and after 2 weeks of assigned treatment using both the oral and intravenous glucose tolerance tests. The primary outcome was the overall glucose response as quantified by the area under the curve for glucose during 2-hour oral glucose tolerance testing. Secondary outcomes included fasting and 2-hour glucose and insulin, the area under the curves for insulin and insulin secretion, norepinephrine, insulin sensitivity, acute insulin response to glucose, and 24-hour blood pressure.

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Section: Original Articlesupporting

confidence: 49%

Section: Original Articlementioning

confidence: 99%

mentioning

confidence: 99%

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Eight Hours of Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea Improves Glucose Metabolism in Patients with Prediabetes. A Randomized Controlled Trial

Pamidi

Wroblewski²,

Stępień

et al. 2015

Am J Respir Crit Care Med

160

117

View full text Add to dashboard Cite

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“…U ntreated obstructive sleep apnea (OSA) is associated with insulin resistance, 1,2 and some studies suggest that treatment with CPAP improves glucose control, 3,4 although this was not found in a randomized controlled trial of diabetics with sleep apnea. 5 The observation that established type 2 diabetics cannot improve glucose control when their OSA is treated with CPAP, emphasizes the importance of understanding the pathophysiology of insulin resistance associated with OSA.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Lack of Association Between Impaired Glucose Tolerance and Appetite Regulating Hormones in Patients with Obstructive Sleep Apnea

Patterson¹,

Twigg²,

Vazir³

et al. 2011

Journal of Clinical Sleep Medicine

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Study Objectives: Understanding the etiologic mechanisms underlying impaired glucose tolerance in obstructive sleep apnea (OSA) would assist development of therapies against this comorbidity. We hypothesized that in patients with OSA impaired glucose tolerance (IGT) would be associated with elevated levels of hormones associated with appetite regulation (leptin, ghrelin, neuropeptide Y [NPY] and peptide tyrosine-tyrosine [PYY]). Method: We studied 68 OSA patients (mean AHI 22 events/h) and 37 age and weight matched healthy controls recruited by advertisement. All participants received a standardized evening meal, attended polysomnography and an oral glucose tolerance test (OGTT) on waking. Hormones were measured in blood taken before sleep (22:30) and at the start of the OGTT. Results: Impaired glucose tolerance was present in 54% of patients and 32% of controls (p = 0.05). The only differences between groups was that leptin was signifi cantly higher at 22:30 in OSA patients compared to controls (9.6 ng/L vs 7.9 ng/L, p = 0.05). OSA patients had marginally elevated plasma NPY levels at 22:30 (56.6 [52, 67] S C I E N T I F I C I N v E S T I G A T I O N SU ntreated obstructive sleep apnea (OSA) is associated with insulin resistance, 1,2 and some studies suggest that treatment with CPAP improves glucose control, 3,4 although this was not found in a randomized controlled trial of diabetics with sleep apnea. 5 The observation that established type 2 diabetics cannot improve glucose control when their OSA is treated with CPAP, emphasizes the importance of understanding the pathophysiology of insulin resistance associated with OSA.One mechanism linking OSA with impaired glucose tolerance could be sympathetic nerve activity which is a recognized phenomenon in OSA 6 ; indeed it has previously been hypothesized that this process is responsible for the elevated leptin levels seen in newly diagnosed OSA patients. 7 Consistent with this sibutramine, a serotonin and noradrenaline reuptake inhibitor, was able to improve insulin resistance in OSA independent of visceral fat. 8 Moreover two studies raise the hypothesis that hormones involved in appetite regulation could contribute to impaired glucose tolerance. Broglio et al. 9 demonstrated that ghrelin administered to healthy subjects simultaneously with glucose, resulted in a transient decrease of insulin concentration that was coupled with signifi cant increase in glucose levels. In addition it has been reported that IR is associated with increased plasma leptin concentration independent of the body fat. 10 Consistent with this hypothesis, previous studies have reported that OSA is independently associated with neuroendocrine dysregulation; in fact OSA has been reported to be bRIEF SUMMARY Current knowledge/Study Rationale: Impaired glucose tolerance is a common and important co-morbidity of obstructive sleep apnea yet its pathogenesis, beyond the shared etiology of obesity is unknown. Here we tested the hypothesis that OSA might induce increases of appetite regulating h...

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“…Hypoxia has been shown to induce a multitude of Dawson et al [49] Type 2 diabetes with OSA [52] OSA and metabolic syndrome 20 None Fasting blood glucose 1 yr No difference in blood glucose seen _ Lam et al [53] OSA patients 61 (30 control and 31 study group)…”

Section: Pathophysiologymentioning

confidence: 99%

Effect of continuous positive airway pressure therapy on glucose control

Surani¹

2012

WJD

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Obstructive sleep apnea (OSA) and diabetes mellitus are both highly prevalent disorders. There has been a recent recognition of an association between insulin resistance and sleep apnea. Continuous positive airway pressure (CPAP) has emerged as an effective therapy for treatment of OSA and has been shown to positively influence numerous pathophysiological factors that contribute to cardiovascular risk. There is emerging data that explores the influence of CPAP therapy, insulin sensitivity and glycemic control. In the current review, we examine this literature critically and formulate a synopsis that summarizes the current knowledge in this field.

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A randomised controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea

Cited by 155 publications

References 40 publications

Eight Hours of Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea Improves Glucose Metabolism in Patients with Prediabetes. A Randomized Controlled Trial

Eight Hours of Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea Improves Glucose Metabolism in Patients with Prediabetes. A Randomized Controlled Trial

Lack of Association Between Impaired Glucose Tolerance and Appetite Regulating Hormones in Patients with Obstructive Sleep Apnea

Effect of continuous positive airway pressure therapy on glucose control

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