Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease

Abstract

Despite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA. RESEARCH DESIGN AND METHODSBlood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea cardioVascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus usual care, or usual care alone. Serum glucose and glycated hemoglobin A 1c (HbA 1c ) were measured at baseline, 6 months, and 2 and 4 years and incident diabetes diagnoses recorded. RESULTSMedian follow-up was 4.3 years. In those with preexisting diabetes (n 5 274), there was no significant difference between the CPAP and usual care groups in serum glucose, HbA 1c , or antidiabetic medications during follow-up. There were also no significant between-group differences in participants with prediabetes (n 5 452) or new diagnoses of diabetes. Interaction testing suggested that women with diabetes did poorly in the usual care group, while their counterparts on CPAP therapy remained stable. CONCLUSIONSAmong patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affects glycemic control in those with diabetes or prediabetes or diabetes risk over standard-of-care treatment. The potential differential effect according to sex deserves further investigation.Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper-airway collapse during sleep that causes intermittent hypoxemia, sleep fragmentation, and daytime sleepiness. The standard therapy for OSA is continuous positive airway pressure (CPAP) to prevent airway obstruction (1).OSA is common in the population and strongly associated with obesity (2). Prospective cohort studies have found associations between moderate to severe OSA and

Positive airway pressure (PAP) treatment reduces glycated hemoglobin (HbA1c) levels in obstructive sleep apnea patients with concomitant weight loss: Longitudinal data from the ESADA

“…In another controlled study, assessing the effect of 6‐month PAP therapy on HbA1c in 26 patients with sub‐optimally controlled diabetes and OSA, PAP significantly improved glycaemic control (Martínez‐Cerón et al., 2016). In contrast to previous studies, long‐term CPAP in addition to usual care in OSA patients with manifest cardiovascular diseases was not associated with improved glycaemic control in those with diabetes, or prevention of new diabetes diagnoses, compared with usual care alone (Loffler et al., 2020). However, this sub‐analysis within the SAVE study included a less symptomatic subpopulation of OSA that may be significantly different from the group of studies included in the current ESADA cohort reflecting a reference patient cohort referred to tertiary sleep centres.…”

“…In another controlled study, assessing the effect of 6-month PAP therapy on HbA1c in 26 patients with sub-optimally controlled diabetes and OSA, PAP significantly improved glycaemic control (Martínez-Cerón et al, 2016). In contrast to previous studies, long-term CPAP in addition to usual care in OSA patients with manifest cardiovascular diseases was not associated with improved glycaemic control in those with diabetes, or prevention of new diabetes diagnoses, compared with usual care alone (Loffler et al, 2020).…”

Long-Term Weight Change and Glycemic Control in Patients With Type 2 Diabetes Mellitus and Treated vs. Untreated Sleep-Disordered Breathing—Analysis From the DIAbetes COhoRtE

“…HbA1c is a measure of glucose levels during the last 2–3 months, which takes time to change ( 18 ). A randomized clinical trial investigated the long-term effect of PAP on glycemic control in 888 patients with OSA and stable cardiovascular disease ( 40 ). In those with pre-existing DM2 ( n = 274, 31%) and prediabetes ( n = 452, 51%), there was no significant difference between the PAP and usual care groups in HbA1c during follow-up (median duration 4.3 years) ( 40 ).…”

Participation in physical activity is associated with reduced nocturnal hypoxaemia in males

“…Our study provides evidence more time spent undertaking MVPA was associated with lower odds of severe OSA, and less severe hypoxaemia. Importantly, whilst CPAP is effective at eliminating hypoxaemia [ 40 ], cardiovascular and metabolic health problems still remain in patients with OSA [ 9 , 10 ]. Therefore, the results of this study, when coupled with the well-established benefits of MVPA on other health conditions [ 11 – 13 ], suggest that MVPA should be prescribed for all patients with OSA.…”

“…R otenburg et al [ 8 ] showed that for each year over a 20-year period (1994–2015), up to 40% of CPAP users were “non-compliant”. Furthermore, recent large randomised controlled trials have demonstrated that CPAP does not reduce the chances of a secondary cardiovascular or cerebrovascular event [ 9 ], nor improve glycaemic control of type 2 diabetes [ 10 ].…”