CPAP in patients with obstructive sleep apnea and type 2 diabetes mellitus: Systematic review and meta‐analysis

Labarca, Gonzalo; B, Tomás Reyes; Jorquera, Jorge; Dreyse, Jorge; Drake, Lauren

doi:10.1111/crj.12915

Cited by 85 publications

(50 citation statements)

References 38 publications

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“…Obstructive sleep apnoea not only increases diabetes risk [72], but also impacts on diabetes complications [20,22,24] since it shares several pathophysiological pathways [28] with diabetic macro-and micro-vascular disease. Receiving treatment for OSA is associated with improved glycaemic control [73], although evidence from randomised clinical trials are inconclusive [74,75]. Obstructive sleep apnoea also results in several co-morbidities that accompany T2DM such as hypertension, atrial fibrillation, depression, erectile dysfunction, and gastro-oesophageal reflux disease.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of clinical practice guidelines to identify recommendations for sleep in type 2 diabetes mellitus management

Smyth

Jenkins

Dunham

et al. 2020

Diabetes Research and Clinical Practice

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Introduction: Sleep quality, quantity and timing have been shown to impact glycaemic control, with a role in insulin sensitivity, glucose tolerance and HbA1C levels, in both diabetic and non-diabetic populations. The aim of this study was to identify recommendations for sleep assessment and management in international clinical practice guidelines focused on type 2 diabetes mellitus management in adults. Study design: Systematic Review. Methodology: Clinical practice guidelines which focused on the management of type 2 diabetes mellitus in adults were included (n = 35). Two independent reviewers utilised the Appraisal of Guidelines for Research and Evaluation tool (AGREE) II and a third reviewer resolved any disagreements. Included guidelines were assessed for recommendations about sleep in diabetes management (n = 14). Data were extracted on sleep recommendations ,themes were generated from the extracted data and narrative syntheses were created. Results: From 1114 identified papers, 35 guidelines met the inclusion criteria. Fourteen of these guidelines included recommendations pertaining to sleep, which broadly fell into five categories; sleep assessment, sleep as a therapeutic target, sleep and co-morbidities of type 2 diabetes mellitus, shift work and sleep and driving. Recommendations varied across guidelines. Conclusion: Few guidelines provided recommendations relating to assessment and management of sleep in type 2 diabetes care. Most of the recommendations were related to obstructive sleep apnoea. However, few guidelines discussed sleep as a therapeutic intervention for diabetes mellitus or described the potential importance of sleep quality and duration in glycaemic control.

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Section: Discussionmentioning

confidence: 99%

Systematic review of clinical practice guidelines to identify recommendations for sleep in type 2 diabetes mellitus management

Smyth

Jenkins

Dunham

et al. 2020

Diabetes Research and Clinical Practice

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“…Treatment of OSA may help to prevent severe consequences of diabetes. This might indeed be the case, since although glycemic control does not improve during CPAP treatment according to meta-analyses [78, 79], untreated OSA in diabetic patients is associated with increased prevalence of neuropathy [80], peripheral arterial disease [81], diabetic retinopathy [82] and diabetic nephropathy [83–85]. Data on the effects of CPAP on diabetic complications are scarce.…”

Section: Common Comorbidities In Osa Patientsmentioning

confidence: 99%

Obstructive sleep apnea and comorbidities: a dangerous liaison

Bonsignore

Baiamonte

Mazzuca

et al. 2019

Multidiscip Respir Med

188

116

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Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbidities, will help to provide better individualized care. The unsatisfactory adherence to CPAP in patients without daytime sleepiness should prompt clinicians to examine the overall risk profile of each patient in order to identify subjects at high risk for worse prognosis and provide the optimal treatment not only for OSA, but also for comorbidities.

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“…Although intermittent hypoxia and sleep fragmentation, the two hallmarks of OSA, have been associated with insulin resistance and higher rates of type 2 diabetes, the effect of CPAP treatment on insulin resistance and glycemic control is conflicting [1,17,23]. Two recent meta-analyses involving 1077 participants with type 2 diabetes showed no effectiveness regarding changes in HbA1c, fasting glucose or fasting insulin levels after 12 or 24 weeks of CPAP treatment [24,25]. A third meta-analysis evaluated the effect of CPAP on 443 participants without diabetes, showing significant improvements in insulin resistance measured with the HOMA-index without any impact on fasting glucose [26].…”

Section: Discussionmentioning

confidence: 99%

Effect of Glucose Improvement on Nocturnal Sleep Breathing Parameters in Patients with Type 2 Diabetes: The Candy Dreams Study

Gutiérrez-Carrasquilla

López‐Cano

Sánchez

et al. 2020

JCM

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Type 2 diabetes exerts a negative impact on sleep breathing. It is unknown whether a long-term improvement in glycemic control ameliorates this effect. We conducted an interventional study with 35 patients with type 2 diabetes and obstructive sleep apnea (OSA) to explore this. At home, sleep breathing parameters were assessed at baseline and after a 4-month period in which antidiabetic therapy was intensified. Patients who decreased their body mass index ≥2kg/m 2 were excluded. Those with an HbA1c reduction ≥0.5% were considered good responders (n = 24). After the follow-up, good responders exhibited an improvement in the apnea-hypopnea index (AHI: 26-1 (95% IC: 8.6-95.0) vs. 20.0 (4.0-62.4) events/hour, p = 0.002) and in time with oxygen saturation below 90% (CT90: 13.3 (0.4-69.0) vs. 8.1 (0.4-71.2) %, p = 0.002). No changes were observed in the group of non-responders (p = 0.722 and p = 0.138, respectively). The percentage of moderate and severe OSA decreased among good responders (p = 0.040). In the wider population, the change in HbA1c correlated positively to decreases in AHI (r = 0.358, p = 0.035) and negatively to increases in the minimum arterial oxygen saturation (r = −0.386, p = 0.039). Stepwise multivariate regression analysis showed that baseline AHI and the absolute change in HbA1c independently predicted decreased AHI (R 2 = 0.496). The improvement of glycemic control exerts beneficial effects on sleep breathing parameters in type 2 diabetes, which cannot be attributed merely to weight loss.

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CPAP in patients with obstructive sleep apnea and type 2 diabetes mellitus: Systematic review and meta‐analysis

Abstract: This systematic review and meta-analysis evaluates the evidence regarding the efficacy of CPAP in patients with T2DM and OSAHS. In conclusion, CPAP does not improve glycemic control measure as HbA1c.

Cited by 85 publications

References 38 publications

Systematic review of clinical practice guidelines to identify recommendations for sleep in type 2 diabetes mellitus management

Systematic review of clinical practice guidelines to identify recommendations for sleep in type 2 diabetes mellitus management

Obstructive sleep apnea and comorbidities: a dangerous liaison

Effect of Glucose Improvement on Nocturnal Sleep Breathing Parameters in Patients with Type 2 Diabetes: The Candy Dreams Study

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