Obstructive Sleep Apnea as a Risk Factor for Type 2 Diabetes

Abstract

PURPOSE-Cross-sectional studies have documented the co-occurrence of obstructive sleep apnea (hereafter sleep apnea) with glucose intolerance, insulin resistance, and type II diabetes mellitus (hereafter diabetes). It has not been determined, however, whether sleep apnea is independently associated with the subsequent development of diabetes, accounting for established risk factors. METHODS-This observational cohort study examined 1233 consecutive patients in the VeteranAffairs Connecticut Health Care System referred for evaluation of sleep-disordered breathing; 544 study participants were free of preexisting diabetes and completed a full, attended, diagnostic polysomnogram. The study population was divided into quartiles based on severity of sleep apnea as measured by the apnea-hypopnea index. The main outcome was incident diabetes defined as fasting glucose level > 126 mg/dL and a corresponding physician diagnosis. Compliance with positive airway pressure therapy, and its impact on the main outcome, was also examined.RESULTS-In unadjusted analysis, increasing severity of sleep apnea was associated with an increased risk of diabetes (P for linear trend < 0.001). After adjusting for age, sex, race, baseline fasting blood glucose, body mass index (BMI), and weight change, an independent association was found between sleep apnea and incident diabetes (hazard ratio per quartile 1.43; CI 1.10 -1.86). Among patients with more severe sleep apnea (upper two quartiles of severity), 60% had evidence of regular positive airway pressure use, and this treatment was associated with an attenuation of the risk of diabetes (log-rank test P=0.04).CONCLUSION-Sleep apnea increases the risk of developing diabetes, independent of other risk factors. Among patients with more severe sleep apnea, regular positive airway pressure use may attenuate this risk.

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

“…Observational studies have also demonstrated that OSA is an independent risk factor for prediabetes and incident diabetes (10)(11)(12)(13). Both animal and human models of intermittent hypoxia and sleep fragmentation acutely mimicking OSA show evidence of insulin resistance and glucose intolerance (14)(15)(16)(17).…”

Nocturnal Hypoxemia and Severe Obstructive Sleep Apnea are Associated with Incident Type 2 Diabetes in a Population Cohort of Men

“…4,8 There is signifi cant heterogeneity across seven published longitudinal studies 4,[9][10][11][12][13][14][15] of OSA-related diabetes risk in terms of sample sizes, numbers of incident cases, followup periods, and referral bias associated with selected samples. In the Wisconsin cohort, no independent association of ; Peter G. Catcheside, PhD 2,4 ; Robert J. Adams, MBBS, MD 1 1 moderate-severe OSA with incident diabetes was observed, 9 and other studies have demonstrated only modest associations.…”

“…In the Wisconsin cohort, no independent association of ; Peter G. Catcheside, PhD 2,4 ; Robert J. Adams, MBBS, MD 1 1 moderate-severe OSA with incident diabetes was observed, 9 and other studies have demonstrated only modest associations. [10][11][12][13][14][15] Consequently, a recent systematic review found "little published evidence of a longitudinal association between OSA and diabetes." 8 The importance of polysomnography (PSG) indices other than the apnea-hypopnea index (AHI), such as hypoxia, for incident diabetes is unclear.…”

Effect of continuous positive airway pressure therapy on glucose control

“…A Veterans Affairs based observational cohort study examined 1233 consecutive patients referred for evaluation of OSA, of whom 544 were free from pre-existing diabetes. At a median follow-up time of 2.7 years, they found a multivariable-adjusted hazard ratio of 1.43 per quartile for incident diabetes [13] . In a case control study from Ja- [34] OSA patients 7 None Hyperinsulinemic euglycemic clamp 3 mo No change in insulin responsiveness _ Pierzchala et al [35] (article in Polish) [39] OSA patients 40 None Hyperinsulinemic euglycemic clamp 3 mo Improvement in insulin sensitivity at day 2 and 3 mo, in patient with BMI < 30, than in patients with BMI > 30 + Harsch et al [40] Type 2 diabetes patients with OSA 9 None Hyperinsulinemic euglycemic clamp 3 mo Insulin sensitivity was unchanged after 2 days, but significantly improved after 3 mo; glycemic control was unaffected after 3 mo +/-Babu et al [41] Type 2 diabetes patients with OSA [42] Non diabetic OSA patients 9 None Continuous glucose monitoring, plasma insulin, HOMA-IR 1 night Mean blood glucose, fasting insulin and HOMA-IR were significantly higher with CPAP treatment -Hassaballa et al [43] Type 2 diabetes and OSA (retrospective)…”