Obstructive sleep apnea, prediabetes and progression of type 2 diabetes: A systematic review and meta‐analysis

Abstract

Aims/Introduction: Obstructive sleep apnea (OSA) is related to prediabetes and diabetes. Whether patients with OSA have a higher risk of prediabetes/diabetes remains unclear. We aimed to carry out a meta-analysis of published studies to evaluate the relationships between OSA and prediabetes and diabetes, and the impact of the severity of OSA on diabetes. Materials and Methods: The PubMed, EMBASE and Cochrane databases were searched from January 2011 to July 2021. The associations between OSA and impaired fasting glucose, impaired glucose tolerance, impaired glucose regulation and diabetes mellitus were analyzed. We estimated the pooled odds ratios using fixed or random effects models. We included 25 studies comprising a total of 154,948 patients with OSA and risk factors for prediabetes/diabetes (20 and 16, respectively) in the analysis. Results: OSA was associated with a higher risk of impaired fasting glucose, impaired glucose tolerance, impaired glucose regulation and diabetes mellitus in the cohort studies and cross-sectional studies. The pooled odds ratios were 2.34 (95% confidence interval [CI] 1.16-4.72), 1.58 (95% CI 1.15-2.15), 1.65 (95% CI 1.12-2.42), 2.15 (95% CI 1.68-2.75) and 3.62 (95% CI 2.75-4.75), respectively. Subgroup analyses were based on the proportions of men and women. The results showed that OSA was a risk factor, and there was no significant difference between the two groups. The risk of diabetes increased with the severity of OSA. Conclusions: The risk of developing prediabetes and diabetes was higher in patients with OSA.

CPAP Therapy on Depressive and Anxiety Symptoms in Patients with Moderate to Severe Obstructive Sleep Apnea Syndrome

“…Moreover, OSA and depression have common risk factors associated with cardiovascular disease and metabolic syndrome [ 6 , 10 ]. The frequency of comorbidities in our study was represented by essential hypertension (63%), ischemic heart disease (28%), and diabetes mellitus (22%), as this result supports the previous argument.…”

“…Studies showed that the prevalence of moderate-to-severe sleep-disorder breathing in adults is 23.4% in women and 49.7% in men [ 4 ]. OSA is an independent risk factor for cardiovascular diseases, essential hypertension [ 5 , 6 ], coronary artery disease, stroke, cerebrovascular disease [ 7 , 8 ], metabolic syndrome [ 9 ], and diabetes [ 10 ]. Sleep fragmentation, hypoxia, and persistent sleep loss lead to symptoms, such as depression since the frontal lobe centers responsible for emotions are sensitive to poor quality sleep [ 11 ].…”

Causal associations of sleep apnea and snoring with type 2 diabetes and glycemic traits and the role of BMI

“…Finally, the hypothesis models proposed by the current study rely on a cross-sectional design, and no longitudinal data were available. Given that the causal relationships between sleep apnea, BMI, and type 2 diabetes are likely dynamic [42,43], further long-term longitudinal studies are needed to clarify the dynamic association. Also, because the population-level, rather than individual-level data, were used in our study, whether BMI is the effect modifier in the associations of sleep apnea and type 2 diabetes was not tested.…”

Risk of diabetes in patients with sleep apnea: Comparison of surgery versus CPAP in a long-term follow-up study

“…Surgery and CPAP treatment break the patterns of sleepiness and desaturation [43], avoid the release of catecholamines, and prevent insulin resistance syndrome and damage to the autonomic system. These treatments also help to limit or prevent the consequences of obesity and metabolic syndrome inherent in diabetes type 2 [44][45][46][47].Fig. 4 This study has some study limitations.…”

“…UAS and CPAP can prevent the development of newonset diabetes in patients with OSA [43][44][45][46][47]. Both treatments decreased the incidence of diabetes in OSA patients aged more than 18 years and with a follow-up of 5 years.…”