Association of Obstructive Sleep Apnea in Rapid Eye Movement Sleep With Reduced Glycemic Control in Type 2 Diabetes: Therapeutic Implications

Abstract

OBJECTIVESeverity of obstructive sleep apnea (OSA) has been associated with poorer glycemic control in type 2 diabetes. It is not known whether obstructive events during rapid eye movement (REM) sleep have a different metabolic impact compared with those during non-REM (NREM) sleep. Treatment of OSA is often limited to the first half of the night, when NREM rather than REM sleep predominates. We aimed to quantify the impact of OSA in REM versus NREM sleep on hemoglobin A1c (HbA1c) in subjects with type 2 diabetes.RESEARCH DESIGN AND METHODSAll participants underwent polysomnography, and glycemic control was assessed by HbA1c.RESULTSOur analytic cohort included 115 subjects (65 women; age 55.2 ± 9.8 years; BMI 34.5 ± 7.5 kg/m2). In a multivariate linear regression model, REM apnea–hypopnea index (AHI) was independently associated with increasing levels of HbA1c (P = 0.008). In contrast, NREM AHI was not associated with HbA1c (P = 0.762). The mean adjusted HbA1c increased from 6.3% in subjects in the lowest quartile of REM AHI to 7.3% in subjects in the highest quartile of REM AHI (P = 0.044 for linear trend). Our model predicts that 4 h of continuous positive airway pressure (CPAP) use would leave 60% of REM sleep untreated and would be associated with a decrease in HbA1c by approximately 0.25%. In contrast, 7 h of CPAP use would cover more than 85% of REM sleep and would be associated with a decrease in HbA1c by as much as 1%.CONCLUSIONSIn type 2 diabetes, OSA during REM sleep may influence long-term glycemic control. The metabolic benefits of CPAP therapy may not be achieved with the typical adherence of 4 h per night.

Association between severity of obstructive sleep apnea and glycated hemoglobin level in Japanese individuals with and without diabetes

“…The severity of OSA has been reported to associate with poor glycemic control in patients with T2DM [7,[9][10][11]. However, in our study, while we found a significant association between the severity of OSA and HbA1c level in non-diabetic subjects, this association was not significant in subjects with T2DM.…”

“…Therefore, in patients with OSA, REM sleep is typically associated with an increased frequency of obstructive events that are often prolonged and accompanied by severe oxygen desaturation [16][17][18]. Grimaldi et al reported that REM AHI but not non-REM AHI was associated with HbA1c level in patients with T2DM [11]. However, in that study, the proportion of patients with severe OSA; i.e., AHI ≥ 30, was only 30% and the majority had mild to moderate OSA.…”

Impact of Adenotonsillectomy on Insulin Resistance and Lipoprotein Profile in Nonobese and Obese Children

“…4 OSA in adults is associated with increased risk of insulin resistance (IR), 5,6 MetSyn, 7,8 and T2DM 6,7 and poorer glycemic control in adults with existing T2DM. [9][10][11] Similarly, OSA prevalence is greater among adults with T2DM 12 vs community-based cohorts. 13 Treating OSA in adults using CPAP improves IR, although the impact on glycemia is more unpredictable.…”

Cpap-Therapy Decreases Glycated Hemoglobin in Patients With Type 2 Diabetes Mellitus and Sleep Apnoea

“…Остается открытым вопрос об опти-мальной длительности СиПАП-терапии в течение отдель-но взятой ночи и количестве необходимых ночей. В недавнем исследовании показано, что гликемия у боль-ных СД2 нарушается в ответ на обструктивные апноэ и гипопноэ в REM-сне, но не во время NREM-сна [16]. На основе предсказательной модели, выстроенной на 115 пациентах с обоими заболеваниями, даются оценки, согласно которым 4-часовая СиПАП-терапия оставит 60% обструктивных эпизодов во время REM-сна без лечения, а HbAc1 снизится на 0,25%.…”

“…В частности, это связано с более высокой представленностью REM-сна в утренние часы, уже после того, как пациент снимает маску СиПАП. В то же время при 7-часовой длительности лечение охва-тит 85% REM-сна и приведет к снижению HbA1c на 1% [16]. С нашей точки зрения, это означает, что подгруппе больных СОАС с СД2 необходим собственный минималь-ный порог приверженности к терапии, возможно, даже больший, чем в нашем исследовании.…”