Clinical Outcomes and Cost-effectiveness of Continuous Positive Airway Pressure to Manage Obstructive Sleep Apnea in Patients With Type 2 Diabetes in the U.K.

Abstract

OBJECTIVETo assess clinical outcomes and cost-effectiveness of using continuous positive airway pressure (CPAP) to manage obstructive sleep apnea (OSA) in patients with type 2 diabetes (T2D) from the perspective of the U.K.'s National Health Service (NHS). RESEARCH DESIGN AND METHODSUsing a case-control design, 150 CPAP-treated patients with OSA and T2D were randomly selected from The Health Improvement Network (THIN) database (a nationally representative database of patients registered with general practitioners in the U.K.) and matched with 150 OSA and T2D patients from the same database who were not treated with CPAP. The total NHS cost and outcomes of patient management in both groups over 5 years and the cost-effectiveness of CPAP compared with no CPAP treatment were estimated. RESULTSUsing CPAP was associated with significantly lower blood pressure at 5 years and increasingly lower HbA 1c levels over 5 consecutive years compared with untreated OSA patients. At 5 years, the HbA 1c level in the CPAP-treated group was 8.2% (66.0 mmol/mol) vs. 12.1% (108.4 mmol/mol) in the control group (P < 0.03). Use of CPAP significantly increased patients' health status by 0.27 quality-adjusted life years (QALYs) per patient over 5 years (P < 0.001) and NHS management costs by £4,141 per patient over 5 years; the cost per QALY gained with CPAP was £15,337. CONCLUSIONSInitiating treatment with CPAP in OSA patients with T2D leads to significantly lower blood pressure and better controlled diabetes and affords a cost-effective use of NHS resources. These observations have the potential for treatment modification if confirmed in a prospective study.

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

“…13 Treating OSA in adults using CPAP improves IR, although the impact on glycemia is more unpredictable. 14 In children, the association of OSA with IR and MetSyn has been inconsistent: some studies have found that OSA increases risk of IR 15 and dyslipidemia, 16 whereas others have found that IR and MetSyn are primarily determined by obesity. 17,18 Most studies have examined associations rather than causal relationships.…”

Response to Comment on Guest et al. Clinical Outcomes and Cost-effectiveness of Continuous Positive Airway Pressure to Manage Obstructive Sleep Apnea in Patients With Type 2 Diabetes in the U.K. Diabetes Care 2014;37:1263–1271

“…OSA is prevalent among patients with diabetes and may contribute to several important aspects, including glycemic control, hypertension, cardiovascular disease, and microvascular complications (3,4). In our observational study in a clinical setting, patients with type 2 diabetes and untreated OSA developed higher HbA 1c levels (and blood pressure) compared with best-matched patients treated with continuous positive airway pressure (CPAP), despite greater prescription of antidiabetes medications (2). Although data were unavailable, it is likely that the patients studied had significant symptomatic OSA given their BMI and the usual symptom-driven presentation to primary care.…”

“…A potential association between obstructive sleep apnea (OSA) and diabetes is intriguing, as acknowledged in the commentary by Tahrani (1) on our article (2). OSA is prevalent among patients with diabetes and may contribute to several important aspects, including glycemic control, hypertension, cardiovascular disease, and microvascular complications (3,4).…”

Артеріальна Гіпертензія, Синдром Обструктивного Апное Сну Та Серцево-Судинний Ризик

“…Ефект СРАР-терапії підвищувався зі збіль-шенням прихильності до лікування і був більш вираженим при СОАС середнього та тяжкого ступенів, ожирінні та у випадках погано конт-рольованого діабету [17,46].…”