Effect of Continuous Positive Airway Pressure on Glycemic Control in Patients with Obstructive Sleep Apnea and Type 2 Diabetes. A Randomized Clinical Trial

Martínez‐Cerón, Elisabet; Barquiel, Beatriz; Bezos, Ana-Maria; Casitas, Raquel; Galera, Raúl; García-Benito, Cristina; Hernánz, Ángel; Alonso-Fernández, Alberto; García‐Río, Francisco

doi:10.1164/rccm.201510-1942oc

Cited by 177 publications

(142 citation statements)

References 49 publications

Supporting

Mentioning

122

Contrasting

Order By: Relevance

“…OSA and dysglycemia limited impact on improvement of glycemic control in patients with T2DM [12][13][14][15], although the effect of CPAP therapy on glycemic control depends on adherence to therapy. Thus, although we confirmed that the severity of OSA is associated with HbA1c level in Japanese nondiabetic individuals, the impact of OSA on glycemic control in Japanese patients with T2DM needs further investigation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

Abstract. Aim of this study was to examine the association between the severity of obstructive sleep apnea (OSA) and dysglycemia in Japanese individuals with and without type 2 diabetes (T2DM). We enrolled 115 individuals diagnosed with OSA with an apnea hypopnea-index (AHI) ≥ 20 in whom continuous positive airway pressure (CPAP) therapy was introduced (N = 115, 44 with T2DM, age 62 ± 11 years, BMI 27.0 ± 4.4 kg/m 2 and AHI median 36.1; interquartile range 27.2-48.1). During admission, the severity of OSA was evaluated by polysomnography, and its association with glycated hemoglobin (HbA1c) level was examined. Continuous glucose monitoring (CGM) was also conducted during the admission in 94 individuals. Apnea-hypopnea index (AHI), non-rapid eye movement (REM) AHI, minimum peripheral capillary oxygen saturation (SpO 2 ) and percentage of sleep time (%TST) with SpO 2 < 90% were significantly associated with HbA1c level in total and non-diabetic individuals (all p < 0.05) but not in those with T2DM, the majority of whom were treated with antidiabetic medications. The associations of the non-REM AHI and %TST with SpO 2 < 90% with HbA1c level remained significant after adjustment for age, sex and BMI in non-diabetic and T2DM subjects treated with dietary therapy only. Mean glucose level, but not SD or coefficient of variation of glucose, assessed by CGM was significantly associated with AHI and non-REM AHI in non-diabetic subjects after adjustment for age, sex and BMI. In conclusion, the severity of OSA was associated with increased HbA1c level independently of BMI in Japanese individuals, especially in those without diabetes.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

show abstract

“…One large randomized clinical trial of PAP therapy in adults with T2DM and SDB showed no effect on HbA1c, but was limited by PAP adherence in only 61.3% of subjects, and an elevated mean residual AHI of 6.2 [5]. In contrast to this, another recent randomized trial of PAP therapy in adults with T2DM and SDB did show a significant reduction in HbA1c [6]. PAP adherence in this study was markedly higher (77%) compared to the prior study.…”

Section: Discussionmentioning

confidence: 91%

Glycemic Improvement with Sleep-Disordered Breathing Treatment in Prader–Willi Syndrome

Chin

Combs

2017

Sleep Vigilance

View full text Add to dashboard Cite

15q11-q13. Frequent comorbidities include obesity, sleepdisordered breathing (SDB) and impaired glucose metabolism. Patients with PWS are at high risk for SDB due to obesity, hypotonia and facial dysmorphism including micrognathia and small nasopharynx and/or oropharynx. We report a morbidly obese 11-year-old girl with PWS, SDB and insulin-dependent type 2 diabetes mellitus (T2DM) with dramatic glycemic improvement following improved control of SDB with positive airway pressure (PAP) therapy treatment after a hospitalization for obesity hypoventilation syndrome and cor pulmonale. Case HistoryThe patient was diagnosed with PWS by genetic testing at 3 months of age. Three years later, she was diagnosed with severe obstructive sleep apnea (OSA) with an apnea-hypopnea index (AHI) of 59 events per hour (normal < 1.5). She subsequently underwent adenotonsillectomy and uvulopalatopharyngoplasty. Four months following surgery, she had a repeat polysomnogram that showed a post-surgical residual AHI of 13 and she was started on PAP therapy. She was diagnosed with T2DM at 6 years of age and was started on basal-bolus insulin therapy and metformin. Due to her severe obesity, T2DM and SDB, she has not been treated with growth hormone. Additionally, while there is some promising research suggesting that bariatric surgery may have a role in weight management for children with PWS [1], bariatric surgery is not available for children at our center. By 8 years of age, she no longer tolerated PAP therapy and was instead initiated on nocturnal supplemental oxygen therapy. Repeat polysomnogram performed on 4 LPM O 2 via nasal cannula at 9 years of age showed persistent OSA (AHI of 7.1) and nocturnal hypoventilation, and PAP Abstract Prader-Willi syndrome (PWS) is a genetic condition frequently associated with extreme obesity, sleep-disordered breathing (SDB) and impaired glucose metabolism. We report an 11-year-old girl with PWS, morbid obesity, SDB and insulin-dependent type 2 diabetes mellitus who had a marked decrease in her hemoglobin A1c following improved control of her SDB. SDB has been shown to impair glucose metabolism though trials of SDB treatment have reported mixed effects on glucose metabolism. This case shows an association between improved control of SDB with optimal positive airway pressure therapy and improved glycemic control in a patient with PWS, extreme obesity and poorly controlled type 2 diabetes mellitus. These findings highlight the need for further investigation into the effects of SDB treatment on glucose regulation in children, particularly in the setting of PWS.

show abstract

“…MARTINEZ-CERON et al [14] have shown that 6 months, but not 3 months of CPAP treatment significantly reduced HbA1c levels in 50 patients with OSA, type 2 diabetes mellitus and baseline HbA1c ⩾6.5% compared with conservative therapy. PAMIDI et al [28] randomised 39 participants with OSA and pre-diabetes to receive either 8 h nightly CPAP or oral placebo for 2 weeks, and found that CPAP treatment improved glucose metabolism compared with placebo.…”

Section: Discussionmentioning

confidence: 97%

“…One very recent meta-analysis of seven studies with a total of 794 patients reported that all the trials predominantly recruited male patients, with a mean percentage of 74% male [12]. Similarly, the effect of CPAP on glucose and lipid metabolism has also been assessed in cohorts in which women usually accounted for <30-40% of the whole sample [14,[27][28][29][30]. Given that OSA differs between women and men, it cannot be taken for granted that the findings obtained in males can be translated to women.…”

Section: Discussionmentioning

confidence: 99%

“…High-quality evidence based on randomised controlled trials (RCTs) has demonstrated that CPAP reduces blood pressure [11][12][13]. Recent data suggest that it may also improve the glucose and lipid profile [14,15]. These studies failed to examine sex differences, however, and they were conducted in either exclusively or predominantly male cohorts.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of continuous positive airway pressure on blood pressure and metabolic profile in women with sleep apnoea

et al. 2017

View full text Add to dashboard Cite

Continuous positive airway pressure (CPAP) reduces blood pressure levels in hypertensive patients with obstructive sleep apnoea (OSA). However, the role of CPAP in blood pressure and the metabolic profile in women has not yet been assessed. In this study we investigated the effect of CPAP on blood pressure levels and the glucose and lipid profile in women with moderate-to-severe OSA.A multicentre, open-label, randomised controlled trial was conducted in 307 women diagnosed with moderate-to-severe OSA (apnoea-hypopnoea index ⩾15 events·h -1 ) in 19 Spanish Sleep Units. Women were randomised to CPAP (n=151) or conservative treatment (n=156) for 12 weeks. Changes in office blood pressure measures as well as in the glucose and lipid profile were assessed in both groups.Compared with the control group, the CPAP group achieved a significantly greater decrease in diastolic blood pressure (−2.04 mmHg, 95% CI −4.02-−0.05; p=0.045), and a nonsignificantly greater decrease in systolic blood pressure (−1.54 mmHg, 95% CI −4.58-1.51; p=0.32) and mean blood pressure (−1.90 mmHg, 95% CI −4.0-0.31; p=0.084). CPAP therapy did not change any of the metabolic variables assessed.In women with moderate-to-severe OSA, 12 weeks of CPAP therapy improved blood pressure, especially diastolic blood pressure, but did not change the metabolic profile, compared with conservative treatment.This article has supplementary material available from

show abstract

Effect of Continuous Positive Airway Pressure on Glycemic Control in Patients with Obstructive Sleep Apnea and Type 2 Diabetes. A Randomized Clinical Trial

Abstract: Among patients with suboptimally controlled type 2 diabetes and OSA, CPAP treatment for 6 months resulted in improved glycemic control and insulin resistance compared with results for a control group. Clinical trial registered with www.clinicaltrials.gov (NCT01801150).

Cited by 177 publications

References 49 publications

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

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

Glycemic Improvement with Sleep-Disordered Breathing Treatment in Prader–Willi Syndrome

Effect of continuous positive airway pressure on blood pressure and metabolic profile in women with sleep apnoea

Contact Info

Product

Resources

About