Effect of One Week of 8-Hour Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea on Glycemic Control in Type 2 Diabetes: A Proof-of-Concept Study

Mokhlesi, Babak; Grimaldi, Daniela; Beccuti, Guglielmo; Abraham, Varghese; Whitmore, Heidi; Delebecque, Fanny; Cauter, Eve Van

doi:10.1164/rccm.201602-0396le

Cited by 63 publications

(62 citation statements)

References 13 publications

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“…One possibility is that the level of PAP adherence obtained was insufficient to derive glycemic benefit. A small highly controlled single-arm trial suggested 8 hours of nightly PAP use over 2 weeks can improve fasting glucose levels in patients with type 2 diabetes, 11 and a recent observational study in patients without diabetes found a beneficial glycemic effect only in those with PAP usage ≥8 hrs/night on ≥90% of nights, 40 a level of use attained in only 6% of patients. Data from generalizable clinical settings suggest 46-83% of OSA patients use PAP at an average of <4 hrs/night, 41 which is consistent with our findings.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, investigations that have demonstrated glycemic benefits with OSA treatment in type 2 diabetes have carefully selected for patients most likely to benefit and used aggressive strategies to increase adherence with PAP therapy—limiting generalizability. 11, 14 By screening all type 2 diabetes patients in a typical academic general medicine practice and using feasible adherence strategies, our work provides the first prospective evidence on the effectiveness of an OSA screening and treatment program as part of usual practice. Such effectiveness studies are particularly necessary with complicated interventions like PAP.…”

Section: Discussionmentioning

confidence: 99%

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The effectiveness of an obstructive sleep apnea screening and treatment program in patients with type 2 diabetes

Donovan

Rueschman

Weng

et al. 2017

Diabetes Research and Clinical Practice

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Aims As recommended by current guidelines, we tested the acceptability and impact of screening patients with type 2 diabetes for obstructive sleep apnea (OSA). Methods In a large urban primary care practice, we instituted a telephone-based OSA screening program using a validated tool (STOP-BANG) in patients with type 2 diabetes. Patients identified as high risk were referred for diagnostic sleep testing, and those diagnosed with OSA were offered positive airway pressure (PAP) therapy. We evaluated the impact of PAP on sleep-related symptoms, glycemic control, and hospitalization rates. Results We identified 738 of 818 (90.1%) patients with type 2 diabetes as high risk for OSA. Only 29.2% (n=213) of high risk patients were willing to undergo diagnostic sleep testing. The prevalence of OSA was 90.6% in this group, but only 66.0% of those with OSA initiated PAP. Patients with higher burden of sleep symptoms were more likely to pursue testing and initiate therapy. PAP use was associated with reduced sleep-related symptoms (mean Epworth sleepiness scale score declined from 8.8 to 7.3, p<0.001), but did not impact hemoglobin A1c levels at one year (7.7 to 7.9%, p=0.12). Changes in glycemic control and hospitalization rates did not differ from comparator groups. Conclusions Despite a high prevalence of OSA, willingness to pursue diagnostic testing and treatment was low in an unselected type 2 diabetes population. Furthermore, glycemic control did not improve. Future screening programs should focus on patients with substantial sleep related symptoms as this group is most likely to derive benefit from treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effectiveness of an obstructive sleep apnea screening and treatment program in patients with type 2 diabetes

Donovan

Rueschman

Weng

et al. 2017

Diabetes Research and Clinical Practice

View full text Add to dashboard Cite

show abstract

“…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, a clinically significant effect size *[37]. To obtain definite evidence regarding the clinical efficacy of CPAP treatment to improve glucose control in T2DM, we recently completed a proof-of-concept study that was designed to test the hypothesis that one week of full night CPAP treatment of OSA in the laboratory, as compared to sham-CPAP (placebo), results in improvement in glycemic control as assessed by mean plasma glucose levels from 24-h blood sampling *[38]. In this study we employed a rigorous methodology of 24-h blood sampling, adherence to standardized meals during 24-h blood sampling, and ensuring CPAP adherence in order to address important limitations faced by several prior studies such as solely relying on fasting measures of glucose and insulin or HbA1c or being limited by low CPAP adherence.…”

Section: Rem Osa and Glucose Metabolismmentioning

confidence: 99%

Obstructive sleep apnea during rapid eye movement sleep

Alzoubaidi

Mokhlesi

2016

Current Opinion in Pulmonary Medicine

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Purpose of review Obstructive sleep apnea (OSA) is a highly prevalent condition that has been associated with cardiovascular morbidity and mortality, impaired glucose metabolism and daytime functional impairment. Compared with non-rapid eye movement (NREM) sleep, rapid eye movement (REM) sleep is associated with higher sympathetic activity and cardiovascular instability in healthy individuals and more so in patients with OSA. Recent findings Recent studies have indicated that REM OSA is independently associated with prevalent and incident hypertension, non-dipping of nocturnal blood pressure, increased insulin resistance and impairment of human spatial navigational memory. Summary These findings have significant clinical implications for the duration of continuous positive airway pressure (CPAP) use that is needed to decrease the health risks associated with OSA. Further research is needed to establish the duration of CPAP needed to effectively treat REM OSA and to evaluate patients with REM OSA with an overall normal apnea-hypopnea index (AHI).

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“…PAP adherence in this study was markedly higher (77%) compared to the prior study. Similarly, a 1-week proof of concept study demonstrated a significant decrease in HbA1c in adults with T2DM and SDB who used PAP therapy for 8 h/night, as compared to mean usage of 5 h/night in the prior reported studies [7]. These results suggest that higher adherence to PAP therapy may be critical to improving glucose control in individuals with T2DM.…”

Section: Discussionmentioning

confidence: 64%

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

Chin

Combs

2017

Sleep Vigilance

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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.

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Effect of One Week of 8-Hour Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea on Glycemic Control in Type 2 Diabetes: A Proof-of-Concept Study

Cited by 63 publications

References 13 publications

The effectiveness of an obstructive sleep apnea screening and treatment program in patients with type 2 diabetes

The effectiveness of an obstructive sleep apnea screening and treatment program in patients with type 2 diabetes

Obstructive sleep apnea during rapid eye movement sleep

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

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