Effects of continuous positive airway pressure on glycemic control and insulin resistance in patients with obstructive sleep apnea: a meta-analysis

Yang, Dan; Liu, Zhihong; Yang, Haixing; Luo, Qin

doi:10.1007/s11325-012-0680-8

Cited by 105 publications

(73 citation statements)

References 35 publications

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“…In the meta-analysis by Yang and colleagues (24), the authors based their results on pre-and postintervention data obtained mostly from observational studies. Their study showed a statistically significant effect of CPAP on HOMA-IR.…”

Section: Original Articlementioning

confidence: 99%

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Meta-analysis: Continuous Positive Airway Pressure Improves Insulin Resistance in Patients with Sleep Apnea without Diabetes

et al. 2013

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Rationale: Obstructive sleep apnea (OSA) is an independent risk factor for the development of insulin resistance (IR). Treatment with continuous positive airway pressure (CPAP) for OSA has shown conflicting results on IR.Objectives: To conduct a meta-analysis of randomized controlled trials (RCTs) that have evaluated the effect of CPAP on a validated index of IR, the homeostasis model assessment of insulin resistance (HOMA-IR).Methods: PubMed and Embase were searched through August 10, 2012. Two independent reviewers screened citations to identify trials of the effect of CPAP on HOMA-IR. Data were extracted for postintervention HOMA-IR values. Measurements and Main Results:A total of five studies that enrolled 244 subjects (83% male) met the inclusion criteria. None of the subjects in the included studies had diabetes. The pooled estimate of the difference in means in HOMA-IR between the CPAP and sham CPAP/control groups was 20.44 (95% confidence interval, 20.82 to 20.06; P = 0.02). The funnel plot does not suggest the presence of any publication bias. The I-squared index for the data on difference in means in HOMA-IR between the CPAP and sham CPAP/control groups was 0.00 (P = 0.61). Conclusions:The pooled estimate of RCTs shows a favorable effect of CPAP on insulin resistance as measured by HOMA-IR in patients with OSA without diabetes. The effect size on HOMA-IR is modest, but not insignificant, when compared with the effects of thiazolidinedione in nondiabetic patients with metabolic syndrome. Further research and RCTs are warranted involving a larger number of patients and longer treatment periods to determine the beneficial effects of CPAP on IR.

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Section: Original Articlementioning

confidence: 99%

“…Two previous meta-analyses have studied the effect of CPAP on HOMA-IR with conflicting results (24,25). Since the publication of these two meta-analyses, two additional randomized control trials (RCTs) (26,27) that reported the effect of CPAP on HOMA-IR were completed that enrolled more OSA subjects than the prior studies combined.…”

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confidence: 99%

Meta-analysis: Continuous Positive Airway Pressure Improves Insulin Resistance in Patients with Sleep Apnea without Diabetes

et al. 2013

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“…9 In adults with obesity and OSA, the homeostasis model assessment of insulin resistance (HOMA-IR) is a well-accepted surrogate marker of insulin sensitivity 10 that has been shown to improve following PAP therapy. 9,11 The association between OSA and insulin resistance is inconsistent across pediatric studies, possibly due to heterogenous populations of different ages and pubertal stages. Four small pediatric studies have not shown significant improvements in IR with adenotonsillectomy in young children with OSA, some of whom were obese.…”

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confidence: 99%

Insulin Resistance and Hypertension in Obese Youth With Sleep-Disordered Breathing Treated With Positive Airway Pressure: A Prospective Multicenter Study

Katz

MacLean

Hoey

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: There is evidence that cardiometabolic disease associated with obesity and sleep-disordered breathing (SDB) in adults is present in youth. SDB is often treated with positive airway pressure (PAP) in youth with obesity. Our aims were to determine: (1) the prevalence of cardiometabolic disease and (2) whether PAP improves markers of cardiometabolic disease, in youth with obesity and newly diagnosed moderate-severe SDB. Methods: A prospective multicenter cohort study was conducted in youth (8 to 16 years old) with obesity, prescribed PAP therapy for newly diagnosed moderate-severe SDB. Assessments occurred at baseline and at 6 and 12 months. Outcomes included markers of insulin resistance (change in homeostasis model assessment of insulin resistance (HOMA-IR) at 6 months = primary outcome), hypertension (24-hour ambulatory/blood pressure) and inflammation (high-sensitivity C-reactive protein: hs-CRP). Results: Twenty-seven participants were enrolled. Of those with baseline testing available, 10/25 (40%) had HOMA-IR above the 97th percentile, 10/23 (44%) were hypertensive, 16/23 (70%) had loss of nocturnal blood pressure dip and hs-CRP was elevated in 16/27 (64%). There were no significant changes over time in markers of metabolic dysfunction or blood pressure, nor between PAP-adherent and non-adherent subgroups. Conclusions:In youth with obesity and SDB, metabolic dysfunction and hypertension were highly prevalent. There were no statistically significant improvements in cardiometabolic markers 1 year after the prescription of PAP therapy, although clinically relevant improvements were seen in insulin resistance and systolic blood pressure load, important predictors of future risk of cardiovascular disease. Larger, longer-term studies are needed to determine whether PAP improves cardiometabolic outcomes in obese youth. I NTRO DUCTI O NThe fivefold increase in prevalence of childhood obesity in North America over the past 20 years has led to an increasing number of pediatric cases of obesity-related sleep-disordered breathing (SDB), which includes both obstructive sleep apnea (OSA) and nocturnal hypoventilation.1 The prevalence of SDB, particularly OSA, is significantly higher among obese children (13% to 66%) compared with the general population (1% to 3%).2 Routine treatment for SDB with adenotonsillectomy is not curative in 70% to 80% of children with obesity.3 Thus, positive airway pressure (PAP) treatment is usually prescribed. 2Additional obesity-related complications are also increasingly recognized in children, including metabolic disturbances with insulin resistance (IR) and hypertension. 4,5 This is concerning, as IR is an identified surrogate measure of future obesity-related sequelae, including diabetes, , hypertension, and systemic inflammation) is highly prevalent at the time of SDB diagnosis in youth with obesity. We were unable to detect statistically significant improvements in cardiometabolic markers 1 year after prescription of PAP therapy. There were, however, clinically relevan...

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“…Two recent meta-analyses, which included non-randomised trials as well as trials with non-diabetic and diabetic OSA patients, demonstrated that CPAP treatment improved insulin sensitivity. (31,32) However, in the only randomised controlled trial by West et al, which specifically evaluated the impact of CPAP treatment on glycaemic control in known Type 2 diabetic patients with newly diagnosed OSA, three months of CPAP intervention did not reveal any significant benefit for insulin resistance or HbA1c. (33) It is possible that longer durations of CPAP usage per night may be required to achieve improvements in glycaemic control.…”

Section: Does Cpap Improve Dm?mentioning

confidence: 97%

Obstructive sleep apnoea and Type 2 diabetes mellitus: are they connected?

Mok

Tan

Wong

et al. 2017

smedj

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Effects of continuous positive airway pressure on glycemic control and insulin resistance in patients with obstructive sleep apnea: a meta-analysis

Cited by 105 publications

References 35 publications

Meta-analysis: Continuous Positive Airway Pressure Improves Insulin Resistance in Patients with Sleep Apnea without Diabetes

Meta-analysis: Continuous Positive Airway Pressure Improves Insulin Resistance in Patients with Sleep Apnea without Diabetes

Insulin Resistance and Hypertension in Obese Youth With Sleep-Disordered Breathing Treated With Positive Airway Pressure: A Prospective Multicenter Study

Obstructive sleep apnoea and Type 2 diabetes mellitus: are they connected?

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