Effects of Sleep Apnea Severity on Glycemic Control in Patients with Type 2 Diabetes Prior to Continuous Positive Airway Pressure Treatment

Abstract

Increased severity of OSA is independently associated with worsening glycemic control following adjustment of various confounders, including insulin dosage. We would hypothesize therefore that identification and treating OSA among patients with T2D may confer benefits in improving glycemic control.

Intermittent hypoxia is an independent marker of poorer glycaemic control in patients with uncontrolled type 2 diabetes

“…The risk of poorer glycaemic control in patients with IH was independent of general and abdominal adiposity and other potentially confounding factors. An association between increased OSA severity and higher HbA 1c levels had been previously described in adults with no known diabetes [23] and in smaller samples of patients with T2D (n = 60 [17] and n = 52 [19] patients). In contrast, another study showed no correlation between HbA 1c levels and AHI in 165 patients with T2D [18].…”

“…The potential effects of OSA on glucose control in patients with T2D is also unclear. The few studies that have addressed whether OSA is associated with poor glycaemic control have found conflicting results [17][18][19], and the prevalence of OSA in stable patients with uncontrolled T2D is unknown.…”

Prevalence and Associations of Obstructive Sleep Apnea in South Asians and White Europeans with Type 2 Diabetes: A Cross-Sectional Study

“…[32][33][34] Although direct comparison with these studies is not possible because of differences in methodology and population characteristics, the higher prevalence of OSA in South Asians with T2DM in our study compared to the prevalence of OSA in the general South Asians population is consistent with many studies that showed a high prevalence of OSA in patients with T2DM. [9][10][11][12][13][14][15][16][17][18][19][20][21] Two other studies compared the prevalence of OSA in South Asians and White Europeans in the context of the metabolic syndrome and/or obesity rather than diabetes, and the results were conflicting. 35,36 In one, the prevalence of OSA was 28.3% and there was no difference between South Asians and White Europeans.…”

“…8 The reported prevalence of OSA in patients with T2DM varies considerably between studies (8.5% to 86%). [9][10][11][12][13][14][15][16][17][18][19][20][21] These discrepancies may reflect differences in the population examined (such as the setting of care, sex, ethnicities, degree of obesity, etc. ), the methods used to diagnose OSA (such as questionnaires, portable home-based devices, polysomnography), and the parameters and definitions used to diagnose OSA (the apnea-hypopnea index (AHI) versus oxygen desaturation index (ODI), cutoffs of 5, 10 or 15 events/h).…”

Obstructive sleep apnoea: a diabetologist’s perspective

“…15,[48][49][50] Lower nocturnal oxygen saturations were associated with higher HbA1c values in one study, 51 but elsewhere there was no association between OSA and HbA1c, 52 probably because only 22% of participants had full polysomnography and the duration of the sleep study was just 4 hours. 53 Prospective studies assessing the impact of OSA on glycaemic measures longitudinally in patients with T2D are lacking.…”