Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study

Adderley, Nicola J; Subramanian, Anuradhaa; Toulis, Konstantinos; Gokhale, Krishna; Taverner, Thomas; Hanif, Wasim; Haroon, Shamil; Thomas, George; Sainsbury, Christopher; Tahrani, Abd A; Nirantharakumar, Krishnarajah

doi:10.2337/dc19-2116

Cited by 53 publications

(36 citation statements)

References 35 publications

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“…Obesity is a risk factor for both OSA and IIH and weight loss can modify both conditions [17][18][19]. The diagnosis of OSA is important as it is associated with poor quality of life as well as increased morbidity from Type 2 diabetes, cardiovascular disease, hypertension and increased mortality [20]. However, the impact of OSA on IIH clinical course is not clear.…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnoea in women with idiopathic intracranial hypertension: a sub-study of the idiopathic intracranial hypertension weight randomised controlled trial (IIH: WT)

et al. 2021

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Objective Obesity is a risk factor for idiopathic intracranial hypertension (IIH) and obstructive sleep apnoea (OSA). We aimed to determine the prevalence of OSA in IIH and evaluate the diagnostic performance of OSA screening tools in IIH. Additionally, we evaluated the relationship between weight loss, OSA and IIH over 12 months. Methods A sub-study of a multi-centre, randomised controlled parallel group trial comparing the impact of bariatric surgery vs. community weight management intervention (CWI) on IIH-related outcomes over 12 months (IIH:WT). OSA was assessed using home-based polygraphy (ApneaLink Air, ResMed) at baseline and 12 months. OSA was defined as an apnoea–hypopnoea index (AHI) ≥ 15 or ≥ 5 with excessive daytime sleepiness (Epworth Sleepiness Scale ≥11 ). Results Of the 66 women in the IIH: WT trial, 46 were included in the OSA sub-study. OSA prevalence was 47% (n = 19). The STOP-BANG had the highest sensitivity (84%) compared to the Epworth Sleepiness Scale (69%) and Berlin (68%) to detect OSA. Bariatric surgery resulted in greater reductions in AHI vs. CWI (median [95%CI] AHI reduction of – 2.8 [ – 11.9, 0.7], p = 0.017). Over 12 months there was a positive association between changes in papilloedema and AHI (r = 0.543, p = 0.045), despite adjustment for changes in the body mass index (R2 = 0.522, p = 0.017). Conclusion OSA is common in IIH and the STOP-BANG questionnaire was the most sensitive screening tool. Bariatric surgery improved OSA in patients with IIH. The improvement in AHI was associated with improvement in papilloedema independent of weight loss. Whether OSA treatment has beneficial impact on papilloedema warrants further evaluation. Trial registration number IIH: WT is registered as ISRCTN40152829 and on ClinicalTrials.gov as NCT02124486 (28/04/2014).

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Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnoea in women with idiopathic intracranial hypertension: a sub-study of the idiopathic intracranial hypertension weight randomised controlled trial (IIH: WT)

et al. 2021

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“…Dr Abd Tahrani from the University of Birmingham presented a comprehensive lecture on sleep and obesity emphasising that there are knowledge gaps in sleep disorders and circadian alignment on metabolic outcomes (Adderley et al, 2020). For example, there is a paucity of data on the impact of sleep extension in people with obesity or type 2 diabetes, and how short sleep duration impacts on health-related outcomes.…”

Section: Non-nutritional Influences On Appetite (Sleep Stress) As Modifiable Behaviours That Impact On Appetite -Future Research Perspectmentioning

confidence: 99%

MRC Hot Topic workshop report: Reshaping the food environment – applying interdisciplinary perspectives in appetite research

Johnstone

Brown

2021

Nutrition Bulletin

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The prevalence of obesity, both worldwide and in the UK, continues to rise and has been classified by the NHS as a major public health issue with current public health survey data indicating that nearly two thirds of adults are living with overweight and obesity. We know from existing appetite research that it is easy to overconsume calories, but difficult to reduce calorie intake below requirements and we seek to expand this evidence base to seek future research themes to provide the evidence on how to manage obesity. This Medical Research Council (MRC)‐funded hot topic workshop explored issues that are evolving from current literature to create discussion about potential future collaborative research around 4 themes: (i) Food reformulation/innovation – how appetite research can influence sustainable and healthy diets, (ii) One diet does not fit all – how should we conduct appetite research to embrace inter‐individual differences (e.g. responder/non‐responders), (iii) Environmental drivers of obesity/food choices – bridging the gap between appetite research and obesity services – future research themes, (iv) Big data approaches to develop understanding of drivers of appetite and food choice. Appetite forms a bridge to understanding the interaction between the internal and external environments and therefore has both biological and behavioural relevance for behaviour change associated with eating. This report summarises how future research can embrace this multidisciplinary challenge.

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“…OSA is a condition characterized by recurrent loss of tone of the upper airway resulting in hypopnoea (partial obstruction) and apnoea (complete obstruction) causing hypoxia and subsequent waking from sleep [ 6 ]. It is a significant contributor to motor vehicle accidents when not treated [ 7 ], and has been shown to exacerbate long-term diabetes complications such as cardiovascular disease (CVD), neuropathy, retinopathy and nephropathy [ 8 – 11 ]. While polysomnography is the “gold standard” for OSA diagnosis, it is often not widely used due to its costs and reduced availability.…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnoea and 12-month weight loss in adults with class 3 obesity attending a multidisciplinary weight management program

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Background Although there is a strong association between obesity and obstructive sleep apnoea (OSA), the effects of OSA and CPAP therapy on weight loss are less well known. The aim of this study in adults with class 3 obesity attending a multidisciplinary weight management program was to assess the relationship between OSA and CPAP usage, and 12-month weight change. Methods A retrospective cohort study of all patients commencing an intensive multidisciplinary publicly funded weight management program in Sydney, Australia, between March 2018 and March 2019. OSA was diagnosed using laboratory overnight sleep studies. Demographic and clinical data, and use of CPAP therapy was collected at baseline and 12 months. CPAP use was confirmed if used ≥4 h on average per night on download. Results Of the 178 patients who joined the program, 111 (62.4 %) completed 12 months in the program. At baseline, 63.1 % (n=70) of patients had OSA, of whom 54.3 % (n=38) were using CPAP. The non-OSA group had more females compared to the OSA with CPAP group and OSA without CPAP group (90.2 % vs. 57.9 % and 62.5 %, respectively; p=0.003), but there were no significant baseline differences in BMI (50.4±9.3 vs. 52.1±8.7 and 50.3±9.5 kg/m2, respectively; p=0.636). There was significant weight loss across all three groups at 12 months. However, there were no statistically significant differences across groups in the percentage of body weight loss (OSA with CPAP: 6.3±5.6 %, OSA without CPAP: 6.8±6.9 %, non-OSA: 7.2±6.5 %; p=0.844), or the proportion of patients who achieved ≥5 % body weight loss (OSA with CPAP: 57.9 %, OSA without CPAP: 59.4 %, non-OSA: 65.9 %; p=0.743). In patients with T2DM, there was a significant reduction in HbA1c from baseline to 12 months (7.8±1.7 % to 7.3±1.4 %, p=0.03), with no difference between groups (p=0.997). Conclusions This multidisciplinary weight management program resulted in significant weight loss at 12 months, regardless of OSA diagnosis or CPAP use in adults with class 3 obesity. Larger studies are needed to further investigate the effects of severity of OSA status and CPAP use in weight management programs. Until completed, this study suggests that the focus should remain on implementing lifestyle changes and weight management regardless of OSA status.

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Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study

Cited by 53 publications

References 35 publications

Obstructive sleep apnoea in women with idiopathic intracranial hypertension: a sub-study of the idiopathic intracranial hypertension weight randomised controlled trial (IIH: WT)

Obstructive sleep apnoea in women with idiopathic intracranial hypertension: a sub-study of the idiopathic intracranial hypertension weight randomised controlled trial (IIH: WT)

MRC Hot Topic workshop report: Reshaping the food environment – applying interdisciplinary perspectives in appetite research

Obstructive sleep apnoea and 12-month weight loss in adults with class 3 obesity attending a multidisciplinary weight management program

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