Obstructive Sleep Apnea, Sleepiness, and Glycemic Control in Type 2 Diabetes

Abstract

Study Objectives: Self-reported sleepiness is common in patients with obstructive sleep apnea (OSA) and is being increasingly recognized as an effect modifier of the association between OSA and cardiovascular outcomes. However, data on whether sleepiness modifies the association between OSA and glycemic outcomes are lacking. The current study sought to characterize the association between glycemic control and sleepiness in people with OSA and type 2 diabetes. Methods: Adults with non-insulin requiring type 2 diabetes and undiagnosed moderate to severe OSA were recruited from the community. Demographic data, Epworth Sleepiness Scale (ESS), hemoglobin A1c (HbA1c), as well a type III home sleep test were obtained. The association between self-reported sleepiness and glycemic control was examined using quantile regression. Results: The study cohort included 311 participants with 56% of the sample being men. Stratified analyses by sex demonstrated that self-reported sleepiness was associated with a higher HbA1c level, but this association was present only in men with a body mass index (BMI) < 35 kg/m 2. Mean HbA1c levels were higher by 0.57% (95% confidence interval: 0.11, 1.02) in men with an ESS ≥ 11 compared to men with an ESS < 11. No such association was observed in men with a BMI ≥ 35 kg/m 2 or in women of any BMI category. Conclusions: The association between self-reported sleepiness and glycemic control in people with type 2 diabetes and moderate to severe OSA varies a function of BMI and sex. The noted differences in association should be considered when assessing possible treatment effects of therapy for OSA on metabolic outcomes.

Impact of obstructive sleep apnea complicated with type 2 diabetes on long-term cardiovascular risks and all-cause mortality in elderly patients

“…Some studies show that OSA is associated with an increased risk of death and cardiovascular disease [ 2 , 3 ]. Type 2 diabetes is a frequent comorbidity in patients with OSA [ 4 – 6 ]. Intermittent hypoxaemia and sleep fragmentation in OSA could contribute independently to the development of insulin resistance, glucose intolerance and type 2 diabetes.…”

Can Long-term Treatment of Obstructive Sleep Apnea With CPAP Improve Glycemia and Prevent Type 2 Diabetes?

“…Moreover, a few studies have shown that OSA severity as measured by hypoxemic burden during sleep is associated with insulin resistance and type 2 diabetes only in sleepy subjects (19,20). The issue of sex differences is also of interest; a previous study in patients with type 2 diabetes revealed that the relationship between OSA severity and HbA 1c was not seen in women (21), yet the current study suggested benefits of CPAP in women only.…”

Postprandial glucose and HbA1c are associated with severity of obstructive sleep apnoea in non-diabetic obese subjects

“…Moreover, several other blood metabolites other than 2 h-PG, HbA1c and uric acid, such as circulating complement component 3, CRP and erythropoietin, have recently been raised as promising biomarkers supporting the diagnosis of OSA [48][49][50][51].…”