The Relationship between Diabetes-Related Complications and Obstructive Sleep Apnea in Type 2 Diabetes

Abstract

This study explored the relationship between obstructive sleep apnea (OSA) and the presence of any diabetes-related complications in type 2 diabetes and whether this was mediated by hypertension. Secondly, the relationship between OSA severity and estimated glomerular filtration rate (eGFR) was investigated. A total of 131 patients participated. OSA was diagnosed using a home monitor, and severity was measured by apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). OSA was found in 75.6% of the participants, 40.5% with moderate-to-severe degree. Any diabetes-related complications (retinopathy, neuropathy, nephropathy, or coronary artery disease) were present in 55.5%, and 70.2% of the participants had hypertension. Mediation analysis indicated that, compared to those with mild or no OSA, those with moderate-to-severe OSA were 3.05 times more likely to have any diabetes-related complications and that this relationship was mediated by the presence of hypertension. After adjusting for confounders, ODI (B = −0.036, p = 0.041), but not AHI, was significantly associated with lower eGFR. In conclusion, moderate-to-severe OSA was related to the presence of any diabetes-related complications in type 2 diabetes, and the relationship was mediated by hypertension. The severity of intermittent hypoxia was associated with lower eGFR. Whether OSA treatment will delay or reduce diabetes-related complications should be investigated.

Associations between ankle-brachial index, diabetes, and sleep apnea in the Hispanic community health study/study of Latinos (HCHS/SOL) database

“…In another population-based study, our findings were in line with the results that the severity of OSA had a significant effect and association with impaired fasting glucose levels after adjusting for demographics and sleep duration [27]. Further, Siwasaranond et al observed that individuals with moderate-to-severe OSA and DM were 3.05 times more likely to experience DM-related complications, such as neuropathy and coronary artery disease [28]. In another study, PAD was found to be significantly associated with SA, however, the association was attenuated after adjusting for multiple comorbidities, including DM.…”

The association between sleep efficiency and diabetes mellitus in community‐dwelling individuals with or without sleep‐disordered breathing

“…Recent studies have shown that SDB is associated with the occurrence of diabetes . SDB was also found to be closely related to daytime sleepiness and insomnia .…”

Effect of Glucose Improvement on Nocturnal Sleep Breathing Parameters in Patients with Type 2 Diabetes: The Candy Dreams Study

“…It should be noted that in our study, the group of good responders experienced a 23.3% reduction in their AHI after almost 4 months of metabolic improvement. As OSA significantly elevates the risk of microangiopathy, kidney disease, coronary heart disease and all-cause mortality in patients with type 2 diabetes in comparison with non-diabetic individuals, it seems reasonable to postulate positive clinical consequences for this intervention [16,17]. In addition, our results might provide new insights into how metabolic control is associated with the prevention and amelioration of diabetic complications.…”

“…Although intermittent hypoxia and sleep fragmentation, the two hallmarks of OSA, have been associated with insulin resistance and higher rates of type 2 diabetes, the effect of CPAP treatment on insulin resistance and glycemic control is conflicting [1,17,23]. Two recent meta-analyses involving 1077 participants with type 2 diabetes showed no effectiveness regarding changes in HbA1c, fasting glucose or fasting insulin levels after 12 or 24 weeks of CPAP treatment [24,25].…”