CPAP, Glycemia, and Diabetes Risk in Patients With Obstructive Sleep Apnea and Comorbid CVD
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
Despite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA.
RESEARCH DESIGN AND METHODS
Blood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea Cardiovascular End Points (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus usual care, or usual care alone. Serum glucose and glycated hemoglobin A1c (HbA1c) were measured at baseline, 6 months, and 2 and 4 years and incident diabetes diagnoses recorded.
RESULTS
Median follow-up was 4.3 years. In those with preexisting diabetes (n = 274), there was no significant difference between the CPAP and usual care groups in serum glucose, HbA1c, or antidiabetic medications during follow-up. There were also no significant between-group differences in participants with prediabetes (n = 452) or in new diagnoses of diabetes. Interaction testing suggested that women with diabetes did poorly in the usual care group, while their counterparts on CPAP therapy remained stable.
CONCLUSIONS
Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affects glycemic control in those with diabetes or prediabetes or diabetes risk over standard-of-care treatment. The potential differential effect according to sex deserves further investigation.
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Additional Info
Disclosure statements are available on the authors' profiles:
Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease
Diabetes Care 2020 Apr 14;[EPub Ahead of Print], KA Loffler, E Heeley, R Freed, R Meng, LR Bittencourt, CC Gonzaga Carvalho, R Chen, M Hlavac, Z Liu, G Lorenzi-Filho, Y Luo, N McArdle, S Mukherjee, HS Yap, X Zhang, LJ Palmer, CS Anderson, RD McEvoy, LF DragerFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This secondary analysis suggests that continuous positive airway pressure (CPAP) therapy does not significantly affect glycemic control or progression to diabetes when evaluated in a real-world population with obstructive sleep apnea (OSA) that was poorly adherent to CPAP, not severely hypoxemic, and had milder sleepiness. The population consisted of nondiabetics, prediabetics, and diabetics with reasonable glucose control. This study is a subanalysis of the Sleep Apnea cardioVascular Endpoints (SAVE) trial and was not initially statistically powered for metabolic outcomes. The initial study excluded patients with severe sleepiness and severe oxygen desaturation, suggesting lower-risk OSA in the population. Average CPAP use was 3.7 hours per night in the original study, suggesting inadequate therapy as the goal of CPAP is to correct OSA during the entire sleep period.1 Adherence was evaluated in this study for correlation with glycemic control and did not appear to have a significant effect. Interestingly, there was an interaction between glycemic control and sex, as women in the usual care population had worse glycemic control than those treated with CPAP. The data on glycemic control with CPAP therapy have been mixed and have been investigated with a variety of study designs.2-6
The benefit of this study is that it was a relatively larger, longer, randomized control trial. Ultimately, more research must be done to evaluate the efficacy of CPAP on glycemic control; however, there did not appear to be a significant effect in this lower-risk population with more reasonable baseline glycemic control.
References