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CPAP fails to improve glycemic control in adults with diabetes, sleep apnea
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Continuous positive airway pressure therapy had no effect on glycemic control in adults with relatively well-controlled type 2 diabetes and newly diagnosed obstructive sleep apnea, according to study findings published in the American Journal of Respiratory and Critical Care Medicine.
“The prevalence of obstructive sleep apnea is high in type 2 diabetes, and clinicians should therefore have a high index of suspicion for it among patients with type 2 diabetes,” Jonathan E. Shaw, MD, FRACP, FRCP, FAAHMS, associate professor and head of population health at the Baker IDI Heart and Diabetes Institute in Melbourne, Australia, told Endocrine Today. “Treating sleep apnea with [continuous positive airway pressure] can be expected to lead to the established benefits in terms of improved daytime sleepiness, quality of life and reduced blood pressure. However, we found no evidence that it would improve glycemic control, despite findings from previous studies that sleep apnea might have an adverse effect on glucose metabolism.”
Jonathan E. Shaw
In an open-label, randomized, parallel-group trial, Shaw and colleagues analyzed data from 298 adults with type 2 diabetes and no previous diagnosis of obstructive sleep apnea attending hospital and specialist clinics in Australia and North America. Participants had HbA1c between 6.5% and 8.5% and an oxygen desaturation index of at least 15 events per hour. Researchers randomly assigned participants to 6 months of continuous positive airway pressure (CPAP) therapy (S8 Autoset Spirit II, ResMed) or to usual care. All participants attended monthly clinic appointments after weekly appointments to assess glucose control, measure adherence to CPAP therapy and report any adverse events. Adherence to CPAP therapy was defined as using the device at least 4 hours per night.
Researchers found no between-group differences in HbA1c at either the 3- or 6-month visits; results persisted after adjusting for difference in BMI over time between groups. The CPAP group experienced a greater mean decrease in diastolic BP compared with the usual care group (–3.5 mm Hg vs. –1.5 mm Hg; P = .07) that was significant among participants who were adherent to CPAP therapy (–4.4 mm Hg vs. –1.6 mm Hg; P = .02). There were no between-group differences observed for systolic BP.
The CPAP group also reported improved daytime sleepiness vs. usual care, measured by the Epworth Sleepiness Scale (P < .0001); researchers also noted significant improvements in vitality, mental health and mental component summary scores among adherent CPAP users.
“It remains possible that there are glycemic benefits of CPAP in either preventing diabetes in those with prediabetes or in improving glycemic control those with poorly controlled diabetes,” Shaw said. “Neither of these groups were included in our study, so it remains important to explore the effects in these populations.” – by Regina Schaffer
For more information:
Jonathan E. Shaw, MD, FRACP, FRCP, FAAHMS, can be reached at the Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, Victoria, Australia, 3004; email: Jonathan.shaw@bakeridi.edu.au.
Disclosure: This study was funded by ResMed Science Center. Shaw reports receiving speakers’ fees and serving on advisory boards for Abbott, AstraZeneca, Janssen, Merck, Novartis, Novo Nordisk, Pfizer, Sanofi and Takeda.
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