Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease
Author:
Loffler Kelly A.1ORCID, Heeley Emma12, Freed Ruth2, Meng Rosie3, Bittencourt Lia R.4, Gonzaga Carvalho Carolina C.5, Chen Rui6, Hlavac Michael7, Liu Zhihong8, Lorenzi-Filho Geraldo9, Luo Yuanming10, McArdle Nigel11, Mukherjee Sutapa11112, Yap Hooi Shan12, Zhang Xilong13, Palmer Lyle J.14, Anderson Craig S.215, McEvoy R. Doug112, Drager Luciano F.16, Barnes Maree, Yu Fengchun, Meng Xiaomei, Liu Wei, Chen Xinping, Tang Xiaomei, Xiao Gaohui, He Maolin, Liu Jingjing, Naughton Matt, Hooy Michelle, Yorkston Sophie, Hlavac Michael, Epton Michael James, Storer Malina Kate, Cook Julie Margaret, Corbett Alastair, Portley Rosie, Brockway Ben, Cowan Jan, Taylor D. Robin, Cox Emma, Palmay Rochelle, Young Alan, Sasso Sue Del, Shinkarksy Irina, Shinkarksy Ilana, Thien Francis, O’Driscoll Denise, Anniss Angela, Wang Wei, Shen Hui, Chew Derek, Kissajukian Frances, Luscombe Kate, Wollaston Fiona, Liu Zhihong, Ou Qiong, Du Baoliang, Wang Yanxia, Guo Yanhua, Dong Wei, Wu Lixin, Yu Kunlun, Wang Shengli, Shi Junyan, Drager Luciano, Souza Gabriela A., Queiróz Daniel B.C., Ferrier Katherine, Dewar Judy, Kleintjes Ria, Kovacs Jo, Campbell Angela, Neill Alister, Li Yuechun, Li Xiue, Pan Ruichun, Xue Hui, Amodeo Celso, Silva Juliana, Depizzol Renata, de Andrade Dalete, Bertolami Adriana, Gonzaga Carolina, Lorenzi-Filho Geraldo, Souza Gabriela A., Queiróz Daniel B.C., Bittencourt Lia, Ferreira Carolina, Bignotto Madga, Pan Zhiqing, Dou Yu, Zhu Meiyu, Lu Gan, Arstall Margaret, Jeffries William, Lamberts Naomi, Hamilton Garun, McKenzie Joanne, Zhang Xiuwei, Xiao Yi, Huang Rong, McEvoy Doug, Antic Nick, Paul Denzil, McKenna Amanda, Anderson Craig, Delcourt Candice, Carcel Cheryl, Ray Elizabeth, Paraskevaidis Theodora, Small Sabrina, Zhu Huili, Liang Yulu, Li Min, Liu Xinbing, Wang Minpeng, Lin Jiangtao, Li YiMing, Graham Neil, Molloy Mary Elizabeth, Wu Li’e, Guo Xia, Wu Junping, Li Zhendong, Xu Xiaohua, Luo Yuangming, Qiu Zhihui, Zhang Xilong, Li Chong, Peng Wanda, Zhen Guocui, Liu Jian Hong, Douglas James, Dunn Nicola, Walters Darren, Lan Ling, Mikli Jane, Wong Andrew, Curtin Deanne, Robinson Jan, Tai Liwen, Wang Huijuan, Chen Rui, Sun Yanqiu, He Yanyu, Wang Bei, Liu Zhuda, Zhao Hui, Gao Xiaoling, Fan Yanfeng, Wang Hanqiao, Chang Cat, Tuffery Christine, Hopping Sandra, McArdle Nigel, Mukherjee Sutapa, Boeing Bernadett, Hillman David, Rea Siobhan Clare, Guo Xuejun, Ren Lianping, Sun Jinyuan, Sun Yiping, Qin Guangyue, Li Shanqun, Li Wenjing, Wu Xiaodan, Zhou Jing, Jiang Hong, Bandick Laura, O'Keefe Michaela, Mercer Jeremy, Jurisevic Mark, Mead Samantha, Heeley Emma, Freed Ruth, Cheung Tina, Espinosa Natalie, Leighton Sarah, Sasse Tara, Leroux Michelle, Ying Shu, Zheng Yuehan, Wei Wei, Zhang Hongyu, Zhou Jing, Jia Haijing, Zhang Meng, Cui Buliang, Deng Hua, Song Aiwu, McEvoy Doug, Anderson Craig, Grunstein Ron, Hedner Jan, Huang Shaoguang, Lorenzi-Filho Geraldo, Neal Bruce, Palmer Lyle, Redline Susan, Wang Jiguang, Zhong Nanshan,
Affiliation:
1. Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia 2. The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia 3. Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia 4. Instituto do Sono, Associação Fundo de Incentivo a Pesquisa, São Paulo, Brazil 5. Sleep Laboratory, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil 6. The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China 7. Christchurch Hospital, Christchurch, New Zealand 8. Fuwai Hospital, Beijing, China 9. Sleep Laboratory, Pulmonary Division, Instituto do Coração, University of São Paulo, São Paulo, Brazil 10. The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong, China 11. West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia 12. Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia 13. The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China 14. School of Public Health, University of Adelaide, Adelaide, South Australia, Australia 15. The George Institute for Global Health China at Peking University Health Science Center, Beijing, China 16. Instituto do Coração and Hospital Universitario, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Abstract
OBJECTIVE
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 Endpoints (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 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.
Funder
National Health and Medical Research Council Respironics Sleep and Respiratory Research Foundation Philips Respironics
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Cited by
40 articles.
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