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Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease

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posted on 07.05.2020 by Kelly A. Loffler, Emma Heeley, Ruth Freed, Rosie Meng, Lia R. Bittencourt, Carolina C. Gonzaga Carvalho, Rui Chen, Michael Hlavac, Zhihong Liu, Geraldo Lorenzi-Filho, Yuanming Luo, Nigel McArdle, Sutapa Mukherjee, Hooi Shan Yap, Xilong Zhang, Lyle J. Palmer, Craig S. Anderson, R. Doug McEvoy, Luciano F. Drager, SAVE substudy investigators
Objective
Despite evidence of a relationship between obstructive sleep apnea (OSA), metabolic dysregulation and diabetes mellitus (DM), 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 DM 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, and six months, two- and four years, and incident diabetes diagnoses recorded.
Results
Median follow-up was 4.3 years. In those with pre-existing DM (n=274), there was no significant difference between CPAP and Usual Care groups in serum glucose, HbA1c or anti-diabetic medications during follow-up. There were also no significant between-group differences in participants with pre-diabetes (n=452), nor in new diagnoses of DM. 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 affected glycemic control in those with diabetes or pre-diabetes, or DM risk over standard of care treatment. The potential differential effect according to sex deserves further investigation.

Funding

The SAVE (Sleep Apnea Cardiovascular Endpoints) trial was funded by project grants 1006501 and 1060078 from the National Health and Medical Research Council (NHMRC) of Australia as well as by the Respironics Sleep and Respiratory Research Foundation and Philips Respironics. Supplementary trial funding was provided by Fisher & Paykel Healthcare and the Australasian Sleep Trials Network (enabling grant 343020 from the NHMRC). In-kind donations were provided by Philips Respironics for continuous positive airway pressure equipment and by ResMed for sleep apnea diagnostic devices.

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