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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 2020-05-07, 17:08 authored 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 investigatorsObjective
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.
