Supplementary_Tables_dc19-2116_revised_16June2020.docx (36.6 kB)
Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study
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posted on 2020-06-17, 14:08 authored by Nicola J Adderley, Anuradhaa Subramanian, Konstantinos Toulis, Krishna Gokhale, Thomas Taverner, Wasim Hanif, Shamil Haroon, G Neil Thomas, Christopher Sainsbury, Abd A Tahrani, Krishnarajah NirantharakumarObjective: To determine risk of cardiovascular diseases (CVD), microvascular
complications and mortality in patients with type 2 diabetes who subsequently
develop obstructive sleep apnoea(OSA) compared to patients with type 2 diabetes
without a diagnosis of OSA.
Research Design and Methods: An age-, sex-, body mass index-
and diabetes duration-matched cohort study using data from a UK primary care database
from 01/01/2005 to 17/01/2018. Participants aged ≥16 years with type 2 diabetes
were included. Exposed participants were those who developed OSA after their
diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes
were composite CVD (ischaemic heart disease(IHD), stroke/transient ischaemic
attack(TIA), heart failure(HF)); peripheral vascular disease(PVD); atrial fibrillation(AF);
peripheral neuropathy(PN); diabetes-related foot disease(DFD); referable
retinopathy; chronic kidney disease(CKD); all-cause mortality. The same
outcomes were explored in patients with pre-existing OSA before a diagnosis of type
2 diabetes versus diabetes without diagnosed OSA.
Results: 3,667 exposed participants and 10,450 matched controls were included.
Adjusted hazard ratios for the outcomes were: composite CVD 1.54(95%CI 1.32,1.79);
IHD 1.55(1.26,1.90); HF 1.67(1.35,2.06); stroke/TIA 1.57(1.27,1.94); PVD 1.10(0.91,1.32);
AF 1.53(1.28,1.83); PN 1.32(1.14,1.51); DFD 1.42(1.16,1.74); retinopathy
0.99(0.82,1.21); CKD (stage 3-5) 1.18(1.02,1.36); albuminuria 1.11(1.01,1.22); all-cause
mortality 1.24(1.10,1.40). In the prevalent OSA cohort the results were similar
but some associations not observed.
Conclusions: Patients with type 2 diabetes who develop OSA are at increased risk of CVD,
AF, PN, DFD, CKD, and all-cause mortality compared to patients without diagnosed
OSA. Patients with type 2 diabetes who develop OSA are a high-risk population
and strategies to detect OSA and prevent cardiovascular and microvascular
complications should be implemented.