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CPAP therapy for patients with sleep apnea and type 2 diabetes mellitus improves control of blood pressure

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea (OSA) is highly associated with type 2 diabetes mellitus (DM), and treatment of OSA may have a positive impact on cardiometabolic profile. This study investigates the effects of continuous positive airway pressure (CPAP) treatment on glycemic control and cardiometabolic parameters in patients with diabetes.

Methods

Diabetic patients, who were newly diagnosed of OSA with an apnea hypopnea index (AHI) ≥15 and HbA1c ≥7%, were randomly assigned to either CPAP treatment or no treatment (control) for 3 months. Measurements included HbA1c, blood pressure, fasting glucose and lipids, urinary albumin, and peripheral arterial tonometry (to assess endothelial function).

Results

Sixty-four patients (52 men) were randomized, with mean (±SD) age of 55.0 ± 9.6 years, body mass index of 29.9 ± 5.3 kg/m2, HbA1c of 8.1 ± 1.1%, and AHI of 45.3 ± 23.2 events/h. In the intention-to-treat analysis, no significant change in HbA1c but reduction of systolic (10 mmHg (−18 to −2), p < 0.05) and diastolic (6 mmHg (−11 to −1), p < 0.05) blood pressures were found in the CPAP group compared to the control group. Excluding those with medication changes or initiated dietary program during the study period and those who dropped out, CPAP treatment decreased HbA1c (intervention group, n = 27; control group, n = 26) by 0.4% (−0.7 to −0.1), p = 0.027.

Conclusions

In patients with type 2 DM and moderate to severe OSA, 3 months of CPAP therapy did not decrease HbA1c but lowered systolic and diastolic blood pressures. In view of a potentially limited effect size of CPAP treatment on glycemic control, sample size estimation for future randomized controlled studies must make adequate allowance for influence from external factors of medications/diet and CPAP use.

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Abbreviations

AHI:

Apnea hypopnea index

CPAP:

Continuous positive airway pressure

DM:

Diabetes mellitus

ESS:

Epworth Sleepiness Scale

HbA1c:

Glycated hemoglobin

ITT:

Intention-to-treat

OSA:

Obstructive sleep apnea

PAT:

Peripheral arterial tonometry

PSG:

Polysomnography

RCT:

Randomized controlled trial

References

  1. Idris I, Happ AP, O’Reilly J, Barnett A, Allen M, Andrews R, Grunstein P, Lewis K, Goenka N, Wilding JP (2009) Obstructive sleep apnoea in patients with type 2 diabetes: aetiology and implications for clinical care. Diabetes Obes Metab 11:733–741. doi:10.1111/j.1463-1326.2009.01045.x

    Article  PubMed  Google Scholar 

  2. Shaw JE, Punjabi NM, Wilding JP, Alberti KGMM, Zimmet PZ (2008) Sleep-disordered breathing and type 2 diabetes. A report from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Diabetes Res Clin Pr 81:2–12. doi:10.1016/j.diabres.2008.04.025

    Article  Google Scholar 

  3. West SD, Nicoll DJ, Stradling JR (2006) Prevalence of obstructive sleep apnoea in men with type 2 diabetes. Thorax 61:945–950. doi:10.1136/thx.2005.057745

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, Wadden TA, Kelley D, Wing RR, Sunyer FX, Darcey V, Kuna ST, Sleep AHEAD Research Group (2009) The Sleep AHEAD Research Group. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 32:1017–1019. doi:10.2337/dc08-1776

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lam DC, Lui MM, Lam JC, Ong LH, Lam KS, Ip MS (2010) Prevalence and recognition of obstructive sleep apnea in Chinese patients with type 2 diabetes mellitus. Chest 138:1101–1107. doi:10.1378/chest.10-0596

    Article  PubMed  Google Scholar 

  6. Schober AK, Neurath MF, Harsch IA (2011) Prevalence of sleep apnoea in diabetic patients. Clin Respir J 5:165–172. doi:10.1111/j.1752-699X.2010.00216.x

    Article  PubMed  Google Scholar 

  7. Botros N, Concato J, Mohsenin V, Selim B, Doctor K, Yaggi HK (2009) Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med 122:1122–1127. doi:10.1016/j.amjmed.2009.04.026

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kent BD, Grote L, Ryan S, Pepin JL, Bonsignore MR, Tkacova R, Saaresranta T, Verbraecken J, Lévy P, Hedner J, McNicholas WT, ESADA collaborators (2014) Diabetes mellitus prevalence and control in sleep disordered breathing: the European Sleep Apnea Cohort (ESADA) study. Chest 146:982–990. doi:10.1378/chest.13-2403

    Article  PubMed  Google Scholar 

  9. Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G (2013) Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol 62(7):569–576. doi:10.1016/j.jacc.2013.05.045

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yang D, Liu Z, Yang H, Luo Q (2013) Effects of continuous positive airway pressure on glycemic control and insulin resistance in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath 17(1):33–38. doi:10.1007/s11325-012-0680-8

    Article  PubMed  Google Scholar 

  11. Kendzerska T, Gershon AS, Hawker G, Tomlinson G, Leung RS (2014) Obstructive sleep apnea and incident diabetes. A historical cohort study. Am J Resp Crit Care 190:218–225. doi:10.1164/rccm.201312-2209OC

    Article  Google Scholar 

  12. Aronsohn RS, Whitmore H, Van Cauter E, Tasali E (2010) Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Resp Crit Care 181:507–513. doi:10.1164/rccm.200909-1423OC

    Article  Google Scholar 

  13. Hassaballa HA, Tulaimat A, Herdegen JJ, Mokhlesi B (2005) The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea. Sleep Breath 9:176–180

    Article  PubMed  Google Scholar 

  14. West SD, Nicoll DJ, Wallace TM, Matthews DR, Stradling JR (2007) Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnea and type 2 diabetes. Thorax 62:969–974. doi:10.1136/thx.2006.074351

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dawson A, Abel SL, Loving RT, Dailey G, Shadan FF, Cronin JW, Kripke DF, Kline LE (2008) CPAP therapy of obstructive sleep apnea in type 2 diabetic improves glycemic control during sleep. J Clin Sleep Med 4:538–542

    PubMed  PubMed Central  Google Scholar 

  16. Prasad B, Carley DW, Krishnan JA, Weaver TE, Weaver FM (2012) Effects of positive airway pressure treatment on clinical measures of hypertension and type 2 diabetes. J Clin Sleep Med 8:481–487. doi:10.5664/jcsm.2136

    PubMed  PubMed Central  Google Scholar 

  17. Myhill PC, Davis WA, Peters KE, Chubb SA, Hillman D, Davis TM (2012) Effect of continuous positive airway pressure therapy on cardiovascular risk factors in patients with type 2 diabetes and obstructive sleep apnea. J Clin Endocr Metab 97:4212–4218. doi:10.1210/jc.2012-2107

    Article  CAS  PubMed  Google Scholar 

  18. Shaw JE, Punjabi NM, Naughton MT, Willes L, Bergenstal RM, Cistulli PA, Fulcher GR, Richards GN, Zimmet PZ. (2016) The effect of treatment of obstructive sleep apnea on glycemic control in type 2 diabetes. Am J Resp Crit Care 2016 Feb 29. doi: 10.1164/rccm.201511-2260OC

  19. Martínez-Cerón E, Barquiel B, Bezos AM, Casitas R, Galera R, García-Benito C, Hernanz A, Alonso-Fernández A, Garcia-Rio F. (2016) Effect of CPAP on glycemic control in patients with obstructive sleep apnea and type 2 diabetes. A randomized clinical trial. Am J Resp Crit Care 2016 Feb 24. doi: 10.1164/rccm.201510-1942OC

  20. Hamburg NM, Palmisano J, Larson MG, Sullivan LM, Lehman BT, Vasan RS, Levy D, Mitchell GF, Vita JA, Benjamin EJ (2011) Relation of brachial and digital measures of vascular function in the community: the Framingham Heart Study. Hypertension 57:390–396. doi:10.1161/HYPERTENSIONAHA.110.160812

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Lui MM, Mak JC, Lai AY, Hui CK, Lam JC, Lam DC, Ip MS (2016) The impact of obstructive sleep apnea and tobacco smoking on endothelial function. Respiration 91(2):124–131. doi:10.1159/000443527

    Article  CAS  PubMed  Google Scholar 

  22. Iftikhar IH, Blankfield RP (2012) Effect of continuous positive airway pressure on hemoglobin A1c in patients with obstructive sleep apnea: a systemic review and meta-analysis. Lung 190:605–611. doi:10.1007/s00408-012-9404-x

    Article  CAS  PubMed  Google Scholar 

  23. Pamidi S, Wroblewski K, Stepien M, Sharif-Sidi K, Kilkus J, Whitmore H, Tasali E (2015) Eight hours of nightly CPAP treatment of obstructive sleep apnea improves glucose metabolism in prediabetes: a randomized controlled trial. Am J Resp Crit Care 192(1):96–105. doi:10.1164/rccm.201408-1564OC

    Article  CAS  Google Scholar 

  24. Lam JCM, Lam B, Yao TJ, Lai AYK, Ooi CG, Tam S, Lam KS, Ip MS (2010) A randomized controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea. Eur Respir J 35:138–145. doi:10.1183/09031936.00047709

    Article  CAS  PubMed  Google Scholar 

  25. Tachikawa R, Ikeda K, Minami T, Matsumoto T, Hamada S, Murase K, Tanizawa K, Inouchi M, Oga T, Akamizu T, Mishima M, Chin K. (2016) Changes in energy metabolism after continuous positive airway pressure for obstructive sleep apnea. Am J Resp Crit Care 2016 Mar 1. doi: 10.1164/rccm.201511-2314OC

  26. American Diabetes Association (2003) Treatment of hypertension in adults with diabetes. Diabetes Care 26:80S–82S. doi:10.2337/diacare.26.2007.S80

    Article  Google Scholar 

  27. Eguchi K, Pickering TG, Kario K (2007) Why is blood pressure so hard to control in patients with type 2 diabetes? Journal of the cardiometabolic syndrome 2:114–118. doi:10.1111/j.1559-4564.2007.06124.x

    Article  PubMed  Google Scholar 

  28. Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, Lévy P, Riha R, Bassetti C, Narkiewicz K, Mancia G, McNicholas WT, EU COST Action B26 members (2013) ERS/ESH Task Force Report. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J 41:523–538. doi:10.1183/09031936.00226711

    Article  CAS  PubMed  Google Scholar 

  29. Campos-Rodriguez F, Perez-Ronchel J, Grilo-Reina A, Lima-Alvarez J, Benitez MA, Almeida-Gonzalez C (2007) Long-term effect of continuous positive airway pressure on BP in patients with hypertension and sleep apnea. Chest 132:1847–1852. doi:10.1378/chest.07-1478

    Article  PubMed  Google Scholar 

  30. Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, Fonseca V, Gerstein HC, Grundy S, Nesto RW, Pignone MP, Plutzky J, Porte D, Redberg R, Stitzel KF, Stone NJ, American Heart Association; American Diabetes Association (2007) Primary prevention of cardiovascular diseases in people with diabetes mellitus—a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care 30:162–172. doi:10.2337/dc07-9917

    Article  CAS  PubMed  Google Scholar 

  31. Goff DC, Gerstein HC, Ginsberg HN, Cushman WC, Margolis KL, Byington RP, Buse JB, Genuth S, Probstfield JL, Simons-Morton DG, ACCORD Study Group (2007) Prevention of cardiovascular disease in persons with type 2 diabetes mellitus: current knowledge and rationale for the action to control cardiovascular risk in diabetes (ACCORD) trial. Am J Cardiol 99(suppla):4i–20i. doi:10.1016/j.amjcard.2007.03.002

    Article  PubMed  Google Scholar 

  32. Chirinos JA, Gurubhagavatula I, Teff K, Rader DJ, Wadden TA, Townsend R, Foster GD, Maislin G, Saif H, Broderick P, Chittams J, Hanlon AL, Pack AI (2014) CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med 370:2265–2275. doi:10.1056/NEJMoa1306187

    Article  PubMed  PubMed Central  Google Scholar 

  33. Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H, Kader G, Mahowald M, Younger J, Pack AI (2007) Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 30:711–719

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lui MM, Ip S-M (2012) OSA and atherosclerosis. Journal of Thoracic Disease 4(2):164–172. doi:10.3978/j.issn.2072-1439.2012.01.06

    PubMed  PubMed Central  Google Scholar 

  35. Lai AY, Fong DY, Lam JC, Weaver TE, Ip MS (2014) The efficacy of a brief motivational enhancement education program on CPAP adherence in OSA: a randomized controlled trial. Chest 146(3):600–610. doi:10.1378/chest.13-2228

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Ms. Michelle Cheong, Ms. Peony Chong and Mr. Kelvin Lau for research assistance and all the clinical staff at the Ho Ting Sik Sleep Disorders Center, Queen Mary Hospital, for patient care during sleep studies and CPAP titration/monitoring.

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Authors and Affiliations

  1. Division of Respiratory Medicine, University Department of Medicine, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, SAR, China

    Jamie Chung Mei Lam, Agnes Yuen Kwan Lai, Terence Chi Chun Tam & Mary Sau Man Ip

  2. Division of Endocrinology, University Department of Medicine, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, SAR, China

    Michele Mae Ann Yuen & Karen Siu Ling Lam

  3. Research Centre for Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong

    Karen Siu Ling Lam & Mary Sau Man Ip

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  1. Jamie Chung Mei Lam
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Corresponding author

Correspondence to Mary Sau Man Ip.

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Funding

The Department of Medicine, The University of Hong Kong, provided financial support in the form of Lee Wing Tat Cardiopulmonary Research Fund. The funding source had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Clinical trial registration

www.clinicaltrials.gov (NCT 00876980)

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Lam, J.C.M., Lai, A.Y.K., Tam, T.C.C. et al. CPAP therapy for patients with sleep apnea and type 2 diabetes mellitus improves control of blood pressure. Sleep Breath 21, 377–386 (2017). https://doi.org/10.1007/s11325-016-1428-7

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  • DOI: https://doi.org/10.1007/s11325-016-1428-7

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