Effect of continuous positive airway pressure on glycemic control in patients with obstructive sleep apnea and type 2 diabetes a randomized clinical trial

Abstract

Rationale: Obstructive sleep apnea (OSA) is a risk factor for type 2 diabetes that adversely impacts glycemic control. However, there is little evidence about the effect of continuous positive airway pressure (CPAP) on glycemic control in patients with diabetes. Objectives: To assess the effect of CPAP on glycated hemoglobin (HbA1c) levels in patients with suboptimally controlled type 2 diabetes and OSA, and to identify its determinants. Methods: In a 6-month, open-label, parallel, and randomized clinical trial, 50 patients with OSA and type 2 diabetes and two HbA1c levels equal to or exceeding 6.5% were randomized to CPAP (n = 26) or no CPAP (control; n = 24), while their usual medication for diabetes remained unchanged. Measurements and Main Results: HbA1c levels, Homeostasis Model Assessment and Qualitative Insulin Sensitivity Check Index scores, systemic biomarkers, and health-related quality of life were measured at 3 and6months.After6months,theCPAPgroupachievedagreaterdecrease in HbA1c levels compared with the control group. Insulin resistance and sensitivitymeasurements(innoninsulinusers)andserumlevelsofIL-1b, IL-6, and adiponectin also improved in the CPAP group compared with the control group after 6 months. In patients treated with CPAP, mean nocturnal oxygen saturation and baseline IL-1b were independently related to the 6-month change in HbA1c levels (r2 = 0.510, P = 0.002). Conclusions: Among patients with suboptimally controlled type 2 diabetes and OSA, CPAP treatment for 6 months resulted in improved glycemic control and insulin resistance compared with results for a control group.