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Diabetes Care. 2019 Mar 12. pii: dc182004. doi: 10.2337/dc18-2004. [Epub ahead of print]

Risk of Incident Obstructive Sleep Apnea Among Patients With Type 2 Diabetes.

Author information

1
Institute of Applied Health Research, University of Birmingham, Birmingham, U.K.
2
Institute of Clinical Sciences, Centre for Translational Inflammation Research, University of Birmingham, Birmingham, U.K.
3
University Hospital Birmingham, Birmingham, U.K.
4
Institute of Applied Health Research, University of Birmingham, Birmingham, U.K. gneilthomas@yahoo.co.uk g.n.thomas@bham.ac.uk.
5
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, U.K.
6
Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, U.K.
7
Midlands Health Data Research, U.K.

Abstract

OBJECTIVE:

This study compared the incidence of obstructive sleep apnea (OSA) in patients with and without type 2 diabetes and investigated risk factors for OSA in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS:

A retrospective cohort study was performed to compare OSA incidence between adult patients with and without type 2 diabetes matched for age, sex, and BMI. Patients with a prevalent OSA diagnosis were excluded. The study cohort was derived from The Health Improvement Network (THIN), a U.K. primary care database, from 1 January 2005 to 31 December 2017.

RESULTS:

There were 3,110 (0.88%) and 5,968 (0.46%) incident OSA cases identified in the 360,250 exposed and 1,296,489 unexposed patient cohorts, respectively. Adjusted incidence rate ratio (aIRR) of OSA in patients with type 2 diabetes compared with those without was 1.48 (95% CI 1.42-1.55; P < 0.001). In a multivariate regression analysis of patients with type 2 diabetes, significant predictors of OSA were diabetes-related foot disease (1.23 [1.06-1.42]; P = 0.005), being prescribed insulin in the last 60 days (1.58 [1.42-1.75]; P < 0.001), male sex (2.27 [2.09-2.46]; P < 0.001), being overweight (2.02 [1.54-2.64]; P < 0.001) or obese (8.29 [6.42-10.69]; P < 0.001), heart failure (1.41 [1.18-1.70]; P < 0.001), ischemic heart disease (1.22 [1.11-1.34]; P < 0.001), atrial fibrillation (1.23 [1.04-1.46]; P = 0.015), hypertension (1.32 [1.23-1.43]; P < 0.001), and depression (1.75 [1.61-1.91]; P < 0.001).

CONCLUSIONS:

When considered alongside previous evidence, this study indicates that the association between type 2 diabetes and OSA is bidirectional. In addition to known predictors of OSA, diabetes-related foot disease and insulin treatment were identified as risk factors in patients with type 2 diabetes.

PMID:
30862657
DOI:
10.2337/dc18-2004

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