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Am J Respir Crit Care Med. 2016 Aug 15;194(4):476-85. doi: 10.1164/rccm.201510-1942OC.

Effect of Continuous Positive Airway Pressure on Glycemic Control in Patients with Obstructive Sleep Apnea and Type 2 Diabetes. A Randomized Clinical Trial.

Author information

1
1 Servicio de Neumología.
2
2 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain.
3
3 Servicio de Endocrinología, and.
4
4 Centro de Salud José Marvá, Madrid, Spain.
5
5 Centro de Salud El Puerto, Coslada, Madrid, Spain.
6
6 Servicio de Bioquímica, Hospital Universitario La Paz, Madrid, Spain.
7
7 Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain; and.
8
8 Universidad Autónoma de Madrid, Madrid, Spain.

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 and 6 months. After 6 months, the CPAP group achieved a greater decrease in HbA1c levels compared with the control group. Insulin resistance and sensitivity measurements (in noninsulin users) and serum levels of IL-1β, 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-1β were independently related to the 6-month change in HbA1c levels (r(2) = 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. Clinical trial registered with www.clinicaltrials.gov (NCT01801150).

KEYWORDS:

clinical trial; diabetes; glycemia; insulin; sleep apnea

PMID:
26910598
DOI:
10.1164/rccm.201510-1942OC
[Indexed for MEDLINE]

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