Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes
- 1 March 2010
- journal article
- research article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 181 (5), 507-513
- https://doi.org/10.1164/rccm.200909-1423oc
Abstract
Rationale: Obstructive sleep apnea (OSA), a treatable sleep disorder that is associated with alterations in glucose metabolism in individuals without diabetes, is a highly prevalent comorbidity of type 2 diabetes. However, it is not known whether the severity of OSA is a predictor of glycemic control in patients with diabetes. Objectives: To determine the impact of OSA on hemoglobin A1c (HbA1c), the major clinical indicator of glycemic control, in patients with type 2 diabetes. Methods: We performed polysomnography studies and measured HbA1c in 60 consecutive patients with diabetes recruited from outpatient clinics between February 2007 and August 2009. Measurements and Main Results: A total of 77% of patients with diabetes had OSA (apnea–hypopnea index [AHI] ≥5). Increasing OSA severity was associated with poorer glucose control, after controlling for age, sex, race, body mass index, number of diabetes medications, level of exercise, years of diabetes and total sleep time. Compared with patients without OSA, the adjusted mean HbA1c was increased by 1.49% (P = 0.0028) in patients with mild OSA, 1.93% (P = 0.0033) in patients with moderate OSA, and 3.69% (P < 0.0001) in patients with severe OSA (P < 0.0001 for linear trend). Measures of OSA severity, including total AHI (P = 0.004), rapid eye movement AHI (P = 0.005), and the oxygen desaturation index during total and rapid eye movement sleep (P = 0.005 and P = 0.008, respectively) were positively correlated with increasing HbA1c levels. Conclusions: In patients with type 2 diabetes, increasing severity of OSA is associated with poorer glucose control, independent of adiposity and other confounders, with effect sizes comparable to those of widely used hypoglycemic drugs.Keywords
This publication has 56 references indexed in Scilit:
- Risk of malignancies in patients with diabetes treated with human insulin or insulin analogues: a cohort studyDiabetologia, 2009
- Alterations in Glucose Disposal in Sleep-disordered BreathingAmerican Journal of Respiratory and Critical Care Medicine, 2009
- Sleep-disordered breathing and type 2 diabetesDiabetes Research and Clinical Practice, 2008
- Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 DiabetesNew England Journal of Medicine, 2008
- Effects of Intensive Glucose Lowering in Type 2 DiabetesNew England Journal of Medicine, 2008
- Sleep-Disordered Breathing and Impaired Glucose Metabolism in Normal-Weight and Overweight/Obese IndividualsDiabetes Care, 2008
- Slow-wave sleep and the risk of type 2 diabetes in humansProceedings of the National Academy of Sciences, 2008
- Efficacy and Safety of Incretin Therapy in Type 2 DiabetesJAMA, 2007
- Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and type 2 diabetesThorax, 2007
- The CES-D ScaleApplied Psychological Measurement, 1977