Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease
Authors: Loffler Kelly A. , Heeley Emma , Freed Ruth , Meng Rosie , Bittencourt Lia R. , Gonzaga Carvalho Carolina C. , Chen Rui , Hlavac Michael , Liu Zhihong , Lorenzi-Filho Geraldo , Luo Yuanming , McArdle Nigel , Mukherjee Sutapa , Yap Hooi Shan , Zhang Xilong , Palmer Lyle J. , Anderson Craig S. , McEvoy R. Doug , Drager Luciano F. ,   SAVE Substudy Investigators, Barnes Maree , Yu Fengchun , Meng Xiaomei , Liu Wei , Chen Xinping , Tang Xiaomei , Xiao Gaohui , He Maolin , Liu Jingjing , Naughton Matt , Hooy Michelle , Yorkston Sophie , Hlavac Michael , Epton Michael James , Storer Malina Kate , Cook Julie Margaret , Corbett Alastair , Portley Rosie , Brockway Ben , Cowan Jan , Taylor D. Robin , Cox Emma , Palmay Rochelle , Young Alan , Sasso Sue Del , Shinkarksy Irina , Shinkarksy Ilana , Thien Francis , O’Driscoll Denise , Anniss Angela , Wang Wei , Shen Hui , Chew Derek , Kissajukian Frances , Luscombe Kate , Wollaston Fiona , Liu Zhihong , Ou Qiong , Du Baoliang , Wang Yanxia , Guo Yanhua , Dong Wei , Wu Lixin , Yu Kunlun , Wang Shengli , Shi Junyan , Drager Luciano , Souza Gabriela A. , Queiróz Daniel B.C. , Ferrier Katherine , Dewar Judy , Kleintjes Ria , Kovacs Jo , Campbell Angela , Neill Alister , Li Yuechun , Li Xiue , Pan Ruichun , Xue Hui , Amodeo Celso , Silva Juliana , Depizzol Renata , de Andrade Dalete , Bertolami Adriana , Gonzaga Carolina , Lorenzi-Filho Geraldo , Souza Gabriela A. , Queiróz Daniel B.C. , Bittencourt Lia , Ferreira Carolina , Bignotto Madga , Pan Zhiqing , Dou Yu , Zhu Meiyu , Lu Gan , Arstall Margaret , Jeffries William , Lamberts Naomi , Hamilton Garun , McKenzie Joanne , Zhang Xiuwei , Xiao Yi , Huang Rong , McEvoy Doug , Antic Nick , Paul Denzil , McKenna Amanda , Anderson Craig , Delcourt Candice , Carcel Cheryl , Ray Elizabeth , Paraskevaidis Theodora , Small Sabrina , Zhu Huili , Liang Yulu , Li Min , Liu Xinbing , Wang Minpeng , Lin Jiangtao , Li YiMing , Graham Neil , Molloy Mary Elizabeth , Wu Li’e , Guo Xia , Wu Junping , Li Zhendong , Xu Xiaohua , Luo Yuangming , Qiu Zhihui , Zhang Xilong , Li Chong , Peng Wanda , Zhen Guocui , Liu Jian Hong , Douglas James , Dunn Nicola , Walters Darren , Lan Ling , Mikli Jane , Wong Andrew , Curtin Deanne , Robinson Jan , Tai Liwen , Wang Huijuan , Chen Rui , Sun Yanqiu , He Yanyu , Wang Bei , Liu Zhuda , Zhao Hui , Gao Xiaoling , Fan Yanfeng , Wang Hanqiao , Chang Cat , Tuffery Christine , Hopping Sandra , McArdle Nigel , Mukherjee Sutapa , Boeing Bernadett , Hillman David , Rea Siobhan Clare , Guo Xuejun , Ren Lianping , Sun Jinyuan , Sun Yiping , Qin Guangyue , Li Shanqun , Li Wenjing , Wu Xiaodan , Zhou Jing , Jiang Hong , Bandick Laura , O'Keefe Michaela , Mercer Jeremy , Jurisevic Mark , Mead Samantha , Heeley Emma , Freed Ruth , Cheung Tina , Espinosa Natalie , Leighton Sarah , Sasse Tara , Leroux Michelle , Ying Shu , Zheng Yuehan , Wei Wei , Zhang Hongyu , Zhou Jing , Jia Haijing , Zhang Meng , Cui Buliang , Deng Hua , Song Aiwu , McEvoy Doug , Anderson Craig , Grunstein Ron , Hedner Jan , Huang Shaoguang , Lorenzi-Filho Geraldo , Neal Bruce , Palmer Lyle , Redline Susan , Wang Jiguang , Zhong Nanshan 
Published: April 2020

OBJECTIVE
Despite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA.

RESEARCH DESIGN AND METHODS
Blood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea cardioVascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus usual care, or usual care alone. Serum glucose and glycated hemoglobin A1c (HbA1c) were measured at baseline, 6 months, and 2 and 4 years and incident diabetes diagnoses recorded.

RESULTS
Median follow-up was 4.3 years. In those with preexisting diabetes (n = 274), there was no significant difference between the CPAP and usual care groups in serum glucose, HbA1c, or antidiabetic medications during follow-up. There were also no significant between-group differences in participants with prediabetes (n = 452) or new diagnoses of diabetes. Interaction testing suggested that women with diabetes did poorly in the usual care group, while their counterparts on CPAP therapy remained stable.

CONCLUSIONS
Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affects glycemic control in those with diabetes or prediabetes or diabetes risk over standard-of-care treatment. The potential differential effect according to sex deserves further investigation.