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

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.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.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.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.