Authors: Jonathan E Shaw, Naresh M Punjabi, Matthew T. Naughton, Leslee Willes, Richard M Bergenstal, Peter A. Cistulli, Greg R Fulcher, Glenn N Richards, Paul Z Zimmet
Summary: Rationale: There is uncertainty about the effects of treating obstructive sleep apnea on glycemic control in type 2 diabetes.
Objectives: To determine whether treatment of obstructive sleep apnea in patients with type 2 diabetes improves glycemic control.
Methods: This trial randomised patients with type 2 diabetes and no previous diagnosis of obstructive sleep apnea, with HbA1c 6.5-8.5%, and oxygen desaturation index ≥15 events per hour to positive airway pressure therapy or to usual care. Measurements and main results: 416 patients met entry criteria as determined by each site, and were randomised. Of the 298 participants who met centrally-adjudicated entry, no differences between the study groups were seen for change in HbA1c. Furthermore, there were no between-group differences when analyses were restricted to those with poorer baseline glycemic control, with more severe sleep apnea, or to those who were adherent to therapy. A greater fall in diastolic blood pressure occurred in the positive airway pressure versus usual care group (-3.5 mmHg vs -1.5 mmHg; p=0.07). This difference was significant in those who were adherent to positive airway pressure therapy (-4.4 mmHg vs -1.6 mmHg; p=0.02). There was a significant reduction in sleepiness in the positive airway pressure therapy group (p<0.0001). Quality of life assessment revealed improvements in vitality, mental health and mental component summary scores in the positive airway pressure therapy group.
Conclusions: This trial showed no effect of positive airway pressure therapy on glycemic control in patients with relatively well-controlled type 2 diabetes and obstructive sleep apnea. Clinical trial registration available at www.clinicaltrials.gov, ID NCT00509223.
Source:
American Journal of Respiratory and Critical Care Medicine; 2016