Type 2 Diabetes, Glycemic Control, and Continuous Positive Airway Pressure in Obstructive Sleep Apnea
Abstract
BACKGROUND: Sleep-disordered breathing (SDB) is a prevalent condition associated with significant comorbidities, including hypertension, obesity, cardiovascular disease, and insulin resistance. It has been previously shown that the severity of insulin resistance is related to the severity of SDB. METHODS: Using a 72-hour continuous glucose monitoring system, we studied changes in interstitial glucose levels and measured hemoglobin A1c levels in 25 patients with type 2 diabetes mellitus before and after continuous positive airway pressure (CPAP) treatment for SDB. RESULTS: With a mean +/- SD CPAP treatment period of 83 +/- 50 days, the mean +/- SD 1-hour postprandial glucose values were significantly reduced for breakfast (191 +/- 68 mg/dL to 130 +/- 41 mg/dL [10.6 +/- 3.8 mmol/L to 7.2 +/- 2.3 mmol/L]), lunch (196 +/- 70 mg/dL to 138 +/- 49 mg/dL [10.9 +/- 3.9 mmol/L to 7.7 +/- 2.7 mmol/L]), and dinner (199 +/- 66 mg/dL to 137 +/- 48 mg/dL [11.0 +/- 3.7 mmol/L to 7.6 +/- 2.7 mmol/L]). In the 17 patients with a baseline hemoglobin A1c level greater than 7%, there was a significant reduction in hemoglobin A1c level (9.2% +/- 2.0% to 8.6% +/- 1.8%). Furthermore, in subjects who used CPAP for more than 4 h/d, the reduction in hemoglobin A1c level was significantly correlated with days of CPAP use. There was no such correlation in subjects who used CPAP for 4 h/d or less. CONCLUSIONS: These findings suggest that SDB is pathophysiologically related to impaired glucose homeostasis, and that CPAP can be an important therapeutic approach for diabetic patients with SDB.
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Obstructive sleep apnea is a highly prevalent syndrome associated with substantial morbidity and increased mortality.
“OBSTRUCTIVE SLEEP APNEA (OSA) IS A HIGHLY PREV-ALENT SYNDROME THAT IS ASSOCIATED WITH SUB-STANTIAL MORBIDITY AND INCREASED MORTALITY. 1-10”
Positive airway pressure is the most uniformly effective therapy for OSA and the only intervention shown to favorably impact both cardiovascular and neurobehavioral morbidities.
“Positive airway pressure (PAP) is the most uniformly effective therapy, and to date this is the only intervention for OSA shown to have a favorable impact on both cardiovascular and neurobehavioral morbidities.1,2,6”
Four positive studies used the hyperinsulinemic-euglycemic clamp, two used continuous glucose monitoring, and one used the minimal model estimate from an intravenous glucose tolerance test.
“Methodological differences may also account for the variability of results obtained: four positive studies relied on the hyperinsulinemic–euglycemic clamp technique to assess SI [15, 65, 66, 142], which is considered the gold standard to evaluate SI; another two used continuous glucose monitoring (CGMS) [4, 205], which provides 288 readings of interstitial glucose levels per 24 h (every 5 min) and”
From Sleep and metabolic function (2012) · cites this paper as [4]
Improvement in glycemic control has been demonstrated after 3 months of CPAP use, with improvement related to number of hours of nightly CPAP use.
“Improvement in glycemic control has been demonstrated after 3 months of CPAP use, with improvement related to number of hours of nightly CPAP use(107, 108).”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [108]
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Polotsky, V. Y., Patil, S. P., Savransky, V., Laffan, A. M., Bevans‐Fonti, S., Frame, L. A., Steele, K., Schweizter, M. A., Clark, J. M., Torbenson, M. S., et al. (2008) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200804-608oc · Cited by 210 · see citing works
“Moreover, adjusting for BMI and waist circumference did not alter the relationship between the severity of nocturnal oxyhemoglobin desaturation and the HOMA index (HOMA index elevated by * P , 0.05; †P , 0.01; and ‡P , 0.001, for the difference between patients with RDI less than 15/hour and greater than 15/hour and b…”
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“Improved glucose tolerance was defined as decreased glucose levels at OGTT , or decreased HbA1c , or lower 24 - h glucose concentrations at CGMS , after CPAP treatment b Improved insulin sensitivity was defined as increased insulin responsiveness index ( M ) or insulin sensitivity index ( ISI ) at HEC , or increased S…”
InfluentialRole of sleep quality in the metabolic syndrome
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“Although CPAP treatment has been shown to improve HbA1c [21] and HDLcholesterol [22] levels in patients with OSA, the increasingly reported associations between diabetes and sleep disordered breathing, in terms of cause or effect [23,24], has provided clinicians with a wider metabolic targets potentially amenable to p…”
BackgroundAdvances in Sleep-disordered Breathing
Pack, A. I. (2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200509-1478oe · Cited by 188 · see citing works
Sleep and the metabolic syndrome
Wolk, R. A., & Somers, V. K. (2006) · Experimental Physiology · doi:10.1113/expphysiol.2006.033787 · Cited by 186 · see citing works
“While some clinical studies suggest that OSA patients have normal hypercapnic responses and CPAP treatment does not markedly affect hypercapnic chemosensitivity in OSA (Narkiewicz et al. 1999; Spicuzza et al. 2006), it should be noted that in those studies only ‘healthy’ and untreated OSA subjects were studied and dia…”
BackgroundInfluentialPamidi, S., Wroblewski, K., Stepien, M., Sharif-Sidi, K., Kilkus, J., Whitmore, H., & Tasali, E. (2015) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201408-1564oc · Cited by 185 · see citing works
“studies (29, 31) have reported positive correlations between the hours of CPAP usage and metabolic benefit following”
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Sleep: important considerations for the prevention of cardiovascular disease
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Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes
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Prediabetes and associated disorders
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The Effect of Treatment of Obstructive Sleep Apnea on Glycemic Control in Type 2 Diabetes
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Obstructive Sleep Apnea Syndrome and Cardiovascular Diseases
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Biological plausibility linking sleep apnoea and metabolic dysfunction
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CPAP Therapy of Obstructive Sleep Apnea in Type 2 Diabetics Improves Glycemic Control During Sleep
Dawson, A., Abel, S. L., Loving, R. T., DAILEY, G. E., Shadan, F. F., CRONIN, J. W., Kripke, D. F., & Kline, L. E. (2008) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27347 · Cited by 144 · see citing works
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“Our findings are consistent with a recent prospective study which demonstrated the effectiveness of CPAP therapy in improving postprandial glucose levels and HbA1c in type 2 diabetics with OSA [16].”
BackgroundMethodResultInfluentialSelf-citationDaytime Sleepiness in the Obese: Not as Simple as Obstructive Sleep Apnea
Dixon, J. B., Dixon, M. E., Anderson, M. L., Schachter, L. M., & O’Brien, P. E. (2007) · Obesity · doi:10.1038/oby.2007.297 · Cited by 136 · see citing works
“Indeed, fasting plasma glucose is strongly associated with AHI in severely obese subjects (10).”
BackgroundEvaluation of Sleep Disorders in the Primary Care Setting: History Taking Compared to Questionnaires
Senthilvel, E., Auckley, D., & Dasarathy, J. (2011) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.28040 · Cited by 137 · see citing works
The association of OSA with insulin resistance, inflammation and metabolic syndrome
Peled, N., Kassirer, M., Shitrit, D., Kogan, Y., Shlomi, D., Berliner, A. S., & Kramer, M. R. (2007) · Respiratory Medicine · doi:10.1016/j.rmed.2007.02.025 · Cited by 128 · see citing works
Reduced Sleep Duration or Quality: Relationships With Insulin Resistance and Type 2 Diabetes
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Insulin resistance, glucose intolerance and diabetes mellitus in obstructive sleep apnoea.
Kent, B. D., McNicholas, W. T., & Ryan, S. (2015) · PubMed Central · doi:10.3978/j.issn.2072-1439.2015.08.11 · Cited by 130 · see citing works
“(24) 25 diabetics with OSA Observational: median 83 days CPAP Continuous glucose monitoring; HbA1c levels Improved post-prandial glucose levels post-CPAP; improved HbA1c in subjects with baseline HbA1c >7%”
BackgroundPrevalence of sleep apnoea in diabetic patients
Schober, A.-K., Neurath, M. F., & Harsch, I. A. (2010) · The Clinical Respiratory Journal · doi:10.1111/j.1752-699x.2010.00216.x · Cited by 123 · see citing works
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Obstructive sleep apnea: role in the risk and severity of diabetes
Pamidi, S., Aronsohn, R. S., & Tasali, E. (2010) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2010.08.009 · Cited by 121 · see citing works
Obstructive sleep apnea as a risk factor for type 2 diabetes mellitus
Greenberg, H. E., & Rajan, P. (2015) · Nature and Science of Sleep · doi:10.2147/nss.s90835 · Cited by 119 · see citing works
Kang, K., Park, K., Kim, J.-E., Kim, S. W., Kim, Y.-T., Kim, J. S., & Lee, H. (2012) · Sleep And Breathing · doi:10.1007/s11325-012-0767-2 · Cited by 119 · see citing works
“OSA is an important medical condition characterized by excessive daytime sleepiness, snoring, and nocturnal hypoxemia during sleep [2] and it has strong association with hypertension, glucose intolerance, cardiovascular disorders, and cerebrovascular disorders [3-6].”
BackgroundObstructive sleep apnea: An update on mechanisms and cardiovascular consequences
Wolf, J., Lewicka, J., & Narkiewicz, K. (2007) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2006.12.005 · Cited by 118 · see citing works
A Nasal Cannula can be used to Treat Obstructive Sleep Apnea
McGinley, B. M., Patil, S. P., Kirkness, J. P., Smith, P. L., Schwartz, A. R., & Schneider, H. (2007) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200609-1336oc · Cited by 120 · see citing works
Prevalence and predictive factors of sleep apnoea syndrome in type 2 diabetic patients
Laaban, J. P., Daenen, S., Léger, D., Pascal, S., Bayon, V., Slama, G., & Elgrably, F. (2009) · Diabetes & Metabolism · doi:10.1016/j.diabet.2009.03.007 · Cited by 109 · see citing works
“demonstrated that continuous positive airway pressure (CPAP) therapy improves glycaemic control [12].”
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Polycystic Ovary Syndrome and Obstructive Sleep Apnea
Tasali, E., Cauter, E. V., & Ehrmann, D. A. (2008) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2007.11.001 · Cited by 108 · see citing works
“A number of interventional studies have shown that the treatment of OSA with continuous airway positive pressure (CPAP) improves insulin sensitivity [70] and is associated with a reduction in postprandial glucose and glycohemoglobin levels in individuals with type 2 diabetes [71].”
BackgroundOxidative Stress in Obstructive Sleep Apnea: Putative Pathways to the Cardiovascular Complications
Yamauchi, M., & Kimura, H. (2008) · Antioxidants and Redox Signaling · doi:10.1089/ars.2007.1946 · Cited by 107 · see citing works
“To date this is the only intervention for OSA shown to have a favorable impact on both cardiovascular and neurobehavioral morbidities (3, 22, 64).”
Metabolic Consequences of Sleep-Disordered Breathing
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Zizi, F., Jean‐Louis, G., Brown, C. D., Ogedegbe, G. G., Boutin‐Foster, C., & McFarlane, S. I. (2010) · Current Diabetes Reports · doi:10.1007/s11892-009-0082-x · Cited by 99 · see citing works
“CPAP studies have shown significant improvement in insulin sensitivity, blood pressure, lipid profile, and left ventricular function [8, 17, 51].”
BackgroundSleep Apnea and Commercial Motor Vehicle Operators:
Hartenbaum, N. P., Collop, N. A., Rosen, I. M., Phillips, B. A., George, C. F., Rowley, J. A., Freedman, N. S., Weaver, T. E., Gurubhagavatula, I., Strohl, K. P., et al. (2006) · Journal of Occupational and Environmental Medicine · doi:10.1097/01.jom.0000236404.96857.a2 · Cited by 97 · see citing works
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Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options
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The metabolic syndrome, diabetes and lung dysfunction
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“OSA also increases the risk of motor vehicle and other accidents [8,9], type 2 diabetes [10], and postoperative complications [11], and it adversely affects the health-related quality of life [12].”
BackgroundPrevalence of Type 2 Diabetes in Patients with Obstructive Sleep Apnea in a Multi-Ethnic Sample
Mahmood, K., Akhter, N. S., Eldeirawi, K. M., Önal, E., Christman, J. W., Carley, D. W., & Herdegen, J. J. (2009) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27489 · Cited by 92 · see citing works
Self-citationCGMap: Characterizing continuous glucose monitor data in thousands of non-diabetic individuals
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Effect of obstructive sleep apnea on type 2 diabetes mellitus: A comprehensive literature review
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The Interlinked Rising Epidemic of Insufficient Sleep and Diabetes Mellitus
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“Sleep-disordered breathing (SDB) is pathophysiologically related to impaired glucose homeostasis, and that Continuous Positive Airway Pressure (CPAP) can be an important therapeutic approach for diabetic patients with SDB [45].”
BackgroundCarotid body, insulin, and metabolic diseases: unraveling the links
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- Authors
- Babu, A. R., Herdegen, J., Fogelfeld, L., Shott, S., & Mazzone, T.
- Affiliations
- Rush University Medical Center (US)
- ORCID
- Fogelfeld, Leon
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2005-02-28
- Volume
- 165
- Issue
- 4
- Pages
- 447
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2103628919
- Cited by
- 453
- References
- 41
- Citations by year
- 2026: 2 · 2025: 12 · 2024: 4 · 2023: 7 · 2022: 13 · 2021: 7 · 2020: 15 · 2019: 12 · 2018: 18 · 2017: 16 · 2016: 21 · 2015: 33 · 2014: 31 · 2013: 22 · 2012: 37
- FWCI
- 21.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, obstructive sleep apnea, sleep-disordered breathing, continuous positive airway pressure, glycemic control, HbA1c, postprandial blood glucose, insulin resistance, glucose homeostasis
- MeSH terms
- Adult, Blood Glucose, Circadian Rhythm, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Insulin Resistance, Male, Middle Aged, Obesity, Prospective Studies, Surveys and Questionnaires, Polysomnography, Sleep Apnea, Obstructive, Glycemic Index, Continuous Positive Airway Pressure
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