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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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In the citing paper
“OBSTRUCTIVE SLEEP APNEA (OSA) IS A HIGHLY PREV-ALENT SYNDROME THAT IS ASSOCIATED WITH SUB-STANTIAL MORBIDITY AND INCREASED MORTALITY. 1-10”
In the citing paper
“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”
In the citing paper
“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]
In the citing paper
“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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“Furthermore, treatment of sleep apnea improves insulin sensitivity and could benefit the metabolic profiles of these patients, although this is not well defined (44–47).”
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“[32] involving 25 obese diabetic patients showed beneficial effects of 3 months of CPAP use on HbA1c and post-prandial glucose levels, and two other studies [33, 36] reported improvements in nocturnal glucose levels after CPAP.”
BackgroundPrevalence of Symptoms and Risk of Sleep Apnea in the US Population
Hiestand, D. M., Britz, P., Goldman, M., & Phillips, B. A. (2006) · CHEST Journal · doi:10.1378/chest.130.3.780 · Cited by 454
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“Furthermore, treatment of OSA with continuous positive airway pressure has shown to improve visceral obesity, suggesting a role of OSA in the pathogenesis of obesity.(163) In physiologic conditions, the collapsibility of the upper airway tract is determined by the critical closing pressure inside the pharynx.”
BackgroundObstructive Sleep Apnea as a Risk Factor for Type 2 Diabetes
Botros, N., Concato, J., Mohsenin, V., Selim, B., Doctor, K., & Yaggi, H. K. (2009) · The American Journal of Medicine · doi:10.1016/j.amjmed.2009.04.026 · Cited by 384
“These findings are consistent with several treatment studies that have demonstrated improvements in insulin sensitivity and postprandial glucose with airway pressurization therapy.(40-42) In contrast, other studies, including 2 short-term randomized controlled trials, have not shown a benefit.”
ResultDisorders of glucose metabolism in sleep apnea
Punjabi, N. M., & Polotsky, V. Y. (2005) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00695.2005 · Cited by 381
“There are now 12 studies (5, 12, 15, 16, 20, 50, 51, 58, 99, 100, 109, 118) examining the metabolic profiles in sleep apnea before and after CPAP treatment.”
BackgroundObstructive Sleep Apnea and Type 2 Diabetes
Tasali, E., Mokhlesi, B., & Van Cauter, E. (2008) · Chest · doi:10.1378/chest.07-0828 · Cited by 371
Obstructive sleep apnea and type 2 diabetes
Rasche, K., Keller, T., Tautz, B., Hader, C., Hergenç, G., Antosiewicz, J., Giulio, C. D., & Pokorski, M. (2010) · European journal of medical research · doi:10.1186/2047-783x-15-s2-152 · Cited by 367
Obstructive Sleep Apnea and Metabolic Syndrome: Alterations in Glucose Metabolism and Inflammation
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International Consensus Statement on Obstructive Sleep Apnea
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Molecular Signatures of Obstructive Sleep Apnea in Adults: A Review and Perspective
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Sleep, sleep-disordered breathing and metabolic consequences
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The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms
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“Similarly, changes in HBA1c levels were associated with CPAP use only in those T2DM patients, who used CPAP for more than 4 hours/night [240].”
MethodSchwab, R. J., Badr, S. M., Epstein, L. J., Gay, P. C., Gozal, D., Kohler, M., Levy, P. A., Malhotra, A., Phillips, B. A., Rosen, I. M., et al. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201307-1282st · Cited by 320
Association between Metabolic Syndrome and Sleep-disordered Breathing in Adolescents
Redline, S. S., Storfer‐Isser, A., ROSEN, C. L., Johnson, N. L., Kirchner, H. L., Emancipator, J. L., & Kibler, A. M. (2007) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200703-375oc · Cited by 303
“Causal relationships are supported by data showing that treatment of SDB is associated with improvement in indices of glucose impairment (13) or diabetes control (14).”
MethodSleep-disordered breathing and type 2 diabetes
Shaw, J. E., Punjabi, N. M., Wilding, J. P. H., Alberti, K. G. M. M., & Zimmet, P. (2008) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2008.04.025 · Cited by 299
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Chronotype is independently associated with glycemic control in type 2 diabetes
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“We did not have objective measures of sleep or circadian parameters or of OSA severity, all of which could impact glycemic control (32,33).”
BackgroundSleep and Metabolism: An Overview
Sharma, S., & Kavuru, M. S. (2010) · International Journal of Endocrinology · doi:10.1155/2010/270832 · Cited by 296
“Several studies have shown improvement in insulin sensitivity after varying periods of CPAP therapy in patients with diabetics and nondiabetics [96–98], including a study showing a reduction in HbA1C [99].”
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Positive Airway Pressure Treatment for Obstructive Sleep Apnea
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Metabolic consequences of intermittent hypoxia: Relevance to obstructive sleep apnea
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Obstructive Sleep Apnea and Type 2 Diabetes: Is There a Link?
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Prevalence of Sleep Apnea in a Population of Adults with Type 2 Diabetes Mellitus
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Obstructive Sleep Apnea and Cardiovascular Disease
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“This concept may also explain why studies of treatment of OSA on glucose control in obese people with type 2 diabetes mellitus have led to different conclusions.(109,110) The randomized trial that found no effect using a crossover design with active and sham CPAP had extremely obese subjects (mean BMI N36 kg/m(2)).”
Inflammation in sleep apnea: An update
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“insulin sensitivity, leading to long-term improvement in glycated hemoglobin levels (Babu et al., 2005; Czupryniak et al., 2005; Dawson et al., 2008; Schahin et al., 2008; Harsch et al., 2004; Lam et al., 2010).”
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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 218
“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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The Epidemiology of Sleep and Diabetes
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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
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Sleep and the metabolic syndrome
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“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
“studies (29, 31) have reported positive correlations between the hours of CPAP usage and metabolic benefit following”
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Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes
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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 146
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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
“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
The association of OSA with insulin resistance, inflammation and metabolic syndrome
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Reduced Sleep Duration or Quality: Relationships With Insulin Resistance and Type 2 Diabetes
Tasali, E., Leproult, R., & Spiegel, K. (2009) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2008.10.002 · Cited by 129
Insulin resistance, glucose intolerance and diabetes mellitus in obstructive sleep apnoea.
Kent, B. D., McNicholas, W. T., & Ryan, S. (2015) · PubMed · doi:10.3978/j.issn.2072-1439.2015.08.11 · Cited by 131
“(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 126
Tasali, E., Chapotot, F., Leproult, R., Whitmore, H. R., & Ehrmann, D. A. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-1187 · Cited by 127
Obstructive sleep apnea: role in the risk and severity of diabetes
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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 125
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 123
“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 121
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 119
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 113
“demonstrated that continuous positive airway pressure (CPAP) therapy improves glycaemic control [12].”
BackgroundTasali, E., Van Cauter, E., Hoffman, L., & Ehrmann, D. A. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0925 · Cited by 111
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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 111
“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 108
“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
Jun, J. C., & Polotsky, V. Y. (2009) · ILAR Journal · doi:10.1093/ilar.50.3.289 · Cited by 107
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 100
“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
Lam, D. C.-L., Lui, M. M., Lam, J., Ong, L. H. Y., Lam, K. S. L., & Ip, M. (2010) · CHEST Journal · doi:10.1378/chest.10-0596 · Cited by 98
Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options
Mehra, R., & Gharibeh (2010) · Nature and Science of Sleep · doi:10.2147/nss.s6844 · Cited by 107
The metabolic syndrome, diabetes and lung dysfunction
Tiengo, A., Fadini, G. P., & Avogaro, A. (2008) · Diabetes & Metabolism · doi:10.1016/j.diabet.2008.08.001 · Cited by 94
Shantha, G. P. S., Kumar, A. A., Cheskin, L. J., & Pancholy, S. B. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.04.014 · Cited by 97
“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
Self-citationCGMap: Characterizing continuous glucose monitor data in thousands of non-diabetic individuals
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Myhill, P. C., Davis, W. A., Peters, K. E., Chubb, S. A. P., Hillman, D. R., & Davis, T. M. E. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-2107 · Cited by 91
Metabolic and Glycemic Sequelae of Sleep Disturbances in Children and Adults
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Interactions Between Pregnancy, Obstructive Sleep Apnea, and Gestational Diabetes Mellitus
Reutrakul, S., Zaidi, N., Wroblewski, K., Kay, H., Ismail, M., Ehrmann, D. A., & Cauter, E. V. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-2348 · Cited by 96
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
Conde, S. V., Sacramento, J. F., Guarino, M. P., González, C., Obeso, A., Diogo, L. N., Monteiro, E. C., & Ribeiro, M. J. (2014) · Frontiers in Physiology · doi:10.3389/fphys.2014.00418 · Cited by 89
Metadata
- 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 (medical) › 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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