Kelly A Loffler1, Emma Heeley2,3, Ruth Freed3, Rosie Meng4, Lia R Bittencourt5, Carolina C Gonzaga Carvalho6, Rui Chen7, Michael Hlavac8, Zhihong Liu9, Geraldo Lorenzi-Filho10, Yuanming Luo11, Nigel McArdle12, Sutapa Mukherjee2,12,13, Hooi Shan Yap13, Xilong Zhang14, Lyle J Palmer15, Craig S Anderson3,16, R Doug McEvoy1,13, Luciano F Drager. 1. Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia kelly.loffler@flinders.edu.au doug.mcevoy@flinders.edu.au. 2. Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia. 3. The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. 4. Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia. 5. Instituto do Sono, Associação Fundo de Incentivo a Pesquisa, São Paulo, Brazil. 6. Sleep Laboratory, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil. 7. The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. 8. Christchurch Hospital, Christchurch, New Zealand. 9. Fuwai Hospital, Beijing, China. 10. Sleep Laboratory, Pulmonary Division, Instituto do Coração, University of São Paulo, São Paulo, Brazil. 11. The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong, China. 12. West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia. 13. Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia. 14. The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. 15. School of Public Health, University of Adelaide, Adelaide, South Australia, Australia. 16. The George Institute for Global Health China at Peking University Health Science Center, Beijing, China.
Abstract
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 hemoglobinA1c (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.
RCT Entities:
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.
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