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Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and type 2 diabetes
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  1. Sophie D West1,
  2. Debby J Nicoll1,
  3. Tara M Wallace2,
  4. David R Matthews2,
  5. John R Stradling1
  1. 1
    Sleep Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
  2. 2
    Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
  1. Dr Sophie D West, Sleep Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Old Road, Oxford OX3 7LJ, UK; sophie{at}west66.freeserve.co.uk

Abstract

Background: The effects of continuous positive airway pressure (CPAP) for obstructive sleep apnoea (OSA) on insulin resistance are not clear. Trials have found conflicting results and no appropriate control groups have been used.

Methods: Forty-two men with known type 2 diabetes and newly diagnosed OSA (>10 dips/h in oxygen saturation of >4%) were randomised to receive therapeutic (n = 20) or placebo CPAP (n = 22) for 3 months. Baseline tests were performed and repeated after 3 months. The study was double blind.

Results: Results are expressed as mean (SD). CPAP improved the Epworth sleepiness score significantly more in the therapeutic group than in the placebo group (−6.6 (4.5) vs −2.6 (4.9), p = 0.01). The maintenance of wakefulness test improved significantly in the therapeutic group but not in the placebo group (+10.6 (13.9) vs −4.7 (11.8) min, p = 0.001). Glycaemic control and insulin resistance did not significantly change in either the therapeutic or placebo groups: HbA1c (−0.02 (1.5) vs +0.1 (0.7), p = 0.7, 95% CI −0.6% to +0.9%), euglycaemic clamp (M/I: +1.7 (14.1) vs −5.7 (14.8), p = 0.2, 95% CI −1.8 to +0.3 l/kg/min1000), HOMA-%S (−1.5 (2.3) vs −1.1 (1.8), p = 0.2, 95% CI −0.3% to +0.08%) and adiponectin (−1.1 (1.2) vs −1.1 (1.3), p = 0.2, 95% CI −0.7 to +0.6 μg/ml). Body mass index, bioimpedance and anthropometric measurements were unchanged. Hours of CPAP use per night were 3.6 (2.8) in the treatment group and 3.3 (3.0) in the placebo group (p = 0.8). There was no correlation between CPAP use and the measures of glycaemic control or insulin resistance.

Conclusion: Therapeutic CPAP does not significantly improve measures of glycaemic control or insulin resistance in men with type 2 diabetes and OSA.

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Supplementary materials

Footnotes

  • This study was funded by Diabetes UK and the Grand Charity.

  • Competing interests: None.

  • Abbreviations:
    BMI
    body mass index
    CPAP
    continuous positive airway pressure
    ESS
    Epworth sleepiness score
    HbA1c
    glycosylated haemoglobin
    HOMA
    homeostatic model assessment
    MWT
    Maintenance of Wakefulness test
    OHA
    oral hypoglycaemic agents
    OSA
    obstructive sleep apnoea
    SAQLI
    Sleep Apnea Quality of Life Index

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