Effects of Positive Airway Pressure Therapy on Glycemic Variability in Patients With Type 2 Diabetes and OSA: A Randomized Controlled Trial

R Nisha Aurora; Mary R Rooney; Dan Wang; Elizabeth Selvin; Naresh M Punjabi

doi:10.1016/j.chest.2023.04.017

Effects of Positive Airway Pressure Therapy on Glycemic Variability in Patients With Type 2 Diabetes and OSA: A Randomized Controlled Trial

Chest. 2023 Oct;164(4):1057-1067. doi: 10.1016/j.chest.2023.04.017. Epub 2023 Apr 14.

Authors

R Nisha Aurora¹, Mary R Rooney², Dan Wang², Elizabeth Selvin², Naresh M Punjabi³

Affiliations

¹ Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Grossman School of Medicine, New York, NY. Electronic address: rashmi.aurora@nyulangone.org.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD.
³ Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami, Miller School of Medicine, Miami, FL.

PMID: 37062349
PMCID: PMC10567929 (available on 2024-10-01)
DOI: 10.1016/j.chest.2023.04.017

Abstract

Background: Glycemic variability is associated with increased risk for cardiovascular disease in patients with type 2 diabetes independent of glycosylated hemoglobin A1c (HbA1c) levels. Given the conflicting evidence on the effect of positive airway pressure (PAP) therapy for OSA on HbA1c, elucidating its effect on glycemic variability has value.

Research question: Does the use of PAP therapy for OSA improve glycemic variability in patients with type 2 diabetes?

Study design and methods: A randomized controlled trial was conducted in 184 patients with type 2 diabetes and moderate-to-severe OSA. Participants received either 3 months of PAP therapy with lifestyle counseling or lifestyle counseling alone. End points included the SD of glucose levels along with other metrics derived from continuous glucose monitoring and self-monitoring of blood glucose.

Results: No differences were noted in either primary or secondary continuous glucose monitoring end points between the two groups. Average use of PAP therapy was 5.4 h/night (SD, 1.6). Exploratory analyses by sex showed significant differences in the primary and secondary outcomes. In female participants, PAP therapy was associated with improvement in the SD of glucose levels, with a mean difference in change between intervention and control groups of 3.5 mg/dL (P = .02). PAP therapy was also associated with lower post-dinner and bedtime glucose levels: 20.1 mg/dL (P < .01) and 34.6 mg/dL (P < .01), respectively.

Interpretation: PAP therapy did not improve glycemic control or variability in patients with moderate-to-severe OSA and type 2 diabetes. Exploratory analyses suggested that PAP therapy may improve glucose variability in female participants. Post-dinner and bedtime glucose levels were higher in those who did not receive PAP therapy.

Trial registration: ClinicalTrials.gov; No.: NCT02454153; URL: www.

Clinicaltrials: gov.

Keywords: OSA; glucose; glycemic variability; positive airway pressure.

Associated data

ClinicalTrials.gov/NCT02454153

Grants and funding

K24 DK106414/DK/NIDDK NIH HHS/United States