CPAP Helps Glycemic Control in OSA Patients

According to research published in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine is a study believed to be the first randomized controlled trial of its kind. The study is titled “Effect of CPAP on glycemic control in patients with obstructive sleep apnea and type 2 diabetes: A randomized clinical trial.”

A randomized clinical trial for this is believed to be the first randomized controlled trial of its kind. Francisco Garcia-Rio, MD, PhD, professor of medicine at Autonoma University of Madrid and senior study author, said the research advanced understanding of the biological relationship between two major public health problems, which epidemiological studies have indicated are related.

"OSA is a public health problem of the first order, due to its high prevalence and marked morbidity and mortality, having been linked to traffic accidents, cardiovascular complications and, more recently, neoplastic diseases," he said. "Diabetes mellitus is a global epidemic. There are currently 382 million diabetics worldwide, a figure which is estimated to reach 592 million in 2035."

Dr. Garcia-Rio and his colleagues studied results from 50 patients with both OSA and sub-optimally controlled type 2 diabetes, who were assigned to CPAP intervention or control. Participants, who ranged in age from 18 to 80, did not change diabetes medications during the trial unless medically necessary, nor were they expected to change their diets or level of physical activity.

The researchers measured glucose control, changes in insulin sensitivity and resistance, inflammatory proteins and other biomarkers associate with type 2 diabetes glycemic control. Researchers found that those using CPAP showed a statistically significant:

1. • Decrease in glycated hemoglobin (HbA1c) levels at 6 months. (The decrease at 3 months was not statistically significant.)
2. • Improvement in insulin sensitivity at 3 and 6 months.
3. • Decrease in insulin resistance at 6 months.

The researchers found that CPAP participants experienced lower levels of the inflammatory molecules IL-1β and IL-6 and higher levels of the hormone adiponectin, an important glucose regulator.

Dr. Garcia-Rio said study findings suggest that "early identification of OSA in patients with type 2 diabetes, and assessment for metabolic abnormalities in those with OSA could reduce the cardiovascular disease risk of patients with these chronic diseases."

Researchers believe results are generalizable, given that patients included in the study were referred from diabetes units or primary care physicians, reflecting standard clinical practice. Study limitations include small sample size, lack of a placebo arm and medication changes that were necessary for some patients during the trial.

Sleep Apnea in the US Threatens Public Health

New studies highlight the destructive nature of obstructive sleep apnea and benefits of CPAP therapy. Public health and safety are threatened by the increasing prevalence of obstructive sleep apnea, which now afflicts at least 25 million adults in the U.S., according to the National Healthy Sleep AwarenessProject. Several new studies highlight the destructive nature of obstructive sleep apnea, a chronic disease that increases the risk of high blood pressure, heart disease, Type 2 diabetes, stroke, and depression.

Public safety is only given a mention, but needs more emphasis as it is unknown how many accidents are caused by people being drowsy or asleep while driving. I have even seen drivers asleep at the when at stoplights. Sometimes other drivers sit and honk at them, but most just drive around them.

Data published previously in the American Journal of Epidemiology shows that the prevalence rates of obstructive sleep apnea have increased substantially during the last two decades, most likely because of the obesity epidemic. The latest estimates predict that 26 percent of adults between the ages of 30 and 70 years have sleep apnea.

Obstructive sleep apnea is destroying the health of millions of Americans, and the problem has only gotten worse over the last two decades. The effective treatment of sleep apnea is one of the keys to success as our nation attempts to reduce health care spending and improve chronic disease management.

Findings from new studies emphasize the negative effects of sleep apnea on brain and heart health. These health risks can be reduced through the effective treatment of sleep apnea with continuous positive airway pressure (CPAP) therapy.

1. “A neuroimaging study in the September issue of the journal Sleep found that participants with severe, untreated sleep apnea had a significant reduction in white matter fiber integrity in multiple brain areas, which was accompanied by impairments to cognition, mood, and daytime alertness. One year of CPAP therapy led to an almost complete reversal of this brain damage.
2. A study published online ahead of print Sept. 21 in the journal NeuroImage found functional and anatomical changes in brainstem regions of people with sleep apnea.
3. A study in the October issue of Anesthesiology shows that diagnosing sleep apnea and prescribing CPAP therapy prior to surgery significantly reduced postoperative cardiovascular complications - specifically cardiac arrest and shock - by more than half.
4. A study published online ahead of print Sept. 19 in the Journal of Hypertension found a favorable reduction of blood pressure with CPAP treatment in patients with resistant hypertension and sleep apnea.
5. A Brazilian population study published online ahead of print Sept. 23 found that nocturnal cardiac arrhythmias occurred in 92 percent of patients with severe sleep apnea, compared with 53 percent of people without sleep apnea. The prevalence of rhythm disturbance also increased with sleep apnea severity. “

Common warning signs for sleep apnea include snoring and choking, gasping, or silent breathing pauses during sleep. The American Academy of Sleep Medicine, Centers for Disease Control and Prevention, Sleep Research Society, and other partners in the National Healthy Sleep Awareness Project urge anyone with signs or symptoms of sleep apnea to visit this website to pledge to "Stop the Snore" and talk to a doctor about sleep apnea.

If you suspect you have sleep apnea, follow the directions above and see a doctor specializing in sleep problems. I use a CPAP machine daily and find that I have not had more problems with sleep and am generally rested when I awake in the morning.