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Effects of continuous positive airway pressure therapy on glycaemic control, insulin sensitivity and body mass index in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis.

Feng Y, Zhang Z, Dong ZZ - NPJ Prim Care Respir Med (2015)

Bottom Line: Evidence suggests that 15-30% of individuals with obstructive sleep apnoea (OSA) have type 2 diabetes mellitus (T2DM), and that OSA is an independent risk factor for T2DM.All relevant studies published before 31 January 2014 were included.The numbers of patients ranged from 9 to 44 (total=128), and mean age ranged from 50.7 to 66.1 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

ABSTRACT

Background: Evidence suggests that 15-30% of individuals with obstructive sleep apnoea (OSA) have type 2 diabetes mellitus (T2DM), and that OSA is an independent risk factor for T2DM. There is considerable interest in ascertaining whether OSA treatment improves glycaemic control and insulin sensitivity in patients with OSA and T2DM.

Aims: To assess the effects of continuous positive airway pressure (CPAP) therapy on glycosylated haemoglobin (HbA1c) level, insulin sensitivity and body mass index (BMI) in patients with OSA and T2DM.

Methods: MEDLINE, EMBASE and the Cochrane Library were searched to identify prospective studies involving patients with OSA and T2DM who had received CPAP, and data on primary outcome (change in HbA1c) and/or secondary outcomes (changes in insulin sensitivity and BMI) were reported. All relevant studies published before 31 January 2014 were included.

Results: Six studies were included in the systematic review and meta-analysis. The numbers of patients ranged from 9 to 44 (total=128), and mean age ranged from 50.7 to 66.1 years. For the change in HbA1c (six studies, 128 patients), the combined standardised paired difference revealed no significant effect of CPAP (-0.071, 95% confidence interval (CI)=-0.245, 0.103; P=0.421). Similarly, there was no significant effect of CPAP on the change in BMI (-0.102, 95% CI=-0.296, 0.092; P=0.302; five studies, 103 patients). In contrast, there was a significant effect of CPAP on the change (improvement) in insulin sensitivity (0.330, 95% CI=0.001, 0.658; P=0.049; three studies, 39 patients).

Conclusion: The limited available evidence from randomised controlled trials and prospective observational studies suggests that CPAP does not decrease HbA1c level or BMI in patients with OSA and T2DM but may improve insulin sensitivity.

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Related in: MedlinePlus

Summary of risk-of-bias assessment for studies included in the systematic review/meta-analysis.
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fig4: Summary of risk-of-bias assessment for studies included in the systematic review/meta-analysis.

Mentions: Figure 4 summarises the overall (a) and individual study (b) risk-of-bias assessments. In four studies,13,15–17 patients were not randomised to control/sham CPAP treatment. Rather, before and after comparisons were made for each patient. In the study reported by Myhill et al.,12 the control group of patients did not receive sub-therapeutic CPAP for ethical reasons (i.e., restricting potentially effective therapy CPAP in a high-risk population). All studies were considered to have a low risk of attrition and reporting bias.


Effects of continuous positive airway pressure therapy on glycaemic control, insulin sensitivity and body mass index in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis.

Feng Y, Zhang Z, Dong ZZ - NPJ Prim Care Respir Med (2015)

Summary of risk-of-bias assessment for studies included in the systematic review/meta-analysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373500&req=5

fig4: Summary of risk-of-bias assessment for studies included in the systematic review/meta-analysis.
Mentions: Figure 4 summarises the overall (a) and individual study (b) risk-of-bias assessments. In four studies,13,15–17 patients were not randomised to control/sham CPAP treatment. Rather, before and after comparisons were made for each patient. In the study reported by Myhill et al.,12 the control group of patients did not receive sub-therapeutic CPAP for ethical reasons (i.e., restricting potentially effective therapy CPAP in a high-risk population). All studies were considered to have a low risk of attrition and reporting bias.

Bottom Line: Evidence suggests that 15-30% of individuals with obstructive sleep apnoea (OSA) have type 2 diabetes mellitus (T2DM), and that OSA is an independent risk factor for T2DM.All relevant studies published before 31 January 2014 were included.The numbers of patients ranged from 9 to 44 (total=128), and mean age ranged from 50.7 to 66.1 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

ABSTRACT

Background: Evidence suggests that 15-30% of individuals with obstructive sleep apnoea (OSA) have type 2 diabetes mellitus (T2DM), and that OSA is an independent risk factor for T2DM. There is considerable interest in ascertaining whether OSA treatment improves glycaemic control and insulin sensitivity in patients with OSA and T2DM.

Aims: To assess the effects of continuous positive airway pressure (CPAP) therapy on glycosylated haemoglobin (HbA1c) level, insulin sensitivity and body mass index (BMI) in patients with OSA and T2DM.

Methods: MEDLINE, EMBASE and the Cochrane Library were searched to identify prospective studies involving patients with OSA and T2DM who had received CPAP, and data on primary outcome (change in HbA1c) and/or secondary outcomes (changes in insulin sensitivity and BMI) were reported. All relevant studies published before 31 January 2014 were included.

Results: Six studies were included in the systematic review and meta-analysis. The numbers of patients ranged from 9 to 44 (total=128), and mean age ranged from 50.7 to 66.1 years. For the change in HbA1c (six studies, 128 patients), the combined standardised paired difference revealed no significant effect of CPAP (-0.071, 95% confidence interval (CI)=-0.245, 0.103; P=0.421). Similarly, there was no significant effect of CPAP on the change in BMI (-0.102, 95% CI=-0.296, 0.092; P=0.302; five studies, 103 patients). In contrast, there was a significant effect of CPAP on the change (improvement) in insulin sensitivity (0.330, 95% CI=0.001, 0.658; P=0.049; three studies, 39 patients).

Conclusion: The limited available evidence from randomised controlled trials and prospective observational studies suggests that CPAP does not decrease HbA1c level or BMI in patients with OSA and T2DM but may improve insulin sensitivity.

Show MeSH
Related in: MedlinePlus