2023-05-02 21:14:10
Why is this important?
Clinical data demonstrate a link between OSAS and carbohydrate metabolism (insulin resistance, glucose intolerance, type 2 diabetes), linked to hypoxemia and the frequency of nocturnal awakenings. Also, the efficacy of OSAS treatment by PPC on these parameters is interesting to study, especially in type 2 diabetics, in whom glycemic excursions have a prognostic impact independent of the value of glycated hemoglobin. The studies available on the subject do not make it possible to conclude, on the one hand because they were carried out by monitoring the HbA1c value, and on the other hand because the adherence of patients to CPAP is often variable. and modest in the population groups monitored. Also, this study has the advantage of having circumvented these two limitations in order to have a better evaluation of the influence of CPAP on the glycaemia of diabetic patients suffering from OSAS.
Methodology
This randomized, open-label, controlled study recruited type 2 diabetic patients aged 21 to 75 years who had recently been diagnosed with OSAS. An eligibility phase was conducted to assess the ability to use CPAP in those who had an HbA1c ≥6.5% and an oxygen desaturation index (ODI) ≥15 events/hour. Those who had minimal CPAP use of at least 4 hours per night for at least 3 consecutive nights were then randomized (1:1) to continue CPAP with lifestyle advice versus that advice alone. , for 3 months. The primary endpoint was glycemic excursions at 3 months, as measured by continuous glucose monitoring (CGM).
Principle results
A total of 184 patients were recruited (mean age 59.6 years, 51% male). They had equivalent characteristics (age, body mass index, treatments) between the two groups, apart from a more frequent cardiovascular history in the control group versus PPC (11% vs 1%). During the study period, CPAP was used for an average of 5.4 h/night (median 5.5 h/night). Compliance (≥4h/night for at least 70% of nights) was 77%.
At the end of the three months, the mean value of glycemic excursions increased by an average of 0.8 mg/dL and 1.1 mg/dL in the CPAP and control groups respectively (difference -0.3 mg/dL, p=0.81). Mean blood glucose values increased by 4.3 mg/dL and 9.5 mg/dL respectively, (difference -5.2 mg/dL, p=0.20). Finally, HbA1c increased by 0.2% in both groups.
The exploratory analyzes carried out on the data at 3 months revealed that the mean glycemic values before lunch, following dinner and at bedtime were higher at 3 months than at inclusion in the control group, whereas the PPC group had no significant change in these values over 3 months, and while no difference was observed concerning the average caloric intake or the average distribution of carbohydrates, proteins or lipids between the two groups.
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#Sleep #apnea #influence #continuous #positive #airway #pressure #glycemic #control