Diabetes mellitus prevalence and control in sleep-disordered breathing: The European Sleep Apnea Cohort (ESADA) study

Brian D. Kent, Ludger Grote, Silke Ryan, Jean Louis Pépin, Maria R. Bonsignore, Ruzena Tkacova, Tarja Saaresranta, Johan Verbraecken, Patrick Lévy, Jan Hedner, Walter T. McNicholas, Ulla Anttalainen, Ferran Barbe, Ozen Basoglu, Piotr Bielicki, Pierre Escourrou, Cristina Esquinas, Ingo Fietze, Lynda Hayes, Marta KumorJohn Artur Kvamme, Lena Lavie, Peretz Lavie, Carolina Lombardi, Oreste Marrone, Juan Fernando Masa, Josep M. Montserrat, Gianfranco Parati, Athanasia Pataka, Thomas Penzel, Robert Plywaczewski, Martin Pretl, Renata Riha, Gabriel Roisman, Richard Schulz, Pawel Sliwinski, Richard Staats, Paschalis Steiropoulos, Giedvar Varoneckas, Audrey Vitols, Heleen Vrints

Research output: Contribution to journalArticlepeer-review


BACKGROUND: OSA is associated with an increased risk of cardiovascular morbidity. A driver of this is metabolic dysfunction and in particular type 2 diabetes mellitus (T2DM). Prior studies identifying a link between OSA and T2DM have excluded subjects with undiagnosed T2DM, and there is a lack of population-level data on the interaction between OSA and glycemic control among patients with diabetes. We assessed the relationship between OSA severity and T2DM prevalence and control in a large multinational population.

METHODS: We performed a cross-sectional analysis of 6,616 participants in the European Sleep Apnea Cohort (ESADA) study, using multivariate regression analysis to assess T2DM prevalence according to OSA severity, as measured by the oxyhemoglobin desaturation index. Patients with diabetes were identified by previous history and medication prescription, and by screening for undiagnosed diabetes with glycosylated hemoglobin (HbA1c) measurement. The relationship of OSA severity with glycemic control was assessed in diabetic subjects.

RESULTS: T2DM prevalence increased with OSA severity, from 6.6% in subjects without OSA to 28.9% in those with severe OSA. Despite adjustment for obesity and other confounding factors, in comparison with subjects free of OSA, patients with mild, moderate, or severe disease had an OR (95% CI) of 1.33 (1.04-1.72), 1.73 (1.33-2.25), and 1.87 (1.45-2.42) ( P <.001), respectively, for prevalent T2DM. Diabetic subjects with more severe OSA had worse glycemic control, with adjusted mean HbA1c levels 0.72% higher in patients with severe OSA than in those without sleep-disordered breathing (analysis of covariance, P <.001).

CONCLUSIONS: Increasing OSA severity is associated with increased likelihood of concomitant T2DM and worse diabetic control in patients with T2DM.

Original languageEnglish
Pages (from-to)982-990
Number of pages9
Issue number4
Publication statusPublished - Oct 1 2014

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)


Dive into the research topics of 'Diabetes mellitus prevalence and control in sleep-disordered breathing: The European Sleep Apnea Cohort (ESADA) study'. Together they form a unique fingerprint.

Cite this