TY - JOUR
T1 - Diabetes mellitus prevalence and control in sleep-disordered breathing
T2 - The European Sleep Apnea Cohort (ESADA) study
AU - Kent, Brian D.
AU - Grote, Ludger
AU - Ryan, Silke
AU - Pépin, Jean Louis
AU - Bonsignore, Maria R.
AU - Tkacova, Ruzena
AU - Saaresranta, Tarja
AU - Verbraecken, Johan
AU - Lévy, Patrick
AU - Hedner, Jan
AU - McNicholas, Walter T.
AU - Anttalainen, Ulla
AU - Barbe, Ferran
AU - Basoglu, Ozen
AU - Bielicki, Piotr
AU - Escourrou, Pierre
AU - Esquinas, Cristina
AU - Fietze, Ingo
AU - Hayes, Lynda
AU - Kumor, Marta
AU - Kvamme, John Artur
AU - Lavie, Lena
AU - Lavie, Peretz
AU - Lombardi, Carolina
AU - Marrone, Oreste
AU - Masa, Juan Fernando
AU - Montserrat, Josep M.
AU - Parati, Gianfranco
AU - Pataka, Athanasia
AU - Penzel, Thomas
AU - Plywaczewski, Robert
AU - Pretl, Martin
AU - Riha, Renata
AU - Roisman, Gabriel
AU - Schulz, Richard
AU - Sliwinski, Pawel
AU - Staats, Richard
AU - Steiropoulos, Paschalis
AU - Varoneckas, Giedvar
AU - Vitols, Audrey
AU - Vrints, Heleen
PY - 2014/10/1
Y1 - 2014/10/1
N2 - 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.
AB - 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.
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U2 - 10.1378/chest.13-2403
DO - 10.1378/chest.13-2403
M3 - Article
C2 - 24831859
AN - SCOPUS:84907929434
SN - 0012-3692
VL - 146
SP - 982
EP - 990
JO - Chest
JF - Chest
IS - 4
ER -