Abstract
BackgroundObstructive sleep apnea syndrome (OSAS) in association with Type 2 Diabetes Mellitus (DM) may result in increased glycemic variability affecting the glycemic control and hence increasing the risk of complications associated with diabetes. We decided to assess the Glycemic Variability (GV) in patients with type 2 diabetes with OSAS and in controls. We also correlated the respiratory disturbance indices with glycemic variability indices.MethodsAfter fulfilling the inclusion and exclusion criteria patients from the Endocrinology and Pulmonology clinics underwent modified Sleep Apnea Clinical Score (SACS) followed by polysomnography (PSG). Patients were then divided into 4 groups: Group A (DM with OSAS, n = 20), Group B (DM without OSAS, n = 20), Group C (Non DM with OSAS, n = 10) and Group D (Non DM without OSAS, n = 10). Patients in these groups were subjected to continuous glucose monitoring using the Medtronic iPro2 and repeat PSG. Parameters of GV: i.e. mean glucose, SD (standard Deviation), CV (Coefficient of Variation), Night SD, Night CV, MAGE and NMAGE were calculated using the Easy GV software. GV parameters and the respiratory indices were correlated statistically. Quantitative data was expressed as mean, standard deviation and median. The comparison of GV indices between different groups was performed by one-way analysis of variance (ANOVA) or Kruskal Wallis (for data that failed normality). Correlation analysis of AHI with GV parameters was done by Pearson correlation.ResultsAll the four groups were adequately matched for age, sex, Body Mass Index (BMI), waist circumference (WC) and blood pressure (BP). We found that the GV parameters Night CV, MAGE and NMAGE were significantly higher in Group A as compared to Group B (p values < 0.05). Similarly Night CV, MAGE and NMAGE were also significantly higher in Group C as compared to Group D (p value < 0.05). Apnea-hypopnea index (AHI) correlated positively with Glucose SD, MAGE and NMAGE in both diabetes (Group A plus Group B) and non- diabetes groups (Group C plus Group D).ConclusionsOSAS has a significant impact on the glycemic variability irrespective of glycemic status. AHI has moderate positive correlation with the glycemic variability.
Highlights
Obstructive sleep apnea syndrome (OSAS) in association with Type 2 Diabetes Mellitus (DM) may result in increased glycemic variability affecting the glycemic control and increasing the risk of complications associated with diabetes
OSAS has a significant impact on the glycemic variability irrespective of glycemic status
Glycemic Variability (GV) may represent an important aspect of glycemia which is not reflected by conventional measures of glucose control, such as HbA1c and fasting plasma glucose [19]
Summary
Obstructive sleep apnea syndrome (OSAS) in association with Type 2 Diabetes Mellitus (DM) may result in increased glycemic variability affecting the glycemic control and increasing the risk of complications associated with diabetes. Experimental studies have demonstrated that OSAS exerts adverse effects on glucose metabolism, such as worsening of insulin resistance, glucose intolerance and pancreatic β-cell dysfunction through complex neurohormonal mechanisms [9,10,11,12,13] This association between OSAS and type 2 DM may be bidirectional as higher Glycated hemoglobin (HbA1c) levels were found even in non-diabetic patients with severe OSAS [14, 15]. OSAS is known to cause rapid fluctuations in blood glucose levels [15] This Glycemic Variability (GV) is an independent risk factor for diabetes related complications, including cardiovascular diseases [16,17,18]. We assessed the GV in patients with type 2 diabetes and OSAS by using a CGMS
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