Abstract
<b>Background:</b> There are controversies regarding the effect of obstructive sleep apnea (OSA) treatment with positive airway pressure (PAP) on diabetes-related outcomes. <b>Aims and Objectives:</b> To explore the association of PAP adherence with clinical outcomes in patients with type 2 diabetes (T2D) and OSA. <b>Methods:</b> In this prospective study T2D patients diagnosed with OSA between 2012 and 2017 were included. PAP adherence (optimal usage for > 6 h/night for ≥ 70% of nights), hemoglobin A1c (HbA1c), systolic and diastolic blood pressure and incident cardiovascular (CV) events were recorded. Regression modeling was utilized for outcomes after controlling for age, gender, body mass index and co-morbidities. <b>Results:</b> Of the 276 patients included, 162 (59%) were PAP adherent and 31 (41%) were non-adherent. The follow-up period was 6.5 (3.8) years. Median PAP adherence was 7 hours/day. Compared to those who were PAP non-adherent, those who were adherent had a significantly lower systolic (β=-5.593 mm Hg, p =0.03) and diastolic blood pressure (β=-4.776 mm Hg, p=0.018). HbA1c (6.3 vs 6.6), incident cardiovascular events (20 vs 29%) and death rates (8 vs 14%) were lower in the PAP adherent group, although the difference was not statistically significant (both p>0.05). However, excluding those with medication changes, HbA1c was significantly decreased (-1.1, p= 0.03) in PAP adherent group compared to the less adherent group (-0.35, p=0.43). <b>Conclusions:</b> Achieving optimal PAP adherence in T2D patients with OSA was associated with lower blood pressure. It seems that greater PAP use was associated with lower HbA1C, but further studies are needed to confirm these findings.
Published Version
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