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Effects of continuous positive airway pressure therapy on glucose metabolism in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis

Jonas Herth, Noriane Adriana Sievi, Felix Schmidt, Malcolm Kohler
European Respiratory Review 2023 32: 230083; DOI: 10.1183/16000617.0083-2023
Jonas Herth
1Faculty of Medicine, University of Zurich, Zurich, Switzerland
2Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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  • ORCID record for Jonas Herth
Noriane Adriana Sievi
2Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Felix Schmidt
1Faculty of Medicine, University of Zurich, Zurich, Switzerland
2Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Malcolm Kohler
1Faculty of Medicine, University of Zurich, Zurich, Switzerland
2Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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  • For correspondence: malcolm.kohler@usz.ch
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  • FIGURE 1
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    FIGURE 1

    Study flow chart. RCT: randomised controlled trial; OSA: obstructive sleep apnoea.

  • FIGURE 2
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    FIGURE 2

    Forrest plot evaluating the effect of continuous positive airway pressure therapy on HbA1c in patients with obstructive sleep apnoea and type 2 diabetes. The sizes of the Forrest plot squares represent the weighting of that trial in the random-effect meta-analysis and the horizontal lines represent the 95% confidence interval. MD: mean difference; REML: restricted maximum likelihood.

  • FIGURE 3
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    FIGURE 3

    Bubble plot evaluating the association of haemoglobin A1c (HbA1c) and mean continuous positive airway pressure (CPAP) usage hours per night. A significant association between increasing CPAP usage hours per night and a reduction of HbA1c was observed.

Tables

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  • TABLE 1

    Baseline characteristics of trials included in meta-analysis

    StudyOSA definition
    (events·h−1)
    InterventionSubjects (n)Follow-up (weeks)Age
    (years)
    Male (%)BMI (kg·m−2)HbA1c
    (%)
    CPAP usage
    (h·night−1)
    AHI
    (events·h−1)
    Duration DMII
    (years)
    Outcomes
    Banghøj et al., 2020 [19]AHI ≥15CPAP
    No CPAP
    721262±7.57534.6±4.28.0±0.8
    8.1±0.8
    5.6±1.932.0 (21–43)
    34.0 (22–49)
    16±8.6HbA1c, FBG, 24 h glucose
    Bakker et al., 2020 [27]AHI ≥10CPAP
    Sham CPAP
    531256.2±9.36435.4±6.86.7±0.5
    7.1±0.6
    4.3±2.423.5±15.1NAHbA1c, FBG
    Chasens et al., 2022 [16]AHI ≥10CPAP
    Sham CPAP
    98658.7±9.85836.2±6.67.7±0.8
    8.0±1.0
    5.0±1.7
    4.4±2.1
    22.5±13.4
    25.9±15.9
    10±9.0HbA1c,
    fructosamine
    Lam et al., 2017 [23]AHI ≥15CPAP
    No CPAP
    641255±9.08129.9±5.38.0±1.2
    8.3±1.4
    2.5±2.343.4±23.1
    47.2±23.5
    9±5.9HbA1c, FBG, fructosamine
    Martínez-Cerón et al., 2016 [15]AHI ≥5CPAP
    No CPAP
    501261±9.06032.5±4.57.6±1.3
    7.6±0.7
    5.2±1.935.6±23.4
    28.2±17.4
    5 (3.0–15.0)HbA1c, FBG, HOMA-IR
    Mokhlesi et al., 2016 [24]AHI ≥15CPAP
    Sham CPAP
    19155±3.34737.8±2.87.3±0.4
    7.0±0.4
    7.9±0.1
    7.9±0.1
    NA4±2.824 h glucose
    Morariu et al., 2017 [25]AHI ≥10CPAP
    Sham CPAP
    23455.6±11.65135.2±5.36.6±0.5
    6.9±1.0
    4.1±2.9
    4.5±2.7
    56.6±29.8
    25.6±11.4
    NA24 h glucose, fructosamine
    Shaw et al., 2016 [13]AHI ≥15CPAP
    No CPAP
    2982462.3±9.06533.0±5.47.3±0.5
    7.3±0.5
    4.9±NA26.2±12.9
    28.0±14.1
    8±6.9HbA1c, FBG,
    West et al., 2007 [26]ODI ≥10CPAP
    Sham CPAP
    421256.1±9.910036.7±4.78.5±1.8
    8.6±1.7
    3.6±2.8
    3.3±3.0
    NANAHbA1c, FBG, HOMA-IR
    Zamarron et al., 2022 [17]AHI ≥10CPAP
    No CPAP
    1855267±9.07632.0±5.17.7±1.6
    7.5±1.4
    4.1±2.937.0±20.0
    33.9±18.7
    16±9.5HbA1c, FBG, HOMA-IR,
    Zhao et al., 2022 [18]AHI ≥5CPAP
    No CPAP
    60653.4±10.25830.5±4.08.5±2.3
    8.7±1.7
    8.3±2.828.3±17.8
    34.5±20.4
    7±6.5HbA1c, FBG, HOMA-IR

    Values are presented as mean±sd or median (interquartile range) unless otherwise stated. OSA: obstructive sleep apnoea; BMI: body mass index; HbA1c: haemoglobin A1c; CPAP: continuous positive airway pressure; AHI: apnoea–hypopnoea index; DMII: type 2 diabetes; FBG: fasting blood glucose; ODI: oxygen desaturation index; NA: not available; HOMA-IR: homeostasis model of assessment for insulin resistance index.

    Supplementary Materials

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    • Supplementary Material

      Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

      Supplementary material ERR-0083-2023.SUPPLEMENT

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    Effects of continuous positive airway pressure therapy on glucose metabolism in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis
    Jonas Herth, Noriane Adriana Sievi, Felix Schmidt, Malcolm Kohler
    European Respiratory Review Sep 2023, 32 (169) 230083; DOI: 10.1183/16000617.0083-2023

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    Effects of continuous positive airway pressure therapy on glucose metabolism in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis
    Jonas Herth, Noriane Adriana Sievi, Felix Schmidt, Malcolm Kohler
    European Respiratory Review Sep 2023, 32 (169) 230083; DOI: 10.1183/16000617.0083-2023
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