Effects of positive airway pressure treatment on clinical measures of hypertension and type 2 diabetes.
OBJECTIVE
Mechanistic and observational studies support an independent increase in risk of hypertension and abnormal glucose metabolism associated with obstructive sleep apnea (OSA). However, the specific populations and outcomes that improve with treatment of OSA in clinical practice are not established. We examined the effectiveness of OSA treatment on clinical blood pressure and diabetes control measures in men with preexisting systemic hypertension or type 2 diabetes.


METHODS
A retrospective cohort of veterans (n = 221) with a new diagnosis of OSA and initiation of positive airway pressure treatment was identified using administrative databases and clinical records.


RESULTS
Outcomes were changes in blood pressure (BP; mean of 3 highest recordings; systolic and diastolic) and glycemic control (mean of 3 highest fasting glucose and hemoglobinA1C values) at 3-6 months (T1) and 9-12 months (T2) following treatment compared to pretreatment. A generalized estimating equation model was used with adjustment for potential confounders: demographics, body mass index (BMI), OSA severity, Charlson comorbidity index, and pharmacologic treatment for hypertension and diabetes. Sustained independent effects of OSA treatment (mean change [95% CI]) were noted in both systolic BP (T1; -7.44 [-10.41 to -4.47] and T2; -6.81 [-9.94 to -3.67]) and diastolic BP (T1; -3.14, [-4.99 to -1.29] and T2; -3.69, [-5.53 to -1.85]). Diabetes control measures did not change with OSA treatment.


CONCLUSIONS
Treatment of OSA improves office blood pressure in hypertensive men. Prospective studies are necessary to better characterize specific populations with OSA that benefit from treatment with respect to progression of hypertension and type 2 diabetes.
Section of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, IL, USA. bpradsad@uic.edu
Bharati
B
Prasad
David W
DW
Carley
Jerry A
JA
Krishnan
Terri E
TE
Weaver
Frances M
FM
Weaver
D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D045422:Continuous Positive Airway Pressure; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology* / Q000628:therapy; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human