Diabetes mellitus prevalence and control in sleep-disordered breathing: the European Sleep Apnea Cohort (ESADA) study.
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.
School of Medicine and Medical Science, University College Dublin and Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland.
Brian D
BD
Kent
Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Ludger
L
Grote
School of Medicine and Medical Science, University College Dublin and Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland.
Silke
S
Ryan
Université Grenoble Alpes, Institut National de la Santé et de la Recherche Médicale, and Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Jean-Louis
JL
Pépin
Biomedical Department of Internal & Specialist Medicine, University of Palermo and National Research Council Institute of Biomedicine and Molecular Immunology, Palermo, Italy.
Maria R
MR
Bonsignore
Department of Respiratory Medicine, Pavol Jozef Šafárik University in Košice and Louis Pasteur University Hospital, Kosice, Slovakia.
Ruzena
R
Tkacova
Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital and Sleep Research Unit, Department of Physiology, University of Turku, Turku, Finland.
Tarja
T
Saaresranta
Department of Pulmonary Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
Johan
J
Verbraecken
Université Grenoble Alpes, Institut National de la Santé et de la Recherche Médicale, and Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Patrick
P
Lévy
Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Jan
J
Hedner
School of Medicine and Medical Science, University College Dublin and Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland. Electronic address: Walter.mcnicholas@ucd.ie.
Walter T
WT
McNicholas
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D005060:Europe; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications*; D055815:Young Adult
D006442:Glycated Hemoglobin