title: Continuous positive airway pressure and diabetes risk in sleep apnea patients: A systemic review and meta-analysis.
abstract: BACKGROUND
  The study assessed the effect of continuous positive airway pressure (CPAP) therapy on the risk of developing type 2 diabetes by evaluating change in the homeostasis model assessment of insulin resistance (HOMA-IR) fasting blood glucose (FBG) and fasting insulin following CPAP treatment in non-diabetic patients and pre-diabetic with obstructive sleep apnea (OSA).
  
  
  METHODS
  Medline, PubMed, Cochrane, and EMBASE databases were searched until August 24, 2015. The analysis included randomized controlled trials (RCTs), two arm prospective studies, cohort studies, and retrospective studies. The primary outcome measure was change of HOMA-IR in pre-diabetic patients receiving CPAP treatment.
  
  
  RESULTS
  Twenty-three studies were included with 965 patients who had OSA. Nineteen studies were prospective studies and four were RCTs. CPAP therapy resulted in a significant reduction in the pooled standard difference in means of HOMA-IR (-0.442, P=0.001) from baseline levels compared with the control group. Change in FBG and fasting insulin from baseline levels was similar for the CPAP and control groups. For RCT studies (n=4), there was no difference in change in HOMA-IR or FBG levels from baseline between CPAP and control groups. The combined effect of RCTs showed that CPAP was associated with a significant reduction in change from baseline in fasting insulin than the control group (standardized diff. in means between groups=-0.479, P value=0.003).
  
  
  CONCLUSIONS
  These findings support the use of CPAP in non-diabetic and pre-diabetic patients with OSA to reduce change of HOMA-IR and possibly reduce the risk of developing type 2 diabetes in this patient population.
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. Electronic address: drchenl@yeah.net.
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Kuang
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Jian-Hao
authors.initials: JH
authors.lastname: Pei
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Hong-Mei
authors.initials: HM
authors.lastname: Chen
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Chen
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Zhong-Wen
authors.initials: ZW
authors.lastname: Li
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Hua-Zhang
authors.initials: HZ
authors.lastname: Yang
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Xiao-Ying
authors.initials: XY
authors.lastname: Fu
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Long
authors.initials: L
authors.lastname: Wang
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Zhi-Jiang
authors.initials: ZJ
authors.lastname: Chen
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Shui-Qing
authors.initials: SQ
authors.lastname: Lai
authors.affiliation: The First Division in the Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Shu-Ting
authors.initials: ST
authors.lastname: Zhang
mesh_terms: D001786:Blood Glucose; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D011236:Prediabetic State / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy*
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: CPAP; Continuous positive airway pressure; Diabetes; HOMA; Insulin resistance; Obstructive sleep apnea