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Original Research: Sleep Disorders |

Diabetes Mellitus Prevalence and Control in Sleep-Disordered BreathingSleep-Disordered Breathing and Diabetes: The European Sleep Apnea Cohort (ESADA) Study

Brian D. Kent, MBBCh; Ludger Grote, PhD; Silke Ryan, PhD; Jean-Louis Pépin, PhD; Maria R. Bonsignore, PhD; Ruzena Tkacova, PhD; Tarja Saaresranta, PhD; Johan Verbraecken, PhD; Patrick Lévy, PhD; Jan Hedner, PhD; Walter T. McNicholas, MD, FCCP; on behalf of the ESADA collaborators
Author and Funding Information

From the School of Medicine and Medical Science (Drs Kent, Ryan, and McNicholas), University College Dublin and Pulmonary and Sleep Disorders Unit, St. Vincent’s University Hospital, Dublin, Ireland; Department of Sleep Medicine (Drs Grote and Hedner), Sahlgrenska University Hospital, Gothenburg, Sweden; Université Grenoble Alpes (Drs Pépin and Lévy), Institut National de la Santé et de la Recherche Médicale, and Centre Hospitalier Universitaire de Grenoble, Grenoble, France; Biomedical Department of Internal & Specialist Medicine (Dr Bonsignore), University of Palermo and National Research Council Institute of Biomedicine and Molecular Immunology, Palermo, Italy; Department of Respiratory Medicine (Dr Tkacova), Pavol Jozef Šafárik University in Košice and Louis Pasteur University Hospital, Kosice, Slovakia; Division of Medicine (Dr Saaresranta), Department of Pulmonary Diseases, Turku University Hospital and Sleep Research Unit, Department of Physiology, University of Turku, Turku, Finland; and Department of Pulmonary Medicine (Dr Verbraecken), Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.

CORRESPONDENCE TO: Walter T. McNicholas, MD, FCCP, Pulmonary and Sleep Disorders Unit, St. Vincent’s University Hospital, Dublin 4, Ireland; e-mail: Walter.mcnicholas@ucd.ie


Part of this article has been published in abstract form (Kent BD, Grote L, Bonsignore MR, et al. Am J Respir Crit Care Med. 2012;185:A5379).

FUNDING/SUPPORT: The maintenance of the European Sleep Apnea (ESADA) study database is supported by unrestricted grants from ResMed and Philips Respironics (Koninklijke Philips N.V.). Drs Kent and Ryan are supported by grants from the Health Research Board, Ireland [HPF/2009/033], and Dr Grote is supported by grants from the Swedish Heart and Lung Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):982-990. doi:10.1378/chest.13-2403
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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.

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