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VOLUME 35, ISSUE 05

CONTROLLED TRIAL OF CPAP THERAPY ON METABOLIC CONTROL
A Controlled Trial of CPAP Therapy on Metabolic Control in Individuals with Impaired Glucose Tolerance and Sleep Apnea

http://dx.doi.org/10.5665/sleep.1816

Tanya G. Weinstock, MD1; Xuelei Wang, PhD4; Michael Rueschman, MA2; Faramarz Ismail-Beigi, MD3; Joan Aylor, BA4; Denise C. Babineau, PhD4; Reena Mehra, MD, MS3,4; Susan Redline, MD1

1Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Boston, MA; 2Department of Medicine, Brigham and Women's Hospital, Boston, MA; 3Department of Medicine, Case Western Reserve University and VA Medical Center, Cleveland, OH; 4Center for Clinical Investigation, Case Western Reserve University, Cleveland, OH



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Study Objectives:

To address whether treatment of sleep apnea improves glucose tolerance.

Design:

Randomized, double-blind crossover study.

Setting:

Sleep clinic referrals.

Patients:

50 subjects with moderate to severe sleep apnea (AHI > 15) and impaired glucose tolerance.

Interventions:

Subjects were randomized to 8 weeks of CPAP or sham CPAP, followed by the alternate therapy after a one-month washout. After each treatment, subjects underwent 2-hour OGTT, polysomnography, actigraphy, and measurements of indices of glucose control.

Measurements and Results:

The primary outcome was normalization of the mean 2-h OGTT; a secondary outcome was improvement in the Insulin Sensitivity Index (ISI (0,120). Subjects were 42% men, mean age of 54 (10), BMI of 39 (8), and AHI of 44 (27). Baseline fasting glucose was 104 (12), and mean 2-h OGTT was 110 (57) mg/dL. Seven subjects normalized their mean 2-h OGTT after CPAP but not after sham CPAP, while 5 subjects normalized after sham CPAP but not after CPAP. Overall, there was no improvement in ISI (0,120) between CPAP and sham CPAP (3.6%; 95% CI: [-2.2%, 9.7%]; P = 0.22). However, in those subjects with baseline AHI ≥ 30 (n = 25), there was a 13.3% (95% CI: [5.2%, 22.1%]; P < 0.001) improvement in ISI (0,120) and a 28.7% (95%CI: [-46.5%, −10.9%], P = 0.002) reduction in the 2-h insulin level after CPAP compared to sham CPAP.

Conclusions:

This study did not show that IGT normalizes after CPAP in subjects with moderate sleep apnea and obesity. However, insulin sensitivity improved in those with AHI ≥ 30, suggesting beneficial metabolic effects of CPAP in severe sleep apnea.

Clinical Trials Information: ClinicalTrials.gov Identifier: NCT01385995.

Citation:

Weinstock TG; Wang X; Rueschman M; Ismail-Beigi F; Aylor J; Babineau DC; Mehra R; Redline S. A controlled trial of CPAP therapy on metabolic control in individuals with impaired glucose tolerance and sleep apnea. SLEEP 2012;35(5):617-625.

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