Bi-Directional Association Observed Between Obstructive Sleep Apnea and Diabetes

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sleep apnea mask
Clinical awareness of the bi-directional association may improve prevention and treatment of both diseases.

Diabetes and obstructive sleep apnea (OSA) have a bidirectional association, in that OSA is associated with a higher risk for diabetes but individuals with diabetes also have a modest increase in risk for developing OSA, according to findings published in Diabetes Care.

Previous research has shown a complex association between OSA and diabetes, but to date there have been no population-based studies that have assessed the potential bi-directional relationship between these two disorders. In this study, the investigators used data from the Nurses’ Health Study (NHS; 2002-2012), Nurses’ Health Study II (NHSII; 1995-2013), and Health Professionals Follow-up Study (HPFS; 1996–2012) to examine that link. All participants were free of diabetes, cardiovascular disease, and cancer at baseline.

A dual approach was taken; participants were assessed for their risk for developing diabetes according to OSA status (n=146,519) and the risk was also estimated for developing OSA according to diabetes status in 151,194 participants.

A total of 9029 incident diabetes cases were identified in a pooled analysis during follow-up, and after adjustments were made for potential confounders, the hazard ratio (HR) for diabetes was 2.06 (95% CI, 1.86-2.28) in patients with OSA compared with patients without OSA. The HR remained statistically significant after adjusting for waist circumference and body mass index (BMI) (HR 1.37 [95% CI, 1.24-1.52]).  Patients with OSA concomitant with excessive daytime sleepiness had the highest risk for diabetes (HR 1.78 [95% CI, 1.13-2.82]).

The second analysis revealed 9364 incident OSA cases during  follow-up, and compared with no diabetes the multivariable HR for OSA was 1.53 (95% CI, 1.32-1.77) in patients with diabetes. A higher risk was noted in individuals with diabetes using insulin vs no diabetes (HR 1.43 [95% CI, 1.11-1.83]), particularly in women (HR 1.60 [95% CI, 1.34-1.89]).

“Clinical awareness of this bi-directional association may improve prevention and treatment of both diseases, and vigilant monitoring of one condition among patients with the other is warranted if our findings are confirmed in other studies,” wrote the investigators.

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Huang T, Lin BM, Stampfer MJ, Tworoger SS, Hu FB, Redline S. A population-based study of the bidirectional association between obstructive sleep apnea and type 2 diabetes in three prospective U.S. cohorts [published online August 2, 2018]. Diabetes Care. doi:10.2337/dc18-0675