Effect of continuous positive airway pressure therapy on glucose control

Table 1 Effect of continuous positive airway pressure on blood glucose control

Study	Study design/ cohort	Sample size	Control group	Outcome/ measurements	Study duration	Conclusions	+/-
Stoohs et al[29]	OSA patients	5	None	Fasting glucose and insulin	2 mo	No change in either fasting or nocturnal insulin level	_
						Increase in nocturnal and fasting glucose
Saini et al[30]	OSA patients BMI 32.7 ± 2.3 Kg/m2	8	None	Glucose and insulin every 10 min interval during sleep	1 night	Mean insulin and glucose did not differ between pre treatment and treatment night	-
Davies et al[31]	OSA patients	10	Matched control	Fasting insulin, lipid profile	3 mo	No change in insulin level with CPAP	-
Brooks et al[32]	OSA patients with BMI 42.7 ± 4.3 kg/m2	10	None	Hyperinsulinemic euglycemic clamp	4 mo	Improvement in insulin responsiveness seen	+
Cooper et al[33]	OSA patients	6	None	Insulin and c-peptide sample every hour and glucose sample every 30 min during sleep	1 night	No changes in glucose, insulin and C-peptide with CPAP treatment	-
Saarelainen et al[34]	OSA patients	7	None	Hyperinsulinemic euglycemic clamp	3 mo	No change in insulin responsiveness	_
Pierzchala et al[35] (article in Polish)	Type 1 and type 2 diabetes patients with OSA	30	None	Blood glucose	6 mo	Better blood glucose control	+
Chin et al[36]	OSA patients	22	OSA patients	Oral glucose tolerance test with insulin measurement	6 mo	No change in glucose and insulin level except in patients who have lost weight	_
Ip et al[37]	OSA patients	30	Matched 30 non-OSA control	Fasting glucose and insulin	6 mo	No change in fasting glucose and insulin seen (decrease in Leptin and triglyceride was seen)	_
Smurra et al[38]	16 OSA patients; 10 from endocrine clinic and 6 other OSA patients	16	None	Oral glucose tolerance test in 10 patients and hyperinsulinemic euglycemic clamp in 6 patients	2 mo	No change in mean glycemia, insulin level or insulin responsiveness was seen	_
Harsch et al[39]	OSA patients	40	None	Hyperinsulinemic euglycemic clamp	3 mo	Improvement in insulin sensitivity at day 2 and 3 mo, in patient with BMI < 30, than in patients with BMI > 30	+
Harsch et al[40]	Type 2 diabetes patients with OSA	9	None	Hyperinsulinemic euglycemic clamp	3 mo	Insulin sensitivity was unchanged after 2 days, but significantly improved after 3 mo; glycemic control was unaffected after 3 mo	+/-
Babu et al[41]	Type 2 diabetes patients with OSA	25	None	HBA1c and post prandial blood glucose	3 mo	Decrease in HBA1c and postprandial am glucose level	+
Czupryniak et al[42]	Non diabetic OSA patients	9	None	Continuous glucose monitoring, plasma insulin, HOMA-IR	1 night	Mean blood glucose, fasting insulin and HOMA-IR were significantly higher with CPAP treatment	-
Hassaballa et al[43]	Type 2 diabetes and OSA (retrospective)	38	None	HBA1c	Approx. 3 mo	Decrease in HBA1c was seen with CPAP therapy	+
Lindberg et al[44]	OSA patients	28	Matched control without OSA	HOMA and fasting insulin	6 mo	Decrease in insulin resistance and fasting insulin	+
West et al[45]	Type 2 diabetes and OSA	42	Randomized, double blind	HOMA, hyperinsulinaemic euglycemic clamp, HBA1c, highly sensitive C-reactive protein	3 mo	No change in glycemic control or insulin resistance	_
Coughlin et al[46]	OSA patients	34	Randomized placebo-controlled blinded crossover trial	Insulin, fasting glucose, HOMA-IR	6 wk	No change in glucose or insulin resistance	_
Pallayova et al[47]	Type 2 diabetes with OSA	14	None	Continuous glucose monitoring	Several d	Reduction in nocturnal glucose variability and improved overnight glucose control	+
Wang et al[48]	Type 2 diabetes and OSA	30	None	HOMA	7 d	Improve ISI	+
Dawson et al[49]	Type 2 diabetes with OSA	20	None	Continuous glucose monitoring	Average 41 d (26-96 d)	Decrease in sleeping blood glucose seen	+
Steiropoulos et al[50]	Diabetes with OSA	56	None	HBA1c, fasting glucose, insulin level, HOMA-IR	6 mo	Only patients with CPAP use > 4 h/night showed decrease in HBA1c	+/-
Wei et al[51]	OSA patients	11	None	Fasting blood glucose, plasma insulin, HOMA-IR	4 d	Decrease in blood glucose and increase in insulin sensitivity seen	+
Oktay et al[52]	OSA and metabolic syndrome	20	None	Fasting blood glucose	1 yr	No difference in blood glucose seen	_
Lam et al[53]	OSA patients	61 (30 control and 31 study group)	Sham CPAP	Short insulin tolerance test	12 wk	Improvement in insulin sensitivity seen only in subjects with BMI ≥ 25	+/-
Garcia et al[54]	Obese OSA patients	20	None	OGTT, insulin level, Gherlin, adiponectin, leptin	6 mo	Increase insulin and IR; gherlin decrease, whereas leptin and adiponectin remains unchanged	-
Shpirer et al[55]	OSA patients	30	None	HBA1c	3-5 mo	Decrease in HBA1c in severe OSA patients	+

HOMA-IR: Homeostatic model assessment of insulin resistance; HBA1c: Glycosylated Hemoglobin; ISI: Insulin sensitivity index; OGTT: Oral glucose tolerance test; BMI: Body mass index; OSA: Obstructive sleep apnea; CPAP: Continuous positive airway pressure.