March 15, 2019
2 min read

'Bidirectional' relationship seen between type 2 diabetes and obstructive sleep apnea

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Type 2 diabetes increases the risk for obstructive sleep apnea in adults, and obesity, diabetes-related foot disease and depression are among the risk factors for the condition, according to findings published in Diabetes Care.

“Cross-sectional and cohort studies have shown that OSA is associated with worse glycemic control in patients with type 2 diabetes and with diabetes-related vascular complications,” G. Neil Thomas, PhD, professor in epidemiology and research methods in the Institute of Applied Health Research at the University of Birmingham in the U.K., and colleagues wrote. “Hence, understanding the complex relationships between OSA and type 2 diabetes is important, because OSA might be considered a modifiable risk factor for type 2 diabetes development and adverse outcomes in these patients.”

Using data collected from 2005 to 2017 in The Health Improvement Network medical record database, Thomas and colleagues examined the association between obstructive sleep apnea (OSA) and type 2 diabetes via a retrospective cohort study. Among the more than 15 million participants in the database, the researchers found 360,250 with type 2 diabetes (mean age, 64.85 years; 44.5% women) and then matched them by age, sex and BMI with up to four participants without type 2 diabetes (n = 1,296,489; mean age, 64.56 years; 45.8% women).

After a latency period of 15 months, the researchers then confirmed OSA in the records via clinical codes. They found 3,110 instances of OSA in participants with type 2 diabetes (0.88%) and 5,968 in the group without type 2 diabetes (0.46%). This equated to an incidence rate of 1.76 per 1,000 person-years in the type 2 diabetes group (95% CI, 1.69-1.84) compared with the group without diabetes, which was used as reference. The incidence rate remained significantly higher for those with type 2 diabetes when adjusting for age, sex, BMI, smoking status and ethnicity (adjusted incidence rate ratio [aIRR] = 1.48; 95% CI, 1.42-1.55) and compositive CVD (aIRR = 1.36; 95% CI, 1.3-1.42), as well as after sensitivity analysis (aIRR = 1.41; 95% CI, 1.32-1.51). Women with type 2 diabetes had a higher rate of OSA (aIRR = 1.76; 95% CI, 1.62-1.91) than men (aIRR = 1.39; 95% CI, 1.32-1.46).

The researchers identified male sex (aIRR = 2.27; 95% CI, 2.09-2.46), overweight (aIRR = 2.02; 95% CI, 1.54-2.64), obesity (aIRR = 8.29; 95% CI, 6.42-10.69), diabetes-related foot disease (aIRR = 1.23; 95% CI, 1.06-1.42), heart failure (aIRR = 1.41; 95% CI, 1.18-1.7), ischemic heart disease (aIRR = 1.22; 95% CI, 1.11-1.34), hypertension (aIRR = 1.32; 95% CI, 1.23-1.43) and depression (aIRR = 1.75; 95% CI, 1.61-1.91) as risk factors, even after sensitivity analysis was performed.


“When taken together with previous evidence, this study indicates that the association between type 2 diabetes and OSA is bidirectional,” the researchers wrote. “Further research is required to investigate whether the sequence in which the two diseases develop has an effect on outcomes in patients with type 2 diabetes and OSA.” – by Phil Neuffer

Disclosures: Thomas reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.