Association of continuous positive airway pressure compliance with complications in patients with type 2 diabetes and obstructive sleep apnea.

Abstract

STUDY OBJECTIVES\nTo explore the association of continuous positive airway pressure (CPAP) compliance with clinical outcomes in patients with type 2 diabetes (T2D) and obstructive sleep apnea (OSA) in a real-world setting.\n\n\nMETHODS\nThis was a retrospective study of patients with T2D diagnosed with OSA between 2010 and 2017. CPAP compliance (usage for ≥4 h/night for ≥70% of nights) was determined from the first CPAP report following the polysomnography. Data including estimated glomerular filtration rate (eGFR), hemoglobin A1C (HbA1c), systolic and diastolic blood pressure (SBP, DBP), lipid panel, and incident cardiovascular/peripheral vascular/cerebrovascular events (CVD, PVD, CVA) were extracted from medical records. Mixed-effects linear regression modeling of longitudinal repeated measures within patients was utilized for continuous outcomes, and logistic regression modeling was used for binary outcomes. Models were controlled for age, sex, body mass index, medications, and baseline levels of outcomes.\n\n\nRESULTS\nOf the 1,295 patients, 260 (20.7%) were CPAP compliant, 318 (24.5%) were CPAP non-compliant, while 717 (55.3%) had insufficient data. The follow up period was on average 2.5 (1.7) years. Compared to those who were CPAP non-compliant, those who were compliant had a significantly lower SBP (β=-1.95 mmHg, p=0.001) and DBP (β=-2.33 mmHg, p<0.0001). Among the CPAP-compliant patients, a 17% greater CPAP compliance was associated with a 2 mmHg lower SBP. Lipids, HbA1c, eGFR and incident CVD/PVD/CVA were not different between the two groups.\n\n\nCONCLUSIONS\nAchieving CPAP compliance in T2D patients with OSA was associated with significantly lower blood pressure. Greater CPAP use within compliant patients was associated with lower SBP.