Diabetes and OSA: How Does One Affect the Other?

Obstructive sleep apnea (OSA) and diabetes have a bidirectional association, according to the results of a recent study.

Previous evidence has suggested a “complex relationship” between OSA and diabetes, but to date, no population-based study has evaluated the potential bidirectional association between the 2 disorders, according to the study authors.

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They followed 146,519 participants from the Nurses’ Health Study (2002-2012), Nurses’ Health Study II (1995-2013), and Health Professionals Follow-Up Study (1996-2012) without diabetes, cardiovascular disease, and cancer at baseline. They used Cox proportional hazard models to estimate hazard ratios (HRs) for diabetes development based on OSA status, as well as OSA risk based on diabetes status.

Overall, 9029 incident cases of diabetes and 9364 cases of OSA were identified.

The risk for diabetes was greater in patients with OSA compared with those without OSA (HR 2.06). This association remained significant following adjustment for waist circumference and BMI (HR 1.37). The highest risk of diabetes was observed in patients with OSA concomitant with sleepiness (HR 1.78).

Similarly, the risk for OSA was higher in individuals with diabetes than in those without (HR 1.53), with an HR of 1.08 following adjustment for BMI and waist circumference. An increased risk was also observed among those with diabetes who used insulin compared with those who did not (HR 1.43), especially among women (HR 1.60).

“Clinical awareness of this bidirectional association may improve prevention and treatment of both diseases. Future research aimed at elucidating the mechanisms that underlie each association may identify novel intervention targets.”

—Michael Potts

Reference:

Huang T, Lin BM, Stampfer MJ, et al. A population-based study of the bidirectional association between obstructive sleep apnea and type 2 diabetes in three prospective US cohorts[published online August 2, 2018]. Diabetes Care. https://doi.org/10.2337/dc18-0675.