How is OSA Related to Diabetes and CV Disease?

Frequent exposure to certain metabolic changes that occur in patients with obstructive sleep apnea (OSA) while asleep may predispose patients to diabetes and cardiovascular disease (CVD), according to a recent study.

For 2 nights, the researchers evaluated 31 patients with moderate to severe OSA who were accustomed to continuous positive airway pressure (CPAP) machines to aid breathing during sleep. While asleep, patients underwent attended polysomnography with therapeutic CPAP, or after CPAP withdrawal, in random order.
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The researchers took venous blood samples at about 20-min intervals during both nights and assessed glucose kinetics with an infusion of 6,6-[²H₂] glucose in 11 patients.

The results showed that CPAP withdrawal caused OSA to recur. This recurrence was associated with hypoxemia, sleep disruption, and heart rate elevation. Furthermore, CPAP withdrawal greatly increased nocturnal plasma free fatty acids (FFA), glucose, and cortisol, in proportion to respiratory event frequency, heart rate elevation, or sleep fragmentation. The researchers noted that diabetes predisposed patients to glucose elevation.

Additionally, CPAP withdrawal increased systolic blood pressure and augmentation index. However, the researchers saw no effect on insulin, triglycerides, glucose production, oral glucose tolerance, cholesterol, or high sensitivity C-reactive protein.

Ultimately, the researchers found that OSA patients who do not use CPAP machines while asleep experienced worsened glucose and cardiovascular health associated with diabetes and CVD.

“OSA recurrence during CPAP withdrawal increases FFA and glucose during sleep, associated with sympathetic and adrenocortical activation,” the researchers concluded. “Recurring exposure to these metabolic changes may foster diabetes and cardiovascular disease.”

—Christina Vogt

Reference:

Chopra S, Rathore A, Younas H, et al. Obstructive sleep apnea dynamically increases nocturnal plasma free fatty acids, glucose, and cortisol during sleep [Published online June 8, 2017]. J Clin Endocrinol Metab. doi:10.1210/jc.2017-00619.