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Ambika R. Babu, MD; James Herdegen, MD; Leon Fogelfeld, MD; Susan Shott, PhD; Theodore Mazzone, MD

Arch Intern Med. 2005;165:447-452.

Background  Sleep-disordered breathing (SDB) is a prevalent condition associated with significant comorbidities, including hypertension, obesity, cardiovascular disease, and insulin resistance. It has been previously shown that the severity of insulin resistance is related to the severity of SDB.

Methods  Using a 72-hour continuous glucose monitoring system, we studied changes in interstitial glucose levels and measured hemoglobin A_1c levels in 25 patients with type 2 diabetes mellitus before and after continuous positive airway pressure (CPAP) treatment for SDB.

Results  With a mean ± SD CPAP treatment period of 83 ± 50 days, the mean ± SD 1-hour postprandial glucose values were significantly reduced for breakfast (191 ± 68 mg/dL to 130 ± 41 mg/dL [10.6 ± 3.8 mmol/L to 7.2 ± 2.3 mmol/L]), lunch (196 ± 70 mg/dL to 138 ± 49 mg/dL [10.9 ± 3.9 mmol/L to 7.7 ± 2.7 mmol/L]), and dinner (199 ± 66 mg/dL to 137 ± 48 mg/dL [11.0 ± 3.7 mmol/L to 7.6 ± 2.7 mmol/L]). In the 17 patients with a baseline hemoglobin A_1c level greater than 7%, there was a significant reduction in hemoglobin A_1c level (9.2% ± 2.0% to 8.6% ± 1.8%). Furthermore, in subjects who used CPAP for more than 4 h/d, the reduction in hemoglobin A_1c level was significantly correlated with days of CPAP use. There was no such correlation in subjects who used CPAP for 4 h/d or less.

Conclusions  These findings suggest that SDB is pathophysiologically related to impaired glucose homeostasis, and that CPAP can be an important therapeutic approach for diabetic patients with SDB.

Author Affiliations: Departments of Medicine (Drs Babu, Herdegen, and Fogelfeld) and Obstetrics and Gynecology (Dr Shott), Rush University Medical Center, Chicago, Ill; Department of Medicine, John H. Stroger, Jr, Hospital of Cook County, Chicago (Drs Babu and Fogelfeld); and Department of Medicine, University of Illinois, Chicago (Dr Mazzone).

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