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CPAP Lowers BP and A1c in Patients with Obstructive Sleep Apnea and Type 2 Diabetes

Researchers also found that Quality of Life improved and costs were lowered…. 

Researchers assessed clinical outcomes and the cost-effectiveness of using continuous positive airway pressure (CPAP) to manage obstructive sleep apnea (OSA) in patients with type 2 diabetes (T2D) from the perspective of the U.K.’s National Health Service (NHS).

Using a case-control design, Julian F. Guest, PhD, a managing director at Catalyst Health Economics Consultants and visiting professor at the School of Biomedical Sciences at King’s College, and his colleagues, randomly selected 150 CPAP-treated patients with OSA and T2D from The Health Improvement Network (THIN) database (a nationally representative database of patients registered with general practitioners in the U.K.) and matched with 150 OSA and T2D patients from the same database who were not treated with CPAP. The total NHS cost and outcomes of patient management in both groups over 5 years and the cost-effectiveness of CPAP compared with no CPAP treatment were estimated.

Using CPAP was associated with significantly lower blood pressure at 5 years and increasingly lower HbA1c levels over 5 consecutive years compared with untreated OSA patients. At 5 years, the HbA1c level in the CPAP-treated group was 8.2% (66.0 mmol/mol) vs. 12.1% (108.4 mmol/mol) in the control group (P < 0.03). Use of CPAP significantly increased patients’ health status by 0.27 quality-adjusted life years (QALYs) per patient over 5 years (P < 0.001) and NHS management costs by £4,141 per patient over 5 years; the cost per QALY gained with CPAP was £15,337.

Initiating treatment with CPAP in OSA patients with T2D leads to significantly lower blood pressure and better controlled diabetes and affords a cost-effective use of NHS resources. These observations have the potential for treatment modification if confirmed in a prospective study.

Practice Pearls:

  • This study showed that patients with OSA and type 2 diabetes who received CPAP experienced significant reductions in blood pressure, increasingly lower HbA1c levels, and significant increases in health status.
  • Researchers believe CPAP could one day be used to help achieve glycemic control in these patients.

CPAP improved outcomes, health status in obstructive sleep apnea, diabetes. Published online before print April 4, 2014, doi: 10.2337/dc13-2539

Diabetes Care May 2014 vol. 37 no. 5 1263-1271