Patients with both type 2 diabetes and obstructive sleep apnea (OSA) demonstrated macrovascular endothelial dysfunction beyond the effect of either disease alone, according to the results of a study (ClinicalTrials.gov Identifier: NCT01629862) published in the Annals of the American Thoracic Society.
Macrovascular endothelial function in patients with type 2 diabetes, OSA, or both conditions was assessed by measuring brachial artery diameter before and after flow-mediated dilation. Participants also underwent cardiovascular magnetic resonance to determine left and right ventricular volume, mass, and ejection fraction. These measurements of cardiac function were then compared between patients of each group to assess the effects of each condition.
Among the 341 patients screened, 141 completed the cross-sectional study. A total of 27 patients had only type 2 diabetes, 29 patients had only OSA, and 57 patients with both conditions were compared with 28 healthy control individuals. Patients with both type 2 diabetes and OSA exhibited macrovascular endothelial dysfunction beyond the effect of either disease alone.
OSA was associated with an additional mean flow-mediated dilation reduction of 3.1% among those with type 2 diabetes in contrast to those with OSA alone. Furthermore, 3 months of continuous positive airway pressure treatment did not reverse the effects on flow-mediated dilation, but the researchers did observe improved left ventricular end diastolic and systolic volumes.
“[A]s very few prior studies assessing cardiovascular risk in [type 2 diabetes] have evaluated the presence of OSA, our results suggesting that OSA plays a major role in both large vessel endothelial dysfunction and ventricular hypertrophy emphasize the importance of accounting for OSA in the design of future interventional studies in [type 2 diabetes].”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures. ApneaLink diagnostic devices, CPAP machines, and masks were provided by ResMed. CPAP masks were provided by Philips. Neither company was involved with the design or conduct of the study. The author is an employee of ResMed.
Bakker JP, Baltzis D, Tecilazich F, et al. The effect of CPAP on vascular function and cardiac structure in diabetes and sleep apnea: a randomized controlled trial [published January 10, 2020]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201905-378OC