2215-PUB: Impact of Continuous Positive Airway Pressure Compliance on Complications in Patients with Type 2 Diabetes and Obstructive Sleep Apnea

Continuous positive airway pressure (CPAP) treatment has been shown to be beneficial to patients with obstructive sleep apnea (OSA) by reducing blood pressure and possibly slowing progression of chronic kidney disease. However, there is a dearth of research on the effects of CPAP treatment, especially compliance, on these outcomes in patients with type 2 diabetes (T2D) in a real world setting.

Methods: A single-center, retrospective chart review was conducted on patients with T2D who were diagnosed with OSA between 2010 and 2018. The first available CPAP report following the polysomnography was used to determine compliance (CPAP usage for >4 h/night for >70% of nights). Data such as estimated glomerular filtration rate (eGFR), A1C, blood pressure, lipid panel, and incident cardiovascular/peripheral vascular/cerebrovascular events (CVD, PVD and CVA) were extracted from the charts. Mixed-effects linear regression modeling of longitudinal repeated measures within patients was utilized for continuous outcomes, and logistic regression modeling was used for incident events. All models were controlled for age, sex, body mass index (BMI), medications, and baseline levels of outcomes.

Results: Of the 1,295 patients, 239 (18.4%) were compliant and 339 (26.2%) were non-compliant with CPAP, while 717 (55.3%) had insufficient data. Compared to those who were CPAP non-compliant, those who were compliant had a significantly lower systolic blood pressure (β=-2.28 mmHg, p=0.0002), lower diastolic blood pressure (β=-2.52 mmHg, p<0.0001), and higher HDL (β=3.81 mg/dL, p=0.03). There were no significant differences between the two groups in eGFR, total cholesterol, LDL, triglycerides, A1C, incident CVD, PVD or CVA.

Conclusion: T2D patients with OSA who were compliant with CPAP had significantly lower blood pressure as well as higher HDL. However, eGFR, A1C, or cardiovascular events did not significantly differ by CPAP compliance in this study.