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Obstructive sleep apnea and incident diabetes: a historical cohort study


Rationale — Despite emerging evidence that obstructive sleep apnea (OSA) may cause metabolic disturbances independently of other known risk factors, it remains unclear whether OSA is associated with incident diabetes.

Objective — To evaluate whether risk of incident diabetes was related to the severity and physiological consequences of OSA.

Methods and Measurements — A historical cohort study was conducted using a clinical and provincial health administrative data. All adults without previous diabetes referred with suspected OSA who underwent a diagnostic sleep study at St. Michael's Hospital (Toronto, Canada) between 1994 and 2010 were followed through health administrative data until May 2011 to examine the occurrence of diabetes. All OSA-related variables collected from the sleep study were examined as predictors in Cox-regression models, controlling for sex, age, body mass index, smoking status, comorbidities and income.

Main Results — Over a median follow-up of 67 months, 1,017 (11.7%) of 8,678 patients developed diabetes, giving a cumulative incidence at five years of 9.1% (95%CI: 8.4% to 9.8%). In fully-adjusted models, patients with apnea-hypopnea index (AHI) > 30 had a 30% higher hazard of developing diabetes than those with AHI < 5. Among other OSA-related variables, AHI in rapid eye movement (REM) sleep and time spent with oxygen saturation less than 90% were associated with incident diabetes, as were heart rate, neck circumference and sleep time.

Conclusions — Among people with OSA, and controlling for multiple confounders, initial OSA severity and its physiologic consequences predicted subsequent risk for incident diabetes.



Kendzerska T, Gershon AS, Hawker G, Tomlinson G, Leung RS. Am J Respir Crit Care Med. 2014; 190(2):218-25. Epub 2014 Jun 4.

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