Hyperglycemic Profiles in Obstructive Sleep Apnea: Effects of PAP Therapy

Research over the last decade has shown that obstructive sleep apnea (OSA) is a common
condition in people with diabetes. Observational and experimental evidence also indicates
that intermittent hypoxemia and recurrent arousals in OSA may alter glucose metabolism and
worsen glycemic control. However, the impact of treating OSA with positive airway pressure
(PAP) therapy on glycemic variability and control is not well defined. Adequately powered
randomized clinical trials have yet to be performed to demonstrate whether PAP therapy for
OSA in diabetics can improve glycemic variability (and control), decrease blood pressure, and
reverse endothelial dysfunction. The overarching goal of this study is to determine whether
PAP therapy for OSA in diabetics leads to improvements in (a) glycemic variability as
assessed by self-monitoring of blood glucose and continuous monitoring of glucose; (b)
glycosylated hemoglobin; (c) blood pressure; (d) endothelial function; (e) serum and urinary
biomarkers; and (f) dyslipidemia.

Inclusion Criteria:

- Type 2 diabetics

- Age > 21 and ≤ 75 years

Exclusion Criteria:

- Inability to consent or commit to the required visits

- Use of insulin or other injections for diabetes

- Weight change of 10% in last six months

- Use of oral steroids in the last six months

- Pulmonary disease (i.e., COPD)

- Renal or hepatic insufficiency

- Recent MI or stroke (< 3 months)

- Sleep-related hypoventilation

- Obesity-hypoventilation syndrome

- Morbid Obesity

- Occupation as a commercial driver or operator of heavy machinery

- Active substance use

- Untreated thyroid disease

- Pregnancy

- Any history of seizures or other neurologic disease

- Poor sleep hygiene or sleep disorder other than sleep apnea

- Central sleep apnea

- Variants of obstructive sleep apnea (e.g., REM-related OSA)

- Participants not suitable for the study based on the clinical judgment

- Use of any investigational drug within the past 30 days

- Participating in another study