A Controlled Trial of CPAP Therapy on Metabolic Control in Individuals with Impaired Glucose Tolerance and Sleep Apnea

STUDY OBJECTIVES: To address whether treatment of sleep apnea improves glucose tolerance. DESIGN: Randomized, double-blind crossover study. SETTING: Sleep clinic referrals. PATIENTS: 50 subjects with moderate to severe sleep apnea (AHI > 15) and impaired glucose tolerance. INTERVENTIONS: Subjects were randomized to 8 weeks of CPAP or sham CPAP, followed by the alternate therapy after a one-month washout. After each treatment, subjects underwent 2-hour OGTT, polysomnography, actigraphy, and measurements of indices of glucose control. MEASUREMENTS AND RESULTS: The primary outcome was normalization of the mean 2-h OGTT; a secondary outcome was improvement in the Insulin Sensitivity Index (ISI (0,120). Subjects were 42% men, mean age of 54 (10), BMI of 39 (8), and AHI of 44 (27). Baseline fasting glucose was 104 (12), and mean 2-h OGTT was 110 (57) mg/dL. Seven subjects normalized their mean 2-h OGTT after CPAP but not after sham CPAP, while 5 subjects normalized after sham CPAP but not after CPAP. Overall, there was no improvement in ISI (0,120) between CPAP and sham CPAP (3.6%; 95% CI: -2.2%, 9.7%; P = 0.22). However, in those subjects with baseline AHI ≥ 30 (n = 25), there was a 13.3% (95% CI: 5.2%, 22.1%; P < 0.001) improvement in ISI (0,120) and a 28.7% (95%CI: -46.5%, -10.9%, P = 0.002) reduction in the 2-h insulin level after CPAP compared to sham CPAP. CONCLUSIONS: This study did not show that IGT normalizes after CPAP in subjects with moderate sleep apnea and obesity. However, insulin sensitivity improved in those with AHI ≥ 30, suggesting beneficial metabolic effects of CPAP in severe sleep apnea. Clinical trials information: ClinicalTrials.gov Identifier: NCT01385995.