#1702695 Impact of Sleep Apnea on Metabolic Parameters in Obese Patients with Diabetes Mellitus: A Large-Scale Cohort Study

This study, employing data from TriNetX, investigated the impact of sleep apnea on metabolic outcomes in obese diabetic patients. We used propensity score matching to compare two cohorts: patients with obesity and diabetes but without sleep apnea (Cohort A: 182,227 patients) and those with obesity, diabetes, and sleep apnea (Cohort B: 182,227 patients). We evaluated hemoglobin A1c, LDL, HDL, triglycerides, systolic and diastolic blood pressure, and incidences of neuropathy, nephropathy, and retinopathy. The study included patients aged ≥18, with BMI ranging from 30-49. After propensity score matching, significant differences in metabolic outcomes and complication risks were observed between the cohorts. Cohort B (with sleep apnea) had lower average HbA1c (6.962 vs. 7.235) and LDL levels (82.533 mg/dL vs. 86.183 mg/dL), with higher HDL levels (43.097 vs. 41.651 mg/dL). Triglyceride levels were marginally higher in Cohort B (159.077 vs. 158.176 mg/dL). Systolic blood pressure was slightly lower in Cohort B (130.570 vs. 131.800 mmHg), while diastolic pressure was marginally higher (74.956 vs. 75.459 mmHg). For complications, the risk of neuropathy in Cohort B (with sleep apnea) was higher at 0.104 compared to 0.068 in Cohort A (without sleep apnea), with a significant risk difference of -0.036 (95% CI: -0.038 to -0.034, p < 0.001). The risk of nephropathy was also higher in Cohort B at 0.077 compared to 0.049 in Cohort A, with a risk difference of -0.028 (95% CI: -0.030 to -0.026, p < 0.001). The risk of retinopathy was low in both groups (0.001), with a marginal risk difference. This study reveals a nuanced relationship between sleep apnea and metabolic control in obese diabetic patients. Post-propensity matching, patients with sleep apnea showed better metabolic outcomes but higher complication risks. This paradox might be attributed to more frequent healthcare interactions and the indirect effects of sleep apnea treatment improving metabolic parameters. Conversely, the increased complication risks highlight the complex interplay of comorbidities in these patients. These findings emphasize the need for comprehensive care strategies, balancing metabolic management with sleep apnea treatment to optimize overall patient outcomes.