Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study

Abstract

This study aimed to obtain a comprehensive view of the risk of developing diabetes in patients with obstructive sleep apnea (OSA) and to compare this risk between patients receiving continuous positive airway pressure (CPAP) therapy versus upper airway surgery (UAS). We used local and the global-scale federated data research network TriNetX to obtain access to electronic medical records, including those for patients diagnosed with OSA, from health-care organizations (HCOs) worldwide. Using propensity score matching and the score-matched analyses of data for 5 years of follow-up, we found that patients who had undergone UAS had a lower risk of developing diabetes than those who used CPAP (risk ratio 0.415, 95% confidence interval (CI) 0.349-0.493). The risk for newly diagnosed diabetes patients showed a similar pattern (hazard ratio 0.382; 95% CI 0.317-0.459). Both therapies seem to protect against diabetes (Risk 0.081 after UAS vs. 0.195 after CPAP). Analysis of the large data sets collected from HCOs in Europe and globally lead us to conclude that, in patients with OSA, UAS can prevent the development of diabetes better than CPAP.

Keywords: Big data; Continuous positive airway pressure (CPAP); Diabetes; Sleep apnea; Survival; Upper airway surgery.

Fig. 1

Flow chart of the study. Diagram of the cohort used for the analysis of newly diagnosed diabetes. OSA patients treated with CPAP and surgery after 5 years of follow up. OSA, obstructive sleep apnea; ICD, international classifications of diseases; CPAP, continuous positive airway pressure

Fig. 2

Risk analysis after excluding patients with the outcome (Diabetes) before the time window

Fig. 3

Kaplan Meir plot comparing outcome of diabetes after five years of follow up in both cohorts

Fig. 4

Waterfall metabolic phenomena in patients with OSA and Diabetes. Surgery and CPAP are useful tools to avoid it