Obstructive sleep apnea: Overlooked comorbidity in patients with diabetes

Table 1 The impact of obstructive sleep apnea on macrovascular complications in type 2 diabetes mellitus

Ref.	Summary of findings
Aurora and Punjabi[4]	Evidence of a bidirectional relationship between OSA and T2DM; OSA exacerbates glycemic control, and T2DM increases OSA severity
Alshehri et al[25]	Presence of DM with abnormal ABI linked to severe OSA; OSA may worsen PAD through hypoxia-induced sympathetic activity
Zhao et al[26]	OSA identified as an independent risk factor for LEAD in T2DM patients, with risk levels increasing alongside OSA severity
Protasiewicz Timofticiuc et al[27]	OSA severity in T2DM patients associated with increased 10-year risk of coronary heart disease; highlights need for prospective studies and precise diagnostic methods
Hermans et al[28]	OSA associated with adverse atherogenic indices and inflammatory markers, indicating a higher risk of CAD
Adderley et al[29]	Incident OSA in T2DM patients linked to increased macrovascular complications and mortality, but not PAD
Strausz et al[30]	Comparable risks of CHD in T2DM patients with and without OSA; higher risk in females
Labarca et al[31]	Coexistence of OSA and DM in the SantOSA cohort showed increased risks of stroke and cardiovascular mortality
Su et al[32]	In older adults, coexistence of OSA and DM increased the risk of MACE and hospitalization for unstable angina, especially in females over 70 years
Wang et al[33]	Concurrent OSA and T2DM in ACS patients increased the risk of MACCE, particularly with elevated baseline glucose or HbA1c levels
Wang et al[34]	OSA in DM patients post-PCI linked to increased risk of MACEs and all-cause mortality

OSA: Obstructive sleep apnea; T2DM: Type 2 diabetes mellitus; ABI: Ankle-brachial index; PAD: Peripheral arterial disease; LEAD: Lower extremity artery disease; CAD: Coronary artery disease; CHD: Coronary heart disease; MACE: Major adverse cardiovascular events; ACS: Acute coronary syndrome; MACCE: Major adverse cardiovascular and cerebrovascular events; PCI: Percutaneous coronary intervention.