Obstructive sleep apnea: Overlooked comorbidity in patients with diabetes

Table 3 The impact of obstructive sleep apnea management on type 2 diabetes mellitus control

Ref./study	Summary of findings
The Sleep AHEAD study[50]	Regular exercise on its own helps improve OSA, and the more someone exercises, the lower the chances of having moderate to severe OSA-odds decrease with 1-2 hours per week (0.62), 3-6 hours per week (0.39), and at least 7 hours per week (0.31) compared to those who do not exercise vigorously
Shechter et al[51]	For individuals with T2DM and OSA, weight loss from a lifestyle intervention is more crucial for improving glycemic control than reductions in OSA severity
MIMOSA[52]	The MLG group exhibited improved insulin and HOMA–IR profiles compared to the SCG counterpart
The Interdisciplinary Weight Loss and Lifestyle Intervention for OSA (INTERAPNEA)[53]	Mediterranean lifestyle group demonstrated the potential benefits of interdisciplinary weight reduction and lifestyle therapies in improving the severity, symptoms, and cardiometabolic profiles, including T2DM, of individuals with OSA, including improvements in blood pressure and in glucose and lipid metabolism. In the intervention group, there were lower glucose and insulin levels, and lower HOMA-IR
The SCALE sleep apnea[55]	3.0 mg liraglutide reduced AHI, bodyweight, HbA1c, and SBP significantly compared to the placebo group
Herth et al[63]	The beneficial impact of CPAP on HbA1c levels was influenced by the duration of CPAP use per night, while it was not affected by baseline AHI, BMI, or diabetes duration
Zamarrón et al[65]	Participants in the CPAP treatment arm, with good adherence, exhibited a greater reduction in UACR [MD, -10.56% (95%CI: -19.06 to -2.06); P = 0.015], along with improvements in glycemic control and insulin resistance
Ding et al[59]	Surgical weight loss improves T2DM and OSA control. Mini GBP is associated with highest remission rate while BPD is associated with sustained long term remission

OSA: Obstructive sleep apnea; T2DM: Type 2 diabetes mellitus; MLG: Mediterranean lifestyle group; HOMA-IR: Homeostatic model assessment for insulin resistance; AHI: Apnea hypopnea index; RDI: Respiratory disturbance index; CPAP: Continuous positive airway pressure; SBP: Systolic blood pressure; UACR: Urine albumin creatinine ratio; GBP: Gastric bypass; BPD: Biliopancreatic diversion without duodenal switch.