Sleep and Breathing

, Volume 17, Issue 1, pp 33–38 | Cite as

Effects of continuous positive airway pressure on glycemic control and insulin resistance in patients with obstructive sleep apnea: a meta-analysis

  • Dan Yang
  • Zhihong LiuEmail author
  • Haixing Yang
  • Qin Luo



Previous studies addressing the question of whether continuous positive airway pressure (CPAP) could improve the insulin resistance and glucose control in patients with obstructive sleep apnea (OSA) have led to conflicting results. Therefore, we conducted the meta-analysis to evaluate the effects of CPAP on glycemic control and insulin resistance in OSA patients.


We searched PubMed, HighWire Press, Ovid Medline (R), Cochrane library, and EMBASE before December 2011 on original English language studies. The meta-analysis was conducted using Review Manager Version 5.


The summary estimate for mean difference of homeostasis model assessment insulin resistance (HOMA) from 12 non-diabetic studies was −0.55 (95 % CI, −0.91 to −0.20; P = 0.002). When compared with fasting blood glucose at baseline, 3 to 24 weeks of CPAP treatment did not improve glycemic control in non-diabetic subjects (−0.12; 95 % CI, −0.3 to 0.06; P = 0.20), as well as in diabetic subjects (−0.71; 95 % CI, −2.24 to 0.83; P = 0.37). There were no intervention-related changes in body mass index.


Our analysis showed that CPAP significantly improved insulin resistance in non-diabetic patients with moderate to severe OSA, while no significant change in body mass index was detected. Compared with fasting blood glucose at baseline, there was no change in glycemic control with CPAP. Further large-scale, randomized, and controlled studies are needed to evaluate the longer treatment and its possible effects on weight loss and glycemic homeostasis.


OSA CPAP HOMA-IR BMI Glucose Meta-analysis 


Declaration of interest

The authors have no relevant interest to declare. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.


  1. 1.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235PubMedCrossRefGoogle Scholar
  2. 2.
    Phillips BG, Hisel TM, Kato M, Pesek CA, Dyken ME, Narkiewicz K, Somers VK (1999) Recent weight gain in patients with newly diagnosed obstructive sleep apnea. J Hypertens 17:1297–1300PubMedCrossRefGoogle Scholar
  3. 3.
    Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS (2002) Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 165:670–676PubMedGoogle Scholar
  4. 4.
    Punjabi NM, Ahmed MM, Polotsky VY, Beamer BA, O'Donnell CP (2003) Sleep-disordered breathing, glucose intolerance, and insulin resistance. Respir Physiol Neurobiol 136:167–178PubMedCrossRefGoogle Scholar
  5. 5.
    Harsch IA, Hahn EG, Konturek PC (2005) Insulin resistance and other metabolic aspects of the obstructive sleep apnea syndrome. Med Sci Monit: Int Med J Exp Clin Res 11:RA70–RA75Google Scholar
  6. 6.
    Saarelainen S, Lahtela J, Kallonen E (1997) Effect of nasal CPAP treatment on insulin sensitivity and plasma leptin. J Sleep Res 6:146–147PubMedCrossRefGoogle Scholar
  7. 7.
    Smurra M, Philip P, Taillard J, Guilleminault C, Bioulac B, Gin H (2001) CPAP treatment does not affect glucose-insulin metabolism in sleep apneic patients. Sleep Med 2:207–213PubMedCrossRefGoogle Scholar
  8. 8.
    Bonora E, Targher G, Alberiche M, Bonadonna RC, Saggiani F, Zenere MB, Monauni T, Muggeo M (2000) Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 23:57–63PubMedCrossRefGoogle Scholar
  9. 9.
    Katsuki A, Sumida Y, Gabazza EC, Murashima S, Furuta M, Araki-Sasaki R, Hori Y, Yano Y, Adachi Y (2001) Homeostasis model assessment is a reliable indicator of insulin resistance during follow-up of patients with type 2 diabetes. Diabetes Care 24:362–365PubMedCrossRefGoogle Scholar
  10. 10.
    Hermans MP, Levy JC, Morris RJ, Turner RC (1999) Comparison of tests of beta-cell function across a range of glucose tolerance from normal to diabetes. Diabetes 48:1779–1786PubMedCrossRefGoogle Scholar
  11. 11.
    Haffner SM, Kennedy E, Gonzalez C, Stern MP, Miettinen H (1996) A prospective analysis of the HOMA model. The Mexico City Diabetes Study. Diabetes Care 19:1138–1141PubMedCrossRefGoogle Scholar
  12. 12.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRefGoogle Scholar
  13. 13.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRefGoogle Scholar
  14. 14.
    Garcia JM, Sharafkhaneh H, Hirshkowitz M, Elkhatib R, Sharafkhaneh A (2011) Weight and metabolic effects of CPAP in obstructive sleep apnea patients with obesity. Respir Res 12:80PubMedCrossRefGoogle Scholar
  15. 15.
    Henley DE, Buchanan F, Gibson R, Douthwaite JA, Wood SA, Woltersdorf WW, Catterall JR, Lightman SL (2009) Plasma apelin levels in obstructive sleep apnea and the effect of continuous positive airway pressure therapy. J Endocrinol 203:181–188PubMedCrossRefGoogle Scholar
  16. 16.
    Lempiainen P, Mykkanen L, Pyorala K, Laakso M, Kuusisto J (1999) Insulin resistance syndrome predicts coronary heart disease events in elderly nondiabetic men. Circulation 100:123–128PubMedCrossRefGoogle Scholar
  17. 17.
    Pyorala M, Miettinen H, Halonen P, Laakso M, Pyorala K (2000) Insulin resistance syndrome predicts the risk of coronary heart disease and stroke in healthy middle-aged men: the 22-year follow-up results of the Helsinki Policemen Study. Arterioscler Thromb Vasc Biol 20:538–544PubMedCrossRefGoogle Scholar
  18. 18.
    Howard G, O'Leary DH, Zaccaro D, Haffner S, Rewers M, Hamman R, Selby JV, Saad MF, Savage P, Bergman R (1996) Insulin sensitivity and atherosclerosis. The Insulin Resistance Atherosclerosis Study (IRAS) Investigators. Circulation 93:1809–1817PubMedCrossRefGoogle Scholar
  19. 19.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419PubMedCrossRefGoogle Scholar
  20. 20.
    Li CL, Tsai ST, Chou P (2003) Relative role of insulin resistance and beta-cell dysfunction in the progression to type 2 diabetes—The Kinmen Study. Diabetes Res Clin Pract 59:225–232PubMedCrossRefGoogle Scholar
  21. 21.
    Bonora E, Formentini G, Calcaterra F, Lombardi S, Marini F, Zenari L, Saggiani F, Poli M, Perbellini S, Raffaelli A, Cacciatori V, Santi L, Targher G, Bonadonna R, Muggeo M (2002) HOMA-estimated insulin resistance is an independent predictor of cardiovascular disease in type 2 diabetic subjects: prospective data from the Verona Diabetes Complications Study. Diabetes Care 25:1135–1141PubMedCrossRefGoogle Scholar
  22. 22.
    Song Y, Manson JE, Tinker L, Howard BV, Kuller LH, Nathan L, Rifai N, Liu S (2007) Insulin sensitivity and insulin secretion determined by homeostasis model assessment and risk of diabetes in a multiethnic cohort of women: the Women's Health Initiative Observational Study. Diabetes Care 30:1747–1752PubMedCrossRefGoogle Scholar
  23. 23.
    Saini J, Krieger J, Brandenberger G, Wittersheim G, Simon C, Follenius M (1993) Continuous positive airway pressure treatment. Effects on growth hormone, insulin and glucose profiles in obstructive sleep apnea patients. Horm Metab Res = Hormon Stoffwechselforschung = Horm Metab 25:375–381CrossRefGoogle Scholar
  24. 24.
    Cooper BG, White JE, Ashworth LA, Alberti KG, Gibson GJ (1995) Hormonal and metabolic profiles in subjects with obstructive sleep apnea syndrome and the acute effects of nasal continuous positive airway pressure (CPAP) treatment. Sleep 18:172–179PubMedGoogle Scholar
  25. 25.
    Randle PJ, Garland PB, Hales CN, Newsholme EA (1963) The glucose fatty-acid cycle. Its role in insulin sensitivity and the metabolic disturbances of diabetes mellitus. Lancet 1:785–789PubMedCrossRefGoogle Scholar
  26. 26.
    Barceló A, Barbé F, de la Peña M, Martinez P, Soriano JB, Piérola J, Agustí AG (2008) Insulin resistance and daytime sleepiness in patients with sleep apnoea. Thorax 63:946–950PubMedCrossRefGoogle Scholar
  27. 27.
    Carneiro G, Togeiro SM, Ribeiro-Filho FF, Truksinas E, Ribeiro AB, Zanella MT, Tufik S (2009) Continuous positive airway pressure therapy improves hypoadiponectinemia in severe obese men with obstructive sleep apnea without changes in insulin resistance. Metab Syndr Relat Disord 7:537–542PubMedCrossRefGoogle Scholar
  28. 28.
    Chung S, Yoon IY, Lee CH, Kim JW (2011) The effects of nasal continuous positive airway pressure on vascular functions and serum cardiovascular risk factors in obstructive sleep apnea syndrome. Sleep Breathing = Schlaf Atmung 15:71–76PubMedCrossRefGoogle Scholar
  29. 29.
    Cuhadaroglu C, Utkusavas A, Ozturk L, Salman S, Ece T (2009) Effects of nasal CPAP treatment on insulin resistance, lipid profile, and plasma leptin in sleep apnea. Lung 187:75–81PubMedCrossRefGoogle Scholar
  30. 30.
    Dawson A, Abel SL, Loving RT, Dailey G, Shadan FF, Cronin JW, Kripke DF, Kline LE (2008) CPAP therapy of obstructive sleep apnea in type 2 diabetics improves glycemic control during sleep. J Clin Sleep Med: JCSM: Off Publ Am Acad Sleep Med 4:538–542Google Scholar
  31. 31.
    de Lima AM, Franco CM, de Castro CM, Bezerra Ade A, Ataide L Jr, Halpern A (2010) Effects of nasal continuous positive airway pressure treatment on oxidative stress and adiponectin levels in obese patients with obstructive sleep apnea. Respir Int Rev Thorac Dis 79:370–376Google Scholar
  32. 32.
    Dorkova Z, Petrasova D, Molcanyiova A, Popovnakova M, Tkacova R (2008) Effects of continuous positive airway pressure on cardiovascular risk profile in patients with severe obstructive sleep apnea and metabolic syndrome. Chest 134:686–692PubMedCrossRefGoogle Scholar
  33. 33.
    Lindberg E, Berne C, Elmasry A, Hedner J, Janson C (2006) CPAP treatment of a population-based sample—what are the benefits and the treatment compliance? Sleep Med 7:553–560PubMedCrossRefGoogle Scholar
  34. 34.
    Murri M, Alcazar-Ramirez J, Garrido-Sanchez L et al (2009) Oxidative stress and metabolic changes after continuous positive airway pressure treatment according to previous metabolic disorders in sleep apnea-hypopnea syndrome patients. Transl Res: J Lab Clin Med 154:111–121CrossRefGoogle Scholar
  35. 35.
    Nena E, Steiropoulos P, Tzouvelekis A, Tsara V, Hatzizisi O, Kyriazis G, Froudarakis M, Trakada G, Papanas N, Bouros D (2010) Reduction of serum retinol-binding protein-4 levels in nondiabetic obstructive sleep apnea patients under continuous positive airway pressure treatment. Respir Int Rev Thorac Dis 80:517–523Google Scholar
  36. 36.
    Nguyen PK, Katikireddy CK, McConnell MV, Kushida C, Yang PC (2010) Nasal continuous positive airway pressure improves myocardial perfusion reserve and endothelial-dependent vasodilation in patients with obstructive sleep apnea. J Cardiovasc Magn Reson: Off J Soc Cardiovasc Magn Reson 12:50CrossRefGoogle Scholar
  37. 37.
    Patruno V, Aiolfi S, Costantino G, Murgia R, Selmi C, Malliani A, Montano N (2007) Fixed and autoadjusting continuous positive airway pressure treatments are not similar in reducing cardiovascular risk factors in patients with obstructive sleep apnea. Chest 131:1393–1399PubMedCrossRefGoogle Scholar
  38. 38.
    Steiropoulos P, Papanas N, Nena E, Tsara V, Fitili C, Tzouvelekis A, Christaki P, Maltezos E, Bouros D (2009) Markers of glycemic control and insulin resistance in non-diabetic patients with obstructive sleep apnea hypopnea syndrome: does adherence to CPAP treatment improve glycemic control? Sleep Med 10:887–891PubMedCrossRefGoogle Scholar
  39. 39.
    Trenell MI, Ward JA, Yee BJ, Phillips CL, Kemp GJ, Grunstein RR, Thompson CH (2007) Influence of constant positive airway pressure therapy on lipid storage, muscle metabolism and insulin action in obese patients with severe obstructive sleep apnoea syndrome. Diabetes Obes Metab 9:679–687PubMedCrossRefGoogle Scholar
  40. 40.
    West SD, Nicoll DJ, Wallace TM, Matthews DR, Stradling JR (2007) Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and type 2 diabetes. Thorax 62:969–974PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.State Key Laboratory of Cardiovascular DiseaseFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  2. 2.Computer Center, Taizhou Hospital of Zhejiang ProvinceWenzhou Medical CollegeTaizhouChina

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