Risk of incident obstructive sleep apnoea in patients with type 1 diabetes: a population-based retrospective cohort study

Ziyad Alshehri; Anuradhaa Subramanian; Nicola Adderley; Krishna Gokhale; Muhammad Ali Karamat; Clare Ray; Prem Kumar; Krishnarajah Nirantharakumar; Abd Tahrani

doi:10.1007/s00125-022-05714-5

Risk of incident obstructive sleep apnoea in patients with type 1 diabetes: a population-based retrospective cohort study

Ziyad Alshehri, Anuradhaa Subramanian, Nicola Adderley, Krishna Gokhale, Muhammad Ali Karamat, Clare Ray, Prem Kumar, Krishnarajah Nirantharakumar, Abd Tahrani

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Abstract

Aims/hypothesis
People with type 2 diabetes are at increased risk of developing obstructive sleep apnoea. However, it is not known whether people with type 1 diabetes are also at an increased risk of obstructive sleep apnoea. This study aimed to examine whether people with type 1 diabetes are at increased risk of incident obstructive sleep apnoea compared with a matched cohort without type 1 diabetes.

Methods
We used a UK primary care database, The Health Improvement Network (THIN), to perform a retrospective cohort study between January 1995 and January 2018 comparing sleep apnoea incidence between patients with type 1 diabetes (exposed) and without type 1 diabetes (unexposed) (matched for age, sex, BMI and general practice). The outcome was incidence of obstructive sleep apnoea. Baseline covariates and characteristics were assessed at the start of the study based on the most recent value recorded prior to the index date. The Cox proportional hazards regression model was used to estimate unadjusted and adjusted hazard ratios, based on a complete-case analysis.

Results
In total, 34,147 exposed and 129,500 matched unexposed patients were included. The median follow-up time was 5.43 years ((IQR 2.19–10.11), and the mean BMI was 25.82 kg/m2 (SD 4.33). The adjusted HR for incident obstructive sleep apnoea in patients with type 1 diabetes vs those without type 1 diabetes was 1.53 (95% CI 1.25, 1.86; p<0.001). Predictors of incident obstructive sleep apnoea in patients with type 1 diabetes were older age, male sex, obesity, being prescribed antihypertensive or lipid-lowering drugs, atrial fibrillation and depression.

Conclusions/interpretation
Individuals with type 1 diabetes are at increased risk of obstructive sleep apnoea compared with people without diabetes. Clinicians should suspect obstructive sleep apnoea in patients with type 1 diabetes if they are old, have obesity, are male, have atrial fibrillation or depression, or if they are taking lipid-lowering or antihypertensive drugs.

Original language	English
Pages (from-to)	1353-1363
Number of pages	11
Journal	Diabetologia
Volume	65
Issue number	8
Early online date	24 May 2022
DOIs	https://doi.org/10.1007/s00125-022-05714-5
Publication status	Published - Aug 2022

Bibliographical note

Funding Information:
THIN data governance does not allow us to share individual patient data. Researchers may apply for individual patient data access at https://www.iqvia.com/contact. Ziyad Alshehri was supported by a PhD scholarship from Taibah University through the Saudi Arabian Cultural Bureau in London. AAT reports grants from Novo Nordisk, personal fees from Novo Nordisk, non-financial support from Novo Nordisk, personal fees from Eli Lilly, non-financial support from Eli Lilly, personal fees from Janssen, personal fees from AstraZeneca, non-financial support from AstraZeneca, non-financial support from Impeto Medical, non-financial support from ResMed, non-financial support from Aptiva, personal fees from Boehringer Ingelheim, non-financial support from Boehringer Ingelheim, personal fees from BMS, non-financial support from BMS, personal fees from Napp, non-financial support from Napp, personal fees from MSD, non-financial support from MSD, personal fees from Nestlé, personal fees from Gilead, grants from Sanofi, and personal fees from Sanofi outside the submitted work. AAT is currently an employee of Novo Nordisk. This work was performed before becoming a Novo Nordisk employee, and Novo Nordisk had no role in this project. KN has been awarded research grants from the NIHR, the UKRI/MRC, the Kennedy Trust for Rheumatology Research, Health Data Research UK, the Wellcome Trust, the European Regional Development Fund, the Institute for Global Innovation, Boehringer Ingelheim, Action Against Macular Degeneration Charity, Midlands Neuroscience Teaching and Development Funds, the South Asian Health Foundation, Vifor Pharma, the College of Police and CSL Behring (all payments were made to his academic institution); he also received consulting fees from Boehringer Ingelheim, Sanofi, Cegedim and MSD, and holds a leadership/fiduciary role with NICST, a charity, and OpenClinical, a social enterprise. ZA, CJR, PK, KN and AAT were responsible for the concept and design of the study. AS, NJA, KMG and KN contributed to data acquisition. ZA, AS, NJA, MAK, CJR, PK, KN, AAT contributed to the analysis and interpretation of data. ZA, CJR, PK and AAT drafted the manuscript. All authors revised the manuscript critically and approved the final version. ZA, AS, AAT and KN had full access to all the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding Information:
AAT reports grants from Novo Nordisk, personal fees from Novo Nordisk, non-financial support from Novo Nordisk, personal fees from Eli Lilly, non-financial support from Eli Lilly, personal fees from Janssen, personal fees from AstraZeneca, non-financial support from AstraZeneca, non-financial support from Impeto Medical, non-financial support from ResMed, non-financial support from Aptiva, personal fees from Boehringer Ingelheim, non-financial support from Boehringer Ingelheim, personal fees from BMS, non-financial support from BMS, personal fees from Napp, non-financial support from Napp, personal fees from MSD, non-financial support from MSD, personal fees from Nestlé, personal fees from Gilead, grants from Sanofi, and personal fees from Sanofi outside the submitted work. AAT is currently an employee of Novo Nordisk. This work was performed before becoming a Novo Nordisk employee, and Novo Nordisk had no role in this project. KN has been awarded research grants from the NIHR, the UKRI/MRC, the Kennedy Trust for Rheumatology Research, Health Data Research UK, the Wellcome Trust, the European Regional Development Fund, the Institute for Global Innovation, Boehringer Ingelheim, Action Against Macular Degeneration Charity, Midlands Neuroscience Teaching and Development Funds, the South Asian Health Foundation, Vifor Pharma, the College of Police and CSL Behring (all payments were made to his academic institution); he also received consulting fees from Boehringer Ingelheim, Sanofi, Cegedim and MSD, and holds a leadership/fiduciary role with NICST, a charity, and OpenClinical, a social enterprise.

Funding Information:
Ziyad Alshehri was supported by a PhD scholarship from Taibah University through the Saudi Arabian Cultural Bureau in London.

Publisher Copyright:
© 2022, The Author(s).

Keywords

Depression
Obesity
Sleep apnoea
Type 1 diabtes
Type 1 diabetes
Humans
Risk Factors
Obesity/epidemiology
Lipids
Male
Sleep Apnea, Obstructive/complications
Diabetes Mellitus, Type 1/complications
Diabetes Mellitus, Type 2/epidemiology
Female
Retrospective Studies
Atrial Fibrillation
Cohort Studies

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s00125-022-05714-5Licence: Creative Commons: Attribution (CC BY)

alshehriz2022riskFinal published version, 620 KBLicence: Creative Commons: Attribution (CC BY)

Cite this

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title = "Risk of incident obstructive sleep apnoea in patients with type 1 diabetes: a population-based retrospective cohort study",

abstract = "Aims/hypothesisPeople with type 2 diabetes are at increased risk of developing obstructive sleep apnoea. However, it is not known whether people with type 1 diabetes are also at an increased risk of obstructive sleep apnoea. This study aimed to examine whether people with type 1 diabetes are at increased risk of incident obstructive sleep apnoea compared with a matched cohort without type 1 diabetes.MethodsWe used a UK primary care database, The Health Improvement Network (THIN), to perform a retrospective cohort study between January 1995 and January 2018 comparing sleep apnoea incidence between patients with type 1 diabetes (exposed) and without type 1 diabetes (unexposed) (matched for age, sex, BMI and general practice). The outcome was incidence of obstructive sleep apnoea. Baseline covariates and characteristics were assessed at the start of the study based on the most recent value recorded prior to the index date. The Cox proportional hazards regression model was used to estimate unadjusted and adjusted hazard ratios, based on a complete-case analysis.ResultsIn total, 34,147 exposed and 129,500 matched unexposed patients were included. The median follow-up time was 5.43 years ((IQR 2.19–10.11), and the mean BMI was 25.82 kg/m2 (SD 4.33). The adjusted HR for incident obstructive sleep apnoea in patients with type 1 diabetes vs those without type 1 diabetes was 1.53 (95% CI 1.25, 1.86; p<0.001). Predictors of incident obstructive sleep apnoea in patients with type 1 diabetes were older age, male sex, obesity, being prescribed antihypertensive or lipid-lowering drugs, atrial fibrillation and depression.Conclusions/interpretationIndividuals with type 1 diabetes are at increased risk of obstructive sleep apnoea compared with people without diabetes. Clinicians should suspect obstructive sleep apnoea in patients with type 1 diabetes if they are old, have obesity, are male, have atrial fibrillation or depression, or if they are taking lipid-lowering or antihypertensive drugs.",

keywords = "Depression, Obesity, Sleep apnoea, Type 1 diabtes, Type 1 diabetes, Humans, Risk Factors, Obesity/epidemiology, Lipids, Male, Sleep Apnea, Obstructive/complications, Diabetes Mellitus, Type 1/complications, Diabetes Mellitus, Type 2/epidemiology, Female, Retrospective Studies, Atrial Fibrillation, Cohort Studies",

author = "Ziyad Alshehri and Anuradhaa Subramanian and Nicola Adderley and Krishna Gokhale and Karamat, {Muhammad Ali} and Clare Ray and Prem Kumar and Krishnarajah Nirantharakumar and Abd Tahrani",

note = "Funding Information: THIN data governance does not allow us to share individual patient data. Researchers may apply for individual patient data access at https://www.iqvia.com/contact. Ziyad Alshehri was supported by a PhD scholarship from Taibah University through the Saudi Arabian Cultural Bureau in London. AAT reports grants from Novo Nordisk, personal fees from Novo Nordisk, non-financial support from Novo Nordisk, personal fees from Eli Lilly, non-financial support from Eli Lilly, personal fees from Janssen, personal fees from AstraZeneca, non-financial support from AstraZeneca, non-financial support from Impeto Medical, non-financial support from ResMed, non-financial support from Aptiva, personal fees from Boehringer Ingelheim, non-financial support from Boehringer Ingelheim, personal fees from BMS, non-financial support from BMS, personal fees from Napp, non-financial support from Napp, personal fees from MSD, non-financial support from MSD, personal fees from Nestl{\'e}, personal fees from Gilead, grants from Sanofi, and personal fees from Sanofi outside the submitted work. AAT is currently an employee of Novo Nordisk. This work was performed before becoming a Novo Nordisk employee, and Novo Nordisk had no role in this project. KN has been awarded research grants from the NIHR, the UKRI/MRC, the Kennedy Trust for Rheumatology Research, Health Data Research UK, the Wellcome Trust, the European Regional Development Fund, the Institute for Global Innovation, Boehringer Ingelheim, Action Against Macular Degeneration Charity, Midlands Neuroscience Teaching and Development Funds, the South Asian Health Foundation, Vifor Pharma, the College of Police and CSL Behring (all payments were made to his academic institution); he also received consulting fees from Boehringer Ingelheim, Sanofi, Cegedim and MSD, and holds a leadership/fiduciary role with NICST, a charity, and OpenClinical, a social enterprise. ZA, CJR, PK, KN and AAT were responsible for the concept and design of the study. AS, NJA, KMG and KN contributed to data acquisition. ZA, AS, NJA, MAK, CJR, PK, KN, AAT contributed to the analysis and interpretation of data. ZA, CJR, PK and AAT drafted the manuscript. All authors revised the manuscript critically and approved the final version. ZA, AS, AAT and KN had full access to all the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: AAT reports grants from Novo Nordisk, personal fees from Novo Nordisk, non-financial support from Novo Nordisk, personal fees from Eli Lilly, non-financial support from Eli Lilly, personal fees from Janssen, personal fees from AstraZeneca, non-financial support from AstraZeneca, non-financial support from Impeto Medical, non-financial support from ResMed, non-financial support from Aptiva, personal fees from Boehringer Ingelheim, non-financial support from Boehringer Ingelheim, personal fees from BMS, non-financial support from BMS, personal fees from Napp, non-financial support from Napp, personal fees from MSD, non-financial support from MSD, personal fees from Nestl{\'e}, personal fees from Gilead, grants from Sanofi, and personal fees from Sanofi outside the submitted work. AAT is currently an employee of Novo Nordisk. This work was performed before becoming a Novo Nordisk employee, and Novo Nordisk had no role in this project. KN has been awarded research grants from the NIHR, the UKRI/MRC, the Kennedy Trust for Rheumatology Research, Health Data Research UK, the Wellcome Trust, the European Regional Development Fund, the Institute for Global Innovation, Boehringer Ingelheim, Action Against Macular Degeneration Charity, Midlands Neuroscience Teaching and Development Funds, the South Asian Health Foundation, Vifor Pharma, the College of Police and CSL Behring (all payments were made to his academic institution); he also received consulting fees from Boehringer Ingelheim, Sanofi, Cegedim and MSD, and holds a leadership/fiduciary role with NICST, a charity, and OpenClinical, a social enterprise. Funding Information: Ziyad Alshehri was supported by a PhD scholarship from Taibah University through the Saudi Arabian Cultural Bureau in London. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = aug,

doi = "10.1007/s00125-022-05714-5",

language = "English",

volume = "65",

pages = "1353--1363",

journal = "Diabetologia",

issn = "0012-186X",

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TY - JOUR

T1 - Risk of incident obstructive sleep apnoea in patients with type 1 diabetes

T2 - a population-based retrospective cohort study

AU - Alshehri, Ziyad

AU - Subramanian, Anuradhaa

AU - Adderley, Nicola

AU - Gokhale, Krishna

AU - Karamat, Muhammad Ali

AU - Ray, Clare

AU - Kumar, Prem

AU - Nirantharakumar, Krishnarajah

AU - Tahrani, Abd

N1 - Funding Information: THIN data governance does not allow us to share individual patient data. Researchers may apply for individual patient data access at https://www.iqvia.com/contact. Ziyad Alshehri was supported by a PhD scholarship from Taibah University through the Saudi Arabian Cultural Bureau in London. AAT reports grants from Novo Nordisk, personal fees from Novo Nordisk, non-financial support from Novo Nordisk, personal fees from Eli Lilly, non-financial support from Eli Lilly, personal fees from Janssen, personal fees from AstraZeneca, non-financial support from AstraZeneca, non-financial support from Impeto Medical, non-financial support from ResMed, non-financial support from Aptiva, personal fees from Boehringer Ingelheim, non-financial support from Boehringer Ingelheim, personal fees from BMS, non-financial support from BMS, personal fees from Napp, non-financial support from Napp, personal fees from MSD, non-financial support from MSD, personal fees from Nestlé, personal fees from Gilead, grants from Sanofi, and personal fees from Sanofi outside the submitted work. AAT is currently an employee of Novo Nordisk. This work was performed before becoming a Novo Nordisk employee, and Novo Nordisk had no role in this project. KN has been awarded research grants from the NIHR, the UKRI/MRC, the Kennedy Trust for Rheumatology Research, Health Data Research UK, the Wellcome Trust, the European Regional Development Fund, the Institute for Global Innovation, Boehringer Ingelheim, Action Against Macular Degeneration Charity, Midlands Neuroscience Teaching and Development Funds, the South Asian Health Foundation, Vifor Pharma, the College of Police and CSL Behring (all payments were made to his academic institution); he also received consulting fees from Boehringer Ingelheim, Sanofi, Cegedim and MSD, and holds a leadership/fiduciary role with NICST, a charity, and OpenClinical, a social enterprise. ZA, CJR, PK, KN and AAT were responsible for the concept and design of the study. AS, NJA, KMG and KN contributed to data acquisition. ZA, AS, NJA, MAK, CJR, PK, KN, AAT contributed to the analysis and interpretation of data. ZA, CJR, PK and AAT drafted the manuscript. All authors revised the manuscript critically and approved the final version. ZA, AS, AAT and KN had full access to all the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: AAT reports grants from Novo Nordisk, personal fees from Novo Nordisk, non-financial support from Novo Nordisk, personal fees from Eli Lilly, non-financial support from Eli Lilly, personal fees from Janssen, personal fees from AstraZeneca, non-financial support from AstraZeneca, non-financial support from Impeto Medical, non-financial support from ResMed, non-financial support from Aptiva, personal fees from Boehringer Ingelheim, non-financial support from Boehringer Ingelheim, personal fees from BMS, non-financial support from BMS, personal fees from Napp, non-financial support from Napp, personal fees from MSD, non-financial support from MSD, personal fees from Nestlé, personal fees from Gilead, grants from Sanofi, and personal fees from Sanofi outside the submitted work. AAT is currently an employee of Novo Nordisk. This work was performed before becoming a Novo Nordisk employee, and Novo Nordisk had no role in this project. KN has been awarded research grants from the NIHR, the UKRI/MRC, the Kennedy Trust for Rheumatology Research, Health Data Research UK, the Wellcome Trust, the European Regional Development Fund, the Institute for Global Innovation, Boehringer Ingelheim, Action Against Macular Degeneration Charity, Midlands Neuroscience Teaching and Development Funds, the South Asian Health Foundation, Vifor Pharma, the College of Police and CSL Behring (all payments were made to his academic institution); he also received consulting fees from Boehringer Ingelheim, Sanofi, Cegedim and MSD, and holds a leadership/fiduciary role with NICST, a charity, and OpenClinical, a social enterprise. Funding Information: Ziyad Alshehri was supported by a PhD scholarship from Taibah University through the Saudi Arabian Cultural Bureau in London. Publisher Copyright: © 2022, The Author(s).

PY - 2022/8

Y1 - 2022/8

N2 - Aims/hypothesisPeople with type 2 diabetes are at increased risk of developing obstructive sleep apnoea. However, it is not known whether people with type 1 diabetes are also at an increased risk of obstructive sleep apnoea. This study aimed to examine whether people with type 1 diabetes are at increased risk of incident obstructive sleep apnoea compared with a matched cohort without type 1 diabetes.MethodsWe used a UK primary care database, The Health Improvement Network (THIN), to perform a retrospective cohort study between January 1995 and January 2018 comparing sleep apnoea incidence between patients with type 1 diabetes (exposed) and without type 1 diabetes (unexposed) (matched for age, sex, BMI and general practice). The outcome was incidence of obstructive sleep apnoea. Baseline covariates and characteristics were assessed at the start of the study based on the most recent value recorded prior to the index date. The Cox proportional hazards regression model was used to estimate unadjusted and adjusted hazard ratios, based on a complete-case analysis.ResultsIn total, 34,147 exposed and 129,500 matched unexposed patients were included. The median follow-up time was 5.43 years ((IQR 2.19–10.11), and the mean BMI was 25.82 kg/m2 (SD 4.33). The adjusted HR for incident obstructive sleep apnoea in patients with type 1 diabetes vs those without type 1 diabetes was 1.53 (95% CI 1.25, 1.86; p<0.001). Predictors of incident obstructive sleep apnoea in patients with type 1 diabetes were older age, male sex, obesity, being prescribed antihypertensive or lipid-lowering drugs, atrial fibrillation and depression.Conclusions/interpretationIndividuals with type 1 diabetes are at increased risk of obstructive sleep apnoea compared with people without diabetes. Clinicians should suspect obstructive sleep apnoea in patients with type 1 diabetes if they are old, have obesity, are male, have atrial fibrillation or depression, or if they are taking lipid-lowering or antihypertensive drugs.

AB - Aims/hypothesisPeople with type 2 diabetes are at increased risk of developing obstructive sleep apnoea. However, it is not known whether people with type 1 diabetes are also at an increased risk of obstructive sleep apnoea. This study aimed to examine whether people with type 1 diabetes are at increased risk of incident obstructive sleep apnoea compared with a matched cohort without type 1 diabetes.MethodsWe used a UK primary care database, The Health Improvement Network (THIN), to perform a retrospective cohort study between January 1995 and January 2018 comparing sleep apnoea incidence between patients with type 1 diabetes (exposed) and without type 1 diabetes (unexposed) (matched for age, sex, BMI and general practice). The outcome was incidence of obstructive sleep apnoea. Baseline covariates and characteristics were assessed at the start of the study based on the most recent value recorded prior to the index date. The Cox proportional hazards regression model was used to estimate unadjusted and adjusted hazard ratios, based on a complete-case analysis.ResultsIn total, 34,147 exposed and 129,500 matched unexposed patients were included. The median follow-up time was 5.43 years ((IQR 2.19–10.11), and the mean BMI was 25.82 kg/m2 (SD 4.33). The adjusted HR for incident obstructive sleep apnoea in patients with type 1 diabetes vs those without type 1 diabetes was 1.53 (95% CI 1.25, 1.86; p<0.001). Predictors of incident obstructive sleep apnoea in patients with type 1 diabetes were older age, male sex, obesity, being prescribed antihypertensive or lipid-lowering drugs, atrial fibrillation and depression.Conclusions/interpretationIndividuals with type 1 diabetes are at increased risk of obstructive sleep apnoea compared with people without diabetes. Clinicians should suspect obstructive sleep apnoea in patients with type 1 diabetes if they are old, have obesity, are male, have atrial fibrillation or depression, or if they are taking lipid-lowering or antihypertensive drugs.

KW - Depression

KW - Obesity

KW - Sleep apnoea

KW - Type 1 diabtes

KW - Type 1 diabetes

KW - Humans

KW - Risk Factors

KW - Obesity/epidemiology

KW - Lipids

KW - Male

KW - Sleep Apnea, Obstructive/complications

KW - Diabetes Mellitus, Type 1/complications

KW - Diabetes Mellitus, Type 2/epidemiology

KW - Female

KW - Retrospective Studies

KW - Atrial Fibrillation

KW - Cohort Studies

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U2 - 10.1007/s00125-022-05714-5

DO - 10.1007/s00125-022-05714-5

M3 - Article

C2 - 35608616

SN - 0012-186X

VL - 65

SP - 1353

EP - 1363

JO - Diabetologia

JF - Diabetologia

IS - 8

ER -

Risk of incident obstructive sleep apnoea in patients with type 1 diabetes: a population-based retrospective cohort study

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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