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

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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 languageEnglish
Pages (from-to)1353-1363
Number of pages11
JournalDiabetologia
Volume65
Issue number8
Early online date24 May 2022
DOIs
Publication statusPublished - 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

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