Obstructive sleep apnea, a risk factor for cardiovascular and microvascular disease in patients with type 2 diabetes: findings from a population-based cohort study

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OBJECTIVE To determine the risk of cardiovascular disease (CVD), microvascular complications, and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnea (OSA) compared with patients with type 2 diabetes without a diagnosis of OSA.

RESEARCH DESIGN AND METHODS This age-, sex-, BMI-, and diabetes duration–matched cohort study used data from a U.K. primary care database from 1 January 2005 to 17 January 2018. Participants aged ≥16 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischemic heart disease [IHD], stroke/transient ischemic attack [TIA], heart failure [HF]), peripheral vascular disease (PVD), atrial fibrillation (AF), peripheral neuropathy (PN), diabetes-related foot disease (DFD), referable retinopathy, chronic kidney disease (CKD), and all-cause mortality. The same outcomes were explored in patients with preexisting OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.

RESULTS A total of 3,667 exposed participants and 10,450 matched control participants were included. Adjusted hazard ratios for the outcomes were as follows: composite CVD 1.54 (95% CI 1.32, 1.79), IHD 1.55 (1.26, 1.90), HF 1.67 (1.35, 2.06), stroke/TIA 1.57 (1.27, 1.94), PVD 1.10 (0.91, 1.32), AF 1.53 (1.28, 1.83), PN 1.32 (1.14, 1.51), DFD 1.42 (1.16, 1.74), referable retinopathy 0.99 (0.82, 1.21), CKD (stage 3–5) 1.18 (1.02, 1.36), albuminuria 1.11 (1.01, 1.22), and all-cause mortality 1.24 (1.10, 1.40). In the prevalent OSA cohort, the results were similar, but some associations were not observed.

Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared with patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population, and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.

Bibliographic note

Funding Information: Acknowledgments. THIN is a registered trade-mark of Cegedim SA in the U.K. and other countries. Reference made to the THIN database is intended to be descriptive of the data asset licensed by IQVIA. Funding. A.A.T. is a clinician scientist supported by the National Institute for Health Research in the U.K. (CS-2013-13-029). Funding Information: Duality of Interest. A.S., G.N.T., and K.N. received funding from AstraZeneca (RSBD20464). W.H. reports personal fees and nonfinancial support from Novo Nordisk, Eli Lilly, Astra-Zeneca, Boehringer Ingelheim, and Napp Pharmaceuticals. A.A.T. reports personal fees and nonfinancial support from Novo Nordisk, Eli Lilly, AstraZeneca, and Boehringer Ingelheim; personal fees from Janssen; and nonfinancial support from Impeto Medical, ResMed, and Aptiva. K.N. reports fees from Sanofi and Boehringer Ingelheim outside the submitted work. No other potential conflicts of interest relevant to this article were reported. Publisher Copyright: © 2020 by the American Diabetes Association.


Original languageEnglish
Pages (from-to)1868-1877
Number of pages10
JournalDiabetes Care
Issue number8
Early online date28 Apr 2020
Publication statusPublished - Aug 2020