ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Inconclusive Evidence for Measuring the Impact of CPAP Treatment on Glucose Markers for Patients with Obstructive Sleep Apnea and Diabetes
Clinical Question Do glucose markers for diabetic patients improve after receiving CPAP treatment?
Clinical Bottom Line The evidence is inconclusive in demonstrating that CPAP treatment independently and directly impacts glucose marker for diabetic patients.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21863134Hect/2011292 adults with diabetes and OSASystematic Review and Meta Analysis
Key resultsCurrent studies are inconclusive more long term RCT and Cohort studies with sufficient power analysis are needed to validate CPAP therapy as a tool that can independently impact glucose markers in diabetic patients.
#2) 22411171Yang/2011non-diabetics using CPAPMeta Analysis
Key resultsFor non-diabetic patients with moderate to severe OSA, CPAP therapy improved insulin resistance. However, it did not improve glycemic control for diabetics or non-diabetics.
#3) 22547887Weinstock/201250 subjects with moderate to severe sleep apnea (AHI > 15) and impaired glucose toleranceControlled Clinical Trial
Key resultsCPAP therapy did not improve glucose tolerance for those with moderate sleep apnea and obesity. However, improved insulin sensitivity was observed for patients with severe sleep apnea (AHI>30).
Evidence Search Continuous Positive Airway Pressure, CPAP Diabetes Mellitus Glucose/metabolism Metabolic Syndrome Insulin Resistance Obstructive Sleep Apnea Therapy Glycemic Control
Comments on
The Evidence
The systematic review and meta-analyses in the literature were unable to consistently and reliably document independent metrics for isolating the association between CPAP therapy and improved glucose markers in diabetic patients.
Applicability Treatment is feasiable and applicable to private practitioners in general dentistry, proshthodonitcs and oral medicine.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Orthodontics) (Prosthodontics)
Keywords CPAP diabetic moderate to severe OSA CPAP impaired glucose tolerance Diabetes Mellitus Obstructive Sleep Apnea Therapy Glucose Metabolism
ID# 2390
Date of submission: 03/12/2013spacer
E-mail nguyenc@uthscsa.edu
Author Carol A. Nguyen, RDH, MS
Co-author(s) Alexander Ling
Co-author(s) e-mail LingA@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Michael Montgomery (San Antonio, Texas) on 05/13/2013
2012 studies by Prasad (PMID 23066358 ; retrospective cohort study) and Myhill (PMID 22962427 ; prospective cohort study) reported no improvement in glycemic control measures (fasting glucose and hemoglobinA1C values) in patients with Type II Diabetes Mellitus. Follow-up periods were one year for the Prasad study and 3 months in the Myhill study. Though the strength of these studies was inferior to those cited in the original CAT, these studies support the conclusion that evidence is lacking to support a therapeutic relationship between CPAP and Diabetic glycemia.
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