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Study suggests CPAP treatment in OSA patients leads to better management of type 2 diabetes and NHS cost savings
SAN DIEGO – April 30, 2014 – CPAP therapy, the gold standard in treatment of obstructive sleep apnoea (OSA), leads to significantly lower blood pressure in OSA patients with type 2 diabetes (T2D) and significantly better controlled diabetes, and affords a cost-effective use of U.K. National Health Service (NHS) resources. This according to a new study sponsored by ResMed, the global leader in the treatment of sleep-disordered breathing and other respiratory conditions. These observations have the potential to alter future treatment decisions, and lead to better management of type 2 diabetes among OSA patients and vice versa.
Untreated OSA, a condition that affects approximately 100 million people worldwide, has been associated with T2D, independent of corresponding risk factors. In fact, according to research published in Endocrine Practice, the prevalence of moderate OSA in patients with T2D has been reported to be 49 percent in men and 21 percent in women worldwide — and this figure is expected to rise as prevalence of T2D and obesity continues to increase in both the U.K. and the U.S.
“Over the last decade, research has drawn more parallels between OSA and T2D than ever before,” said Holger Woehrle, M.D., vice president of clinical research and medical director for ResMed Europe. “Studies have found a relationship between OSA and increased insulin resistance, independent of obesity. Additionally, disturbed sleep and intermittent hypoxia caused by OSA are associated with impaired glucose tolerance, increased insulin resistance and further significant metabolic changes, affecting leptin and ghrelin metabolism. Identifying treatment that can minimize the resulting clinical and health economic implications of this are crucial.”
The study, designed by Julian F. Guest of Catalyst Health Economics Consultants in the U.K., used a case-control design, during which 300 patients with OSA and T2D were randomly selected from a nationally representative database of patients in the U.K. Researchers then analyzed the total NHS cost and outcomes of patient management over a five-year span in the 150 patients who underwent CPAP therapy, compared to the remaining 150 patients who did not.
Researchers found that using CPAP therapy was associated with significantly lower blood pressure at five years, and increasingly lower HbA1c levels over five consecutive years, compared with untreated OSA patients. At five years, the HbA1c level in the CPAP-treated group was 8.2 percent versus 12.1 percent in the control group.
The study also demonstrated that use of CPAP led to an increase in patients’ health status by 0.27 quality-adjusted life years (QALYs) per patient over five years, and only increased NHS management costs by £4,141 per patient over that same five year period. The NHS uses QALYs to measure how much a patient’s life is improved by a therapy. If a treatment costs more than £20,000 per QALY gained, it is not considered cost-effective by NHS standards. Researchers found that the cost per QALY gained with CPAP was £15,337, suggesting that initiating treatment with CPAP in OSA patients with T2D is a cost-effective use of resources.
“It is well recognized that OSA is very common in patients with type 2 diabetes. However, what remains unknown is the impact of OSA and CPAP treatment on diabetes-related outcomes,” said Abd Tahrani, NIHR Clinician Scientist at University of Birmingham. “Hence, the findings of the study by Julian F. Guest and colleagues showing favorable impact of CPAP on blood pressure and glycemic control and that CPAP treatment is cost effective in patients with OSA and T2D are very interesting and important. These findings highlight the need for well-designed clinical trials to assess the efficacy of CPAP treatment on diabetes and related outcomes, which will have significant impact on the care provided to patients with T2D.”
The paper is available online at Diabetes Care: http://care.diabetesjournals.org/content/early/2014/04/02/dc13-2539.full.pdf+html