A randomised controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea Association of sleep apnea and type II diabetes: a population-based study. Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and type 2 diabetes Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome Effects of continuous positive airway pressure on systemic inflammation in patients with moderate to severe obstructive sleep apnoea: a randomised controlled trial The occurrence of sleep-disordered breathing among middle-aged adults. The Impact of CPAP on Cardiovascular Biomarkers in Minimally Symptomatic Patients with Obstructive Sleep Apnea: A Pilot Feasibility Randomized Crossover Trial Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial [Sleep apnea syndrome in patients with diabetes. Effectiveness of treatment for respiratory assistance at night with continuous positive airway pressure]. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Fixed and autoadjusting continuous positive airway pressure treatments are not similar in reducing cardiovascular risk factors in patients with obstructive sleep apnea. Obstructive sleep apnea in obese noninsulin-dependent diabetic patients: effect of continuous positive airway pressure treatment on insulin responsiveness. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. [The clinical investigation of the relationship between obstructive sleep apnea-hypopnea syndrome and insulin resistance]. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
The effects of treatment of obstructive sleep apnoea ( OSA ) on glucose metabolism have been investigated previously with conflicting results . This study evaluated the impact of nasal continuous positive airway pressure ( nCPAP ) treatment of OSA on insulin sensitivity . Males with moderate/severe OSA and no significant comorbidity were r and omised to a therapeutic or sham nCPAP treatment group for 1 week and then reassessed . Those who received therapeutic nCPAP were further evaluated at 12 weeks . Insulin sensitivity ( Kitt ) was estimated by the short insulin tolerance test . Other evaluations included blood pressure , metabolic profile , urinary catecholamines and intra-abdominal fat . In total , 61 Chinese subjects were r and omised . 31 subjects receiving therapeutic nCPAP showed an increase in Kitt ( 6.6±2.9 to 7.6±3.2 % · min−1 ; p = 0.017 ) , while the 30 patients on sham CPAP had no significant change , and the changes in Kitt were different between the two groups ( p = 0.022 ) . At 12 weeks , improvement in Kitt was seen in 20 subjects with BMI ≥25 kg·m−2 ( median ( interquartile range ) 28.3 ( 26.6–31.5 ) ; p = 0.044 ) , but not in the nine subjects with BMI < 25 kg·m−2 , or the entire group . The findings indicate that therapeutic nCPAP treatment of OSA for 1 week improved insulin sensitivity in nondiabetic males , and the improvement appeared to be maintained after 12 weeks of treatment in those with moderate obesity RATIONALE Cross-sectional association has been reported between sleep-disordered breathing ( SDB ) and insulin resistance , but no prospect i ve studies have been performed to determine whether SDB is causal in the development of diabetes . OBJECTIVES The purpose of our study was to investigate the prevalence and incidence of type II diabetes  in subjects with SDB and whether an independent relationship exists between them . METHODS A cross-sectional and longitudinal analysis was performed in 1,387 participants of the Wisconsin Sleep Cohort .  Full polysomnography was used to characterize SDB . Diabetes was defined in two ways : ( 1 ) physician-diagnosis alone or ( 2 ) for those with glucose measurements , either fasting glucose > or = 126 mg/dl or physician diagnosis . MEASUREMENTS AND MAIN RESULTS There was a greater prevalence of diabetes in subjects with increasing levels of SDB . A total of 14.7 % of subjects with an apnea-hypopnea index ( AHI ) of 15 or more had a diagnosis of diabetes compared with 2.8 % of subjects with an AHI of less than 5 . The odds ratio for having a physician diagnoses of diabetes mellitus with an AHI of 15 or greater versus an AHI of less than 5 was 2.30 ( 95 % confidence interval , 1.28 - 4.11 ; p = 0.005 ) after adjustment for age , sex , and body habitus . The odds ratio for developing diabetes mellitus within 4 yr with an AHI of 15 or more compared with an AHI of less than 5 was 1.62 ( 95 % confidence interval , 0.67 - 3.65 ; p = 0.24 ) when adjusting for age , sex , and body habitus . CONCLUSIONS Diabetes is more prevalent in SDB and this relationship is independent of other risk factors . However , it is not clear that SDB is causal in the development of diabetes Background : The effects of continuous positive airway pressure ( CPAP ) for obstructive sleep apnoea ( OSA ) on insulin resistance are not clear . Trials have found conflicting results and no appropriate control groups have been used . Methods : Forty-two men with known type 2 diabetes and newly diagnosed OSA ( > 10 dips/h in oxygen saturation of > 4 % ) were r and omised to receive therapeutic ( n = 20 ) or placebo CPAP ( n = 22 ) for 3 months . Baseline tests were performed and repeated after 3 months . The study was double blind . Results : Results are expressed as mean ( SD ) . CPAP  improved the Epworth sleepiness score significantly more in the therapeutic group than in the placebo group ( −6.6 ( 4.5 ) vs −2.6 ( 4.9 ) , p = 0.01 ) . The maintenance of wakefulness test improved significantly in the therapeutic group but not in the placebo group ( + 10.6 ( 13.9 ) vs −4.7 ( 11.8 ) min , p = 0.001 ) . Glycaemic control and insulin resistance did not significantly change in either the therapeutic or placebo groups : HbA1c ( −0.02 ( 1.5 ) vs + 0.1 ( 0.7 ) , p = 0.7 , 95 % CI −0.6 % to + 0.9 % ) , euglycaemic clamp ( M/I : + 1.7 ( 14.1 ) vs −5.7 ( 14.8 ) , p = 0.2 , 95 % CI −1.8 to + 0.3 l/kg/min1000 ) , HOMA-%S ( −1.5 ( 2.3 ) vs −1.1 ( 1.8 ) , p = 0.2 , 95 % CI −0.3 % to + 0.08 % ) and adiponectin ( −1.1 ( 1.2 ) vs −1.1 ( 1.3 ) , p = 0.2 , 95 % CI −0.7 to + 0.6 & mgr;g/ml ) . Body mass index , bioimpedance and anthropometric measurements were unchanged . Hours of CPAP use per night were 3.6 ( 2.8 ) in the treatment group and 3.3 ( 3.0 ) in the placebo group ( p = 0.8 ) . There was no correlation between CPAP use and the measures of glycaemic control or insulin resistance . Conclusion : Therapeutic CPAP does not significantly improve measures of glycaemic control or insulin resistance in men with type 2 diabetes and OSA BACKGROUND Patients with the sleep apnoea/hypopnoea syndrome ( SAHS ) report improved sleepiness , cognitive function , and psychological well being after continuous positive airway pressure ( CPAP ) therapy , and it is for these daytime features that CPAP is usually given . However , few r and omised or controlled studies exist on the effects of CPAP on daytime function . METHODS A prospect i ve , r and omised , single blind , placebo controlled , crossover trial of daytime function after CPAP was conducted in 23 patients with SAHS , all with ⩾15 apnoeas+hypopnoeas/hour and ⩾2 symptoms of SAHS . All patients spent four weeks on CPAP therapy and four weeks on oral placebo treatment , following r and omisation to treatment order . With ethics committee approval , patients were told the placebo tablet might improve upper airway function . Average effective CPAP use was monitored using hidden time clocks . Assessment s of objective and subjective sleepiness , symptoms , cognitive performance , and psychological well being were performed on the last day of each treatment and compared . RESULTS Objective sleepiness measured by sleep onset latency on the multiple sleep latency test improved with CPAP ( mean difference from placebo + 2.4 min , 95 % CI 0.8 to 4.0 ; p<0.001 ) as did subjective sleepiness on the Epworth scale ( mean difference –6 , 95 % CI –3 to –9 ; p = 0.001 ) . Symptom total score also fell with CPAP ( mean difference –1.6 , 95 % CI –2.2 to –1.0 ; p<0.001 ) . No determinants of these changes with active treatment were identified , and no significant enhancements to cognitive function or psychosocial well being were found in this small sample . CONCLUSIONS These findings provide further evidence for clinical ly significant benefits to daytime function  from CPAP Background : Obstructive sleep apnoea syndrome ( OSAS ) has been associated with cardiovascular disease in epidemiological and observational studies . Continuous positive airway pressure ( CPAP ) is the treatment of choice for OSAS , but the impact of this intervention on systemic inflammation involved in the atherosclerotic process remains unclear . Methods : 100 men with moderate – severe OSAS were r and omised to therapeutic ( n = 51 ) or subtherapeutic ( n = 49 ) CPAP treatment for 4 weeks to investigate the effects of active treatment on inflammatory markers such as highly sensitive C reactive protein ( hsCRP ) , interleukin (IL)6 , interferon γ ( IFNγ ) and anti-inflammatory adiponectin . Results : 4 weeks of therapeutic CPAP did not significantly change blood levels of hsCRP compared with the subtherapeutic control group ( difference between median changes −0.24 mg/l ( 95 % CI −0.88 to + 0.24 ) ; p = 0.30 ) . Plasma levels of IL6 and IFNγ did not change significantly following therapeutic compared with subtherapeutic CPAP ( difference between median changes + 0.52 and −0.07 pg/ml ( 95 % CI −0.72 to + 1.94 and −0.81 to + 0.44 ) ; p = 0.45 and p = 0.82 , respectively ) . Furthermore , 4 weeks of therapeutic CPAP did not significantly change levels of adiponectin in plasma compared with the subtherapeutic control group ( difference between median changes + 0.05 pg/ml ( 95 % CI −0.36 to + 0.47 ) ; p = 0.84 ) . If patients with hsCRP values above 8 mg/l at baseline were excluded , differences between the changes in hsCRP , IL6 , IFNγ and adiponectin after 4 weeks of CPAP were smaller , and again not statistically different between groups . Conclusions : 4 weeks of CPAP treatment has no beneficial effect on blood markers of inflammation and adiponectin in patients with moderate – severe obstructive sleep apnoea BACKGROUND Limited data have suggested that sleep-disordered breathing , a condition of repeated episodes of apnea and hypopnea during sleep , is prevalent among adults . Data from the Wisconsin Sleep Cohort Study , a longitudinal study of the natural history of cardiopulmonary disorders of sleep , were used to estimate the prevalence of undiagnosed sleep-disordered breathing among adults and address its importance to the public health . METHODS A r and om sample of 602 employed men and women 30 to 60 years old were studied by overnight polysomnography to determine the frequency of episodes of apnea and hypopnea per hour of sleep ( the apnea-hypopnea score ) . We measured the age- and sex-specific prevalence of sleep-disordered breathing in this group using three cutoff points for the apnea-hypopnea score ( > or = 5 , > or = 10 , and > or = 15 ) ; we used logistic regression to investigate risk factors . RESULTS The estimated prevalence of sleep-disordered breathing , defined as an apnea-hypopnea score of 5 or higher , was 9 percent for women and 24 percent for men . We estimated that 2 percent of women and 4 percent of men in the middle-aged work force meet the minimal diagnostic criteria for the sleep apnea syndrome ( an apnea-hypopnea score of 5 or higher and daytime hypersomnolence ) . Male sex and obesity were strongly associated with the presence of sleep-disordered breathing . Habitual snorers , both men and women , tended to have a higher prevalence of apnea-hypopnea scores of 15 or higher . CONCLUSIONS The prevalence of undiagnosed sleep-disordered breathing is high among men and is much higher than previously suspected among women . Undiagnosed sleep-disordered breathing is associated with daytime hypersomnolence Background Previous , largely uncontrolled studies demonstrated the substantial effects of continuous positive airway pressure ventilation ( CPAP ) on a variety of physiologic and biochemical markers known to be risk factors for cardiovascular disease in patients with obstructive sleep apnea ( OSA ) . In this pilot crossover study , we assessed ( 1 ) the feasibility of using CPAP in a group of minimally symptomatic patients with OSA , assessed through patient compliance and ( 2 ) CPAP therapy ’s effect on biomarkers in these patients . Methods We studied patients with minimal daytime sleepiness who were referred to the University of British Columbia ’s Hospital Sleep Clinic with suspected OSA and an apnea-hypopnea index ( AHI ) > 15 events/h . Patients were r and omized to either CPAP or no therapy for 4 weeks followed by a washout of 4 weeks , and then a crossover to the other intervention . Fasting morning blood and urine , 24-h blood pressure ( BP ) measurements , and endothelial function ( peak flow-mediated dilation to nitroglycerin-mediated dilation ratio ) were assessed before and after each study intervention . Results Nine adult male and four female patients were studied . Mean ( SD ) age was 55 ( 7 ) years , mean AHI = 27.9/h , mean Epworth Sleepiness Score = 6.8 ( 11/13 had a score < 10 ) , and mean BMI = 31.1 kg/m2 .  Mean compliance with CPAP therapy was 5.53 h/night . Compared to no therapy , potential improvements were observed with CPAP for urinary microalbumin , norepinephrine , and epinephrine to creatinine ratios ( decreased by 3.51 mg/mmol , 1.70 nmol/mmol , and 0.95 nmol/mmol , respectively ) ; 24-h BP ( systolic decreased by 3.60 mmHg , diastolic by 0.70 mmHg ) ; homeostasis model for insulin resistance score ( decreased by 1.11 ) ; and endothelial function ( increased by 7.4 % ) . However , none of the above differences was significant ( p > 0.10 ) . Conclusion In this pilot study there were potential improvements in a variety of cardiovascular biomarkers with CPAP . CPAP compliance was reasonably good even though patients were not particularly sleepy . Accordingly , larger r and omized controlled trials in this area appear feasible and warranted BACKGROUND Nasal continuous positive airway pressure ( NCPAP ) is widely used as a treatment for obstructive sleep apnoea . However , to date there are no r and omised controlled trials of this therapy against a well-matched control . We undertook a r and omised prospect i ve parallel trial of therapeutic NCPAP for obstructive sleep apnoea compared with a control group on subtherapeutic NCPAP . METHODS Men with obstructive sleep apnoea , defined as an Epworth sleepiness score of 10 or more and ten or more dips per h of more than 4 % SaO2 caused by obstructive sleep apnoea on overnight sleep study , were r and omly assigned therapeutic NCPAP or subtherapeutic NCPAP ( about 1 cm H2O ) for 1 month . Primary outcomes were subjective sleepiness ( Epworth sleepiness score ) , objective sleepiness ( maintenance of wakefulness test ) , and SF-36 question naire measurements of self-reported functioning and well-being . FINDINGS 107 men entered the study : 53 received subtherapeutic NCPAP and 54 therapeutic NCPAP . Use of NCPAP by the two treatment groups was similar : 5.4 h ( therapeutic ) and 4.6 h ( subtherapeutic ) per night . Subtherapeutic NCPAP did not alter the overnight number of SaO2 dips per h compared with baseline , and thus acted as a control . Therapeutic NCPAP was superior to subtherapeutic NCPAP in all primary outcome measures . The Epworth score was decreased from a median of 15.5 to 7.0 on therapeutic NCPAP , and from 15.0 to 13.0 on subtherapeutic NCPAP ( between treatments , p<0.0001 ) . Mean maintenance-of-wakefulness time increased from 22.5 to 32.9 min on therapeutic NCPAP and , not significantly , from 20.0 to 23.5 min on subtherapeutic NCPAP ( between treatments p<0.005 ) . Effect sizes for SF-36 measures of energy and vitality were 1.68 ( therapeutic ) and 0.97 ( subtherapeutic ) NCPAP ( between treatments p<0.0001 ) . For mental summary score , the corresponding values were 1.02 and 0.4 ( between treatments p=0.002 ) . INTERPRETATION Therapeutic NCPAP reduces excessive daytime sleepiness and improves self-reported health status compared with a subtherapeutic control . Compared with controls , the effects of therapeutic NCPAP are large and confirm previous uncontrolled clinical observations and the results of controlled trials that used an oral placebo The group of 30 patients with OSA and diabetes type I or II has been examined . After the first test with MESAM 4 , 5 patients with considerable nocturnal desaturation and heart rate disorders during sleep have been found . All diabetes type II . Two polisomnographic studies ( the first diagnostic polisomnography and the second study for the settlement of treatment with CPAP ) have been performed in the patients . After 6 months of applying CPAP all the patients have been examined again . The apnoea index was decreased ( from 87.5 to 11.2 ) and a better control of both systemic arterial pressure and glycaemia , saturation > 80 % has been obtained The minimal disease severity at which patients with the sleep apnea/hypopnea syndrome ( SAHS ) gain benefit from treatment is not well characterized , although a pilot study of continuous positive airway pressure ( CPAP ) therapy showed daytime improvements in patients with 5 to 15 apneas + hypopneas per hour slept ( AHI ) . We have thus performed a second , larger , r and omized , placebo- controlled study in a prospect i ve series of 34 patients ( 13 female ) with mild SAHS ( AHI 5 to 15 ) and daytime sleepiness . Patients spent 4 wk on CPAP treatment and 4 wk on an oral placebo , with r and omization of treatment order , and daytime assessment s on the last day of each treatment . Effective  CPAP  use averaged 2.8 + /- 2.1 h ( mean + /- SD ) per night . Compared with placebo , CPAP improved symptom score ( p < 0.01 ) , subjective ( Epworth ; p < 0.01 ) but not objective ( maintenance of wakefulness test ; p > 0.2 ) sleepiness , performances on 2 of 7 cognitive tasks ( p < 0.02 ) , depression score ( p < 0.01 ) , and five subscales of the SF-36 health/functional status question naire ( p < /= 0.03 ) . Fourteen of 34 patients preferred CPAP . In 14 patients with AHI in the range 5 to 10 , symptoms , cognitive function , psychological well-being and quality of life were improved . These results confirm benefits for daytime function after CPAP treatment for mild SAHS , but highlight unacceptability of CPAP in many such patients BACKGROUND A strong association between obstructive sleep apnea ( OSA ) and the risk for cardiovascular and cerebrovascular diseases has been reported . Continuous positive airway pressure ( CPAP ) is the first-line therapy for OSA , able not only to reduce daytime sleepiness but also to improve cardiovascular and metabolic outcomes . Autoadjusting CPAP ( APAP ) , an alternative treatment to CPAP , can reduce OSA symptoms while increasing long-term CPAP compliance without the high costs of CPAP titration . However , no data are available on the effects of APAP on cardiovascular risk factors METHODS We performed st and ard full polysomnography ; obtained plasma levels of glucose , insulin , and C-reactive protein ( CRP ) ; and measured systolic BP ( SBP ) and diastolic BP ( DBP ) in 31 patients with newly diagnosed , severe OSA . After st and ard CPAP titration , all subjects were r and omized to CPAP or APAP treatment . Measurements were obtained at baseline and after 3 months of treatment . RESULTS The two groups were similar in terms of age , sex , body mass index ( BMI ) , and severity of OSA . SBP , DBP , heart rate ( HR ) , homeostasis model assessment index ( HOMA-IR ) , and CRP were similar in the two groups . After 3 months of treatment , BMI , HR , and compliance to therapy were also comparable . OSA indexes were significantly reduced in both groups . Significant reductions in SBP , DBP , and HOMA-IR were observed in the CPAP group but not in the APAP group , while CRP plasma levels were similarly reduced . CONCLUSIONS Our results suggest that CPAP and APAP , despite significant effects on OSA indexes and symptoms , do not improve cardiovascular risk factors in the same fashion Patients with noninsulin-dependent diabetes mellitus ( NIDDM ) are often obese and frequently complain of tiredness . These features are also characteristically seen in patients with obstructive sleep apnea ( OSA ) .  Therefore , it was the aim of this study to assess the prevalence of OSA among a group of obese NIDDM patients who have some clinical features of OSA . The effect of reversal of OSA by nasal continuous positive airway pressure ( CPAP ) treatment on insulin responsiveness was also investigated . From a population of 179 NIDDM patients with a body mass index ( BMI ) greater than 35 kg/m2 , we performed ambulatory sleep monitoring on 31 ( 15 males and 16 females ) who admitted to either heavy snoring or excessive sleepiness . Results were review ed by a sleep physician blinded to the clinical status of the patients , and 22 ( 70 % ) were found to have moderate or severe OSA , with mean oxygen desaturation indexes of 10.3 + /- 5.3 and 30.7 + /- 13.2 episodes/h , respectively . A subgroup of 10 patients ( seven males and three females ) with a mean BMI of 42.7 + /- 4.3 kg/m2 was treated with nightly CPAP for 4 months . These subjects all had significant OSA , with frequent obstructive apneas ( mean , 47 + /- 31.6 episodes/h ) and oxygen desaturation ( mean minimum O2 saturation , 74 + /- 9.5 % ) , as determined by polysomnography . One patient was excluded from analysis because of infrequent use of CPAP . Insulin responsiveness in terms of glucose disposal measured by hyperinsulinemic euglycemic clamps improved from 11.4 + /- 6.2 to 15.1 + /- 4.6 mumol/kg.min ( P < 0.05 ) during CPAP treatment . These results indicate that OSA occurs commonly in obese NIDDM patients with excessive sleepiness or heavy snoring . Treatment of their OSA may improve insulin responsiveness Continuous positive airway pressure ( CPAP ) is worldwide considered as the st and ard treatment of sleep apnea/hypopnea syndrome ( SAHS ) although studies on the effectiveness of this treatment are limited . The aim of our study was to evaluate the effectiveness of CPAP in improving SAHS-related symptoms , daytime function , perceived health status , and quality of life in patients with moderate to severe SAHS . The effect of conservative treatment ( CT ) measures -sleep hygiene and weight loss- was compared with CT + CPAP . We included 105 consecutive patients ( 13 females , age 53 + /- 10 yr , body mass index [ BMI ] = 32 + /- 6 kg/m2 , apnea/hypopnea index [ AHI ] = 56 + /- 20 , Epworth sleepiness scale [ ESS ] = 12 + /- 5 ) who met our criteria for CPAP treatment . Patients were r and omly allocated in two groups of similar characteristics . Group 1 ( n = 37 ) was asked to improve sleep hygiene and started a weight loss program . Group 2 ( n = 68 ) received , in addition , treatment with CPAP . Both groups were followed through weekly telephone calls and appointments . Sleepiness , other symptoms related to SAHS , daytime function , perceived health status , and quality of life were assessed through question naires at inclusion and after 3 mo of treatment . The relief of sleepiness and other SAHS-related clinical symptoms and improvement in perceived health status was much greater in Group 2 receiving CT + CPAP compared with Group 1 , only receiving CT . The odds of experiencing a treatment response with CPAP + CT compared with CT alone was 6.52 ( odds ratio [ OR ] = 2.51 to 17.6 , 95 % confidence interval [ 95 % CI ] ) . CPAP is currently the treatment of choice . At this time , the indication of CPAP treatment in moderate to severe SAHS is adequately supported OBJECTIVE To study the relationship between obstructive sleep apnea-hypopnea syndrome ( OSAHS ) and insulin resistance ( IR ) , then evaluate the effectiveness of the improved Uvulopalatopharyngoplasty ( MUPPP ) and continuous positive airway pressure ( CPAP ) on IR . METHOD Fourteen patients of OSAHS were treated by MUPPP , and sixteen patients of OSAHS were treated by CPAP . All index of the nocturnal polysomnography , fasting plasma insulin , fasting plasma glucose , insulin and blood sugar of 2 hours after meal were analyzed before and after therapy , and 10 patients of OSAHS were untreated by MUPPP or CPAP . The other 33 cases of non-OSAHS were selected as control group . According to the model of HOMA and the formula of LiGuangwei , insulin resistance index and insulin sensitivity index were calculated , respectively . RESULT There were significant differences between OSAHS group before treatment and control group , before and after treatment , after treatment and untreated group ( P < 0.01 or P < 0.05 ) . There was very significant correlation between IAI and LSaO2 ( r = 0.633 ) , and there was significantly negative correlation between IAI and AHI ( r = -0.654 ) . CONCLUSION OSAHS is an important risk factor for the development of insulin resistance . It shows that OSAHS may develop IR of the patients and the treatment of MUPPP and CPAP can improve insulin sensitivity The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials
BACKGROUND Obstructive Sleep Apnoea Syndrome ( OSAS ) is a condition of obstruction , apneas and arousals while sleeping .
It has been suggested that OSAS independently influences glucose metabolism .
The main treatment for OSAS is continuous positive airways pressure ( CPAP ) .
OBJECTIVES To assess the effects of CPAP on insulin resistance and glucose metabolism .