Effect of continuous positive airway pressure on ventricular remodeling of patients with combined diabetes mellitus and obstructive sleep apnea: a cross-sectional study and follow-on randomized clinical trial

Aug 18, 2025International journal of cardiology

Continuous positive airway pressure and heart changes in patients with both diabetes and sleep apnea

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Abstract

The left ventricular remodeling index was significantly higher in participants with both type 2 diabetes mellitus and obstructive sleep apnea, measuring 0.78 ± 0.16 g/ml.

Participants with both T2DM and OSA were older and had a higher body mass index compared to other groups.
The left ventricular remodeling index was significantly elevated in those with T2DM + OSA compared to controls, even after adjusting for age, sex, and BMI.
Diagnosis of OSA only and the combined diagnosis of OSA + T2DM were linked to adverse left ventricular remodeling.
Continuous positive airway pressure (CPAP) treatment for 3 months was associated with prevention of progression in left ventricular remodeling.
No significant changes were observed in right ventricular remodeling in relation to T2DM or OSA.

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BACKGROUND: Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are independently associated with adverse left (LV) and right (RV) ventricular remodeling. However, little is known about the effect of T2DM and OSA overlap and any additional impact of continuous positive airway pressure (CPAP).

METHODS: In this prospective study, 141 participants (Control: 28; T2DM only: 27; OSA only: 29; T2DM + OSA: 57) underwent sleep testing and cardiac magnetic resonance (CMR). Subsequently, 53 with T2DM + OSA were randomized in a 3-month, parallel-arm, trial comparing active and sham CPAP. Measures of interest were LV and RV remodeling indices (mass/volume).

RESULTS: Groups were of similar sex; T2DM + OSA participants were older and had a higher BMI. At baseline, LV remodeling index (g/ml) was higher in T2DM + OSA (0.67 ± 0.12; 0.71 ± 0.10; 0.75 ± 0.13; 0.78 ± 0.16*; respectively, p = 0.01vs. control), whereas RV remodeling index was similar (0.19 ± 0.03; 0.20 ± 0.03; 0.20 ± 0.03; 0.21 ± 0.04; p = 0.33). The difference in LV remodeling index persisted after adjustment for age, sex, and BMI (p < 0.001). The diagnoses of OSA only (b coefficient: 0.08, p = 0.04), and of OSA + T2DM (interaction term; b coefficient: 0.11, p < 0.01) were associated with adverse LV but not RV remodeling. CPAP treatment for 3 months prevented progression of adverse LV remodeling [difference: CPAP: -0.01 (-0.08, 0.08) g/ml; sham: 0.11 (-0.03, 0.17) g/ml; p = 0.03)] but not RV remodeling [difference: CPAP: 0.01 (-0.04, 0.08) g/ml; sham: 0.003 (-0.02, 0.04) g/ml; p = 0.82)].

CONCLUSION: The overlap of T2DM and OSA had an incremental effect on adverse LV remodeling but not RV remodeling. CPAP prevented the progression of LV but not RV remodeling.

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Effect of continuous positive airway pressure on ventricular remodeling of patients with combined diabetes mellitus and obstructive sleep apnea: a cross-sectional study and follow-on randomized clinical trial

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