Abstract 13856: Ventricular Remodeling and the Effect of Continuous Positive Airway Pressure in Patients With Combined Diabetes Mellitus and Obstructive Sleep Apnea: A Secondary Analysis of a Randomized Clinical Trial

Introduction: Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are independently associated with adverse left (LV) and right (RV) ventricular remodeling. However, the effect of continuous positive airway pressure (CPAP) is unknown. Hypothesis: CPAP prevents adverse remodeling in T2DM+OSA overlap. Methods: In this prospective study, 141 participants (Control: 28; T2DM only: 27; OSA only: 29; T2DM+OSA: 57) were recruited and underwent home sleep testing and cardiac magnetic resonance. Subsequently, 53 adults from the T2DM+OSA group were enrolled in a 3-month, parallel-arm, randomized, placebo-controlled trial comparing active and sham CPAP. The measures of interest were LV and RV remodeling indices (mass/volume). Kruskal-Wallis for multiple groups and Wilcoxon rank-sum and signed-rank tests for paired samples for two groups were applied. Results: Groups were of similar sex [Control (males): 54%; T2DM: 44%; OSA only: 52%; T2DM+OSA: 65%; p=0.31)]; OSA and T2DM+OSA participants were older (age in years: 46± 15; 51±7.8; 53±10; 56±9.1* # ; respectively p=0.001; *p<0.05 vs. control, # p<0.05 vs. T2DM only) and had higher BMI (29.8±6.3; 31±4.8; 34±6.3*; 35.2±6.6* # kg/m 2 , respectively p=0.001). 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=0.01), 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). CPAP treatment over 3 months prevented progression of adverse LV remodeling compared with sham [difference: CPAP: -0.01 (-0.08, 0.08) g/ml; sham: 0.11 (-0.03, 0.17) g/ml; p=0.03)] but not of RV remodeling index [difference: CPAP: 0.01 (-0.04, 0.08) g/ml; sham: 0.003 (-0.02, 0.04) g/ml; p=0.82)]. Conclusion: T2DM and OSA increased adverse LV but not RV remodeling. CPAP prevented the progression of adverse LV but not RV remodeling.