Abstract 17519: Distinct Impacts of Sleep-disordered Breathing on Glycemic Variability in Patients With and Without Heart Failure
Introduction: Sleep-disordered breathing (SDB) is highly prevalent in patients with heart failure (HF) and diabetes mellitus (DM) and contributes to poor cardiovascular outcomes. Elevated glycemic variability (GV) was found to be associated with adverse cardiac events in patients with myocardial infarction. However, the influence of SDB on GV and the benefit of GV control in non-DM patients are unknown. Here we examined whether SDB is correlated with GV, and if so, how the correlation is affected by the presence of HF and/or DM.
Methods and results: One hundred sixty-six patients (68.0±13.9 [SD] years old, 112 males) who were admitted to our institute for treatment of HF and/or DM underwent continuous glucose monitoring for 3 days and overnight polysomnography. Both HbA1c (7.8±1.8 vs. 5.7±0.4%) and mean amplitude of glycemic excursion (MAGE: 99.9±33.6 vs. 67.5±26.2 mg/dl) were significantly higher in DM patients (n=86) than in non-DM patients (n=80), but apnea-hypopnea index (AHI: 30.7±23.6 vs. 32.7±21.5) and BNP level (318±551 vs. 480±662 pg/mL) were similar in the two groups. Multiple logistic regression analysis showed that HbA1c and AHI were independently correlated with MAGE in non-DM patients but not in DM patients. We then divided non-DM patients into two subgroups according to the BNP level (100 pg/mL). Although LV ejection fraction was lower in the high-BNP subgroup (46.0±16.4%) than in the low-BNP subgroup (61.9±10.5%), HbA1c, MAGE (66.8±24.8 vs. 69.7±30.7 mg/dl) and AHI (31.0±20.0 vs. 37.7±25.4) were similar in the two subgroups. AHI was positively correlated with MAGE (r=0.786, p<0.001) in the low-BNP subgroup, but such a correlation was not found in the high-BNP subgroup. In non-DM patients who received treatment with continuous positive airway pressure (CPAP), MAGE was reduced by CPAP from 78.2±1.3 to 46.0±1.8 mg/dl. In DM patients, AHI was not correlated with MAGE regardless of BNP level or drug treatment.
Conclusion: The severity of SDB is closely associated with higher GV, but this relationship was diminished by the presence of HF and/or DM. The findings suggest that elevated sympathetic nerve activity in patients with HF and/or DM overwhelm the effect of SDB on GV and that SDB is a possible target for reducing cardiac events via stabilizing GV.
Author Disclosures: K. Nakata: None. T. Miki: None. M. Tanno: None. T. Yano: None. A. Muranaka: None. A. Kuno: None. W. Ohwada: None. M. Mizuno: None. Y. Tatekoshi: None. T. Miura: None.
- © 2016 by American Heart Association, Inc.