{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T13:37:00Z","timestamp":1791639420832,"version":"4.3.4"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>A bidirectional relationship exists between obstructive sleep apnoea (OSA) and type 2 diabetes (T2D). We aimed to examine the cumulative impact of having both OSA and T2D on patient outcomes, relative to having either condition alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      Using TriNetX, a global federated research network (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009128 million), we undertook two retrospective cohort studies, using time\u2010to\u2010event analysis. Analysis 1 compared OSA with T2D versus OSA alone; analysis 2 compared T2D with OSA versus T2D alone. Propensity score matching using greedy nearest neighbour (calliper 0.1) balanced the cohorts (1:1) for significant covariates. Primary outcomes were cardiovascular, liver, diabetes\u2010related (microvascular) and cancer events over 1\u20135\u2009years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Analysis 1 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009179\u2009688): A codiagnosis of T2D\/OSA significantly increased risk of all\u2010cause mortality (hazard ratio [HR] 1.52; confidence interval [CI]: 1.48, 1.57), dementia (HR 1.19; CI: 1.12, 1.26), liver (HR 2.20; CI: 1.77, 2.73), pancreatic (HR 1.62; CI: 1.35, 1.93), colon, renal and endometrial cancers; all cardiovascular, microvascular and liver related outcomes versus OSA alone over 1\u20135 5\u2009years following OSA diagnosis. Analysis 2 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009240\u2009094): A codiagnosis of OSA\/T2D significantly increased the risk of peripheral (HR 1.39; CI: 1.36, 1.43) and autonomic (HR 1.63; CI: 1.51, 1.75) neuropathy; retinopathy (HR 1.13; CI: 1.09, 1.18), CKD (HR 1.21; CI: 1.18, 1.23); all cardiovascular and liver outcomes; all\u2010cause mortality and several obesity related cancers versus T2D alone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>T2D significantly potentiates risk of cardiovascular, malignancy and liver\u2010related outcomes in individuals with OSA. OSA, in individuals with T2D, significantly potentiates risk of cardiovascular disease, malignancy, death and several microvascular complications (retinopathy, CKD, peripheral\/autonomic neuropathy).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.16059","type":"journal-article","created":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T02:24:13Z","timestamp":1731378253000},"page":"663-674","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["The cumulative impact of type 2 diabetes and obstructive sleep apnoea on cardiovascular, liver, diabetes\u2010related and cancer outcomes"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0905-6524","authenticated-orcid":false,"given":"David R.","family":"Riley","sequence":"first","affiliation":[{"name":"Department of Cardiovascular and Metabolic Medicine University of Liverpool  Liverpool UK"},{"name":"Department of Diabetes, Obesity and Endocrinology University Hospital Aintree, Liverpool University NHS Foundation Trust  Liverpool UK"},{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart &amp; Chest Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Henney","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Metabolic Medicine University of Liverpool  Liverpool UK"},{"name":"Department of Diabetes, Obesity and Endocrinology University Hospital Aintree, Liverpool University NHS Foundation Trust  Liverpool UK"},{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart &amp; Chest Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Anson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Metabolic Medicine University of Liverpool  Liverpool UK"},{"name":"Department of Diabetes, Obesity and Endocrinology University Hospital Aintree, Liverpool University NHS Foundation Trust  Liverpool UK"},{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart &amp; Chest Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gema","family":"Hernadez","sequence":"additional","affiliation":[{"name":"TriNetX LLC  Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sizheng S.","family":"Zhao","sequence":"additional","affiliation":[{"name":"Centre for Musculoskeletal Research at University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uazman","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Metabolic Medicine University of Liverpool  Liverpool UK"},{"name":"Department of Diabetes, Obesity and Endocrinology University Hospital Aintree, Liverpool University NHS Foundation Trust  Liverpool UK"},{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart &amp; Chest Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P. H.","family":"Wilding","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Metabolic Medicine University of Liverpool  Liverpool UK"},{"name":"Department of Diabetes, Obesity and Endocrinology University Hospital Aintree, Liverpool University NHS Foundation Trust  Liverpool UK"},{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart &amp; Chest Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonya","family":"Craig","sequence":"additional","affiliation":[{"name":"Liverpool Sleep &amp; Ventilation Unit Aintree University Hospitals NHS Foundation Trust  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Cuthbertson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Metabolic Medicine University of Liverpool  Liverpool UK"},{"name":"Department of Diabetes, Obesity 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