{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T06:15:27Z","timestamp":1793168127729,"version":"4.5.0"},"reference-count":38,"publisher":"American Diabetes Association","issue":"8","license":[{"start":{"date-parts":[[2020,7,20]],"date-time":"2020-07-20T00:00:00Z","timestamp":1595203200000},"content-version":"vor","delay-in-days":83,"URL":"https:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["CS-2013-13-029"],"award-info":[{"award-number":["CS-2013-13-029"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To determine the risk of cardiovascular disease (CVD), microvascular complications, and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnea (OSA) compared with patients with type 2 diabetes without a diagnosis of OSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>This age-, sex-, BMI-, and diabetes duration\u2013matched cohort study used data from a U.K. primary care database from 1 January 2005 to 17 January 2018. Participants aged \u226516 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischemic heart disease [IHD], stroke\/transient ischemic attack [TIA], heart failure [HF]), peripheral vascular disease (PVD), atrial fibrillation (AF), peripheral neuropathy (PN), diabetes-related foot disease (DFD), referable retinopathy, chronic kidney disease (CKD), and all-cause mortality. The same outcomes were explored in patients with preexisting OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 3,667 exposed participants and 10,450 matched control participants were included. Adjusted hazard ratios for the outcomes were as follows: composite CVD 1.54 (95% CI 1.32, 1.79), IHD 1.55 (1.26, 1.90), HF 1.67 (1.35, 2.06), stroke\/TIA 1.57 (1.27, 1.94), PVD 1.10 (0.91, 1.32), AF 1.53 (1.28, 1.83), PN 1.32 (1.14, 1.51), DFD 1.42 (1.16, 1.74), referable retinopathy 0.99 (0.82, 1.21), CKD (stage 3\u20135) 1.18 (1.02, 1.36), albuminuria 1.11 (1.01, 1.22), and all-cause mortality 1.24 (1.10, 1.40). In the prevalent OSA cohort, the results were similar, but some associations were not observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared with patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population, and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc19-2116","type":"journal-article","created":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T22:55:36Z","timestamp":1588114536000},"page":"1868-1877","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":84,"title":["Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study"],"prefix":"10.2337","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0543-3254","authenticated-orcid":false,"given":"Nicola J.","family":"Adderley","sequence":"first","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuradhaa","family":"Subramanian","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Toulis","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Gokhale","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Taverner","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wasim","family":"Hanif","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamil","family":"Haroon","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Neil","family":"Thomas","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Sainsbury","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9037-1937","authenticated-orcid":false,"given":"Abd A.","family":"Tahrani","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K."},{"name":"Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, U.K."},{"name":"Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6816-1279","authenticated-orcid":false,"given":"Krishnarajah","family":"Nirantharakumar","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, U.K."},{"name":"Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K."},{"name":"Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, U.K."},{"name":"Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, U.K."},{"name":"Midlands Health Data Research UK, Birmingham, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2020,4,28]]},"reference":[{"key":"2022031300282462400_B1","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1056\/NEJMoa1608664","article-title":"Mortality and cardiovascular disease in type 1 and type 2 diabetes","volume":"376","author":"Rawshani","year":"2017","journal-title":"N Engl J Med"},{"key":"2022031300282462400_B2","doi-asserted-by":"crossref","first-page":"617","DOI":"10.2337\/diacare.28.3.617","article-title":"Associations of mortality and diabetes complications in patients with type 1 and type 2 diabetes: early treatment diabetic retinopathy study report no. 27","volume":"28","author":"Cusick","year":"2005","journal-title":"Diabetes Care"},{"key":"2022031300282462400_B3","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.2337\/diacare.22.7.1125","article-title":"Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37)","volume":"22","author":"U.K. Prospective Diabetes Study Group","year":"1999","journal-title":"Diabetes Care"},{"key":"2022031300282462400_B4","doi-asserted-by":"crossref","first-page":"2669","DOI":"10.2337\/dci18-0033","article-title":"Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)","volume":"41","author":"Davies","year":"2018","journal-title":"Diabetes Care"},{"key":"2022031300282462400_B5","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1056\/NEJMoa1310799","article-title":"Changes in diabetes-related complications in the United States, 1990-2010","volume":"370","author":"Gregg","year":"2014","journal-title":"N Engl J Med"},{"key":"2022031300282462400_B6","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1056\/NEJMoa1800256","article-title":"Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes","volume":"379","author":"Rawshani","year":"2018","journal-title":"N Engl J Med"},{"key":"2022031300282462400_B7","doi-asserted-by":"crossref","first-page":"954","DOI":"10.2337\/dc18-2004","article-title":"Risk of incident obstructive sleep apnea among patients with type 2 diabetes","volume":"42","author":"Subramanian","year":"2019","journal-title":"Diabetes Care"},{"key":"2022031300282462400_B8","doi-asserted-by":"crossref","first-page":"R91","DOI":"10.1530\/EJE-18-0411","article-title":"Mechanisms of disease: the endocrinology of obstructive sleep apnoea","volume":"180","author":"Lavrentaki","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"2022031300282462400_B9","doi-asserted-by":"crossref","first-page":"43","DOI":"10.17925\/EE.2014.10.01.43","article-title":"Obstructive sleep apnoea and type 2 diabetes","volume":"10","author":"Tahrani","year":"2014","journal-title":"Eur Endocrinol"},{"key":"2022031300282462400_B10","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/S0140-6736(05)71141-7","article-title":"Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study","volume":"365","author":"Marin","year":"2005","journal-title":"Lancet"},{"key":"2022031300282462400_B11","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/jsr.12181","article-title":"Efficacy of continuous positive airway pressure treatment on 5-year survival in patients with ischaemic stroke and obstructive sleep apnea: a randomized controlled trial","volume":"24","author":"Parra","year":"2015","journal-title":"J Sleep Res"},{"key":"2022031300282462400_B12","first-page":"1071","article-title":"Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort","volume":"31","author":"Young","year":"2008","journal-title":"Sleep"},{"key":"2022031300282462400_B13","doi-asserted-by":"crossref","first-page":"e1000132","DOI":"10.1371\/journal.pmed.1000132","article-title":"Sleep-disordered breathing and mortality: a prospective cohort study","volume":"6","author":"Punjabi","year":"2009","journal-title":"PLoS Med"},{"key":"2022031300282462400_B14","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1164\/rccm.2105124","article-title":"Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up","volume":"166","author":"Peker","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"key":"2022031300282462400_B15","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.1056\/NEJMoa043104","article-title":"Obstructive sleep apnea as a risk factor for stroke and death","volume":"353","author":"Yaggi","year":"2005","journal-title":"N Engl J Med"},{"key":"2022031300282462400_B16","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1164\/rccm.201112-2135OC","article-title":"Obstructive sleep apnea and diabetic neuropathy: a novel association in patients with type 2 diabetes","volume":"186","author":"Tahrani","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"2022031300282462400_B17","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1164\/rccm.201701-0175OC","article-title":"Obstructive sleep apnea and retinopathy in patients with type 2 diabetes. A longitudinal study","volume":"196","author":"Altaf","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"2022031300282462400_B18","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1177\/1479164117714397","article-title":"Obstructive sleep apnoea in diabetes: does it matter","volume":"14","author":"Tahrani","year":"2017","journal-title":"Diab Vasc Dis Res"},{"key":"2022031300282462400_B19","doi-asserted-by":"crossref","first-page":"3718","DOI":"10.2337\/dc13-0450","article-title":"Obstructive sleep apnea and diabetic nephropathy: a cohort study","volume":"36","author":"Tahrani","year":"2013","journal-title":"Diabetes Care"},{"key":"2022031300282462400_B20","doi-asserted-by":"crossref","first-page":"e1002488","DOI":"10.1371\/journal.pmed.1002488","article-title":"Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: a population-based cohort study","volume":"15","author":"Daly","year":"2018","journal-title":"PLoS Med"},{"key":"2022031300282462400_B21","doi-asserted-by":"crossref","first-page":"k1717","DOI":"10.1136\/bmj.k1717","article-title":"Risk of stroke and transient ischaemic attack in patients with a diagnosis of resolved atrial fibrillation: retrospective cohort studies","volume":"361","author":"Adderley","year":"2018","journal-title":"BMJ"},{"key":"2022031300282462400_B22","doi-asserted-by":"crossref","first-page":"3298","DOI":"10.1002\/art.39330","article-title":"Sleep apnea and the risk of incident gout: a population-based, body mass index\u2013matched cohort study","volume":"67","author":"Zhang","year":"2015","journal-title":"Arthritis Rheumatol"},{"key":"2022031300282462400_B23","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1002\/pds.1688","article-title":"The importance of defining periods of complete mortality reporting for research using automated data from primary care","volume":"18","author":"Maguire","year":"2009","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2022031300282462400_B24","doi-asserted-by":"crossref","first-page":"b5087","DOI":"10.1136\/bmj.b5087","article-title":"Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes","volume":"340","author":"L\u00e9vesque","year":"2010","journal-title":"BMJ"},{"key":"2022031300282462400_B25","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"2022031300282462400_B26","first-page":"3","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease","year":"2013","journal-title":"Kidney Int Suppl"},{"key":"2022031300282462400_B27","article-title":"2016\/17 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF) Guidance for GMS contract 2016\/17","author":"General Practitioners Committee","year":"2016"},{"key":"2022031300282462400_B28","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"2022031300282462400_B29","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.5665\/sleep.2090","article-title":"The relationship between obstructive sleep apnea and self-reported stroke or coronary heart disease in overweight and obese adults with type 2 diabetes mellitus","volume":"35","author":"Rice","year":"2012","journal-title":"Sleep (Basel)"},{"key":"2022031300282462400_B30","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/j.amjcard.2012.12.053","article-title":"Sleep disordered breathing as a risk of cardiac events in subjects with diabetes mellitus and normal exercise echocardiographic findings","volume":"111","author":"Seicean","year":"2013","journal-title":"Am J Cardiol"},{"key":"2022031300282462400_B31","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.2337\/dc17-0759","article-title":"Obstructive sleep apnea and diabetes independently add to cardiovascular risk after coronary revascularization","volume":"41","author":"Koo","year":"2018","journal-title":"Diabetes Care"},{"key":"2022031300282462400_B32","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.ijcard.2016.12.120","article-title":"Obstructive sleep and atrial fibrillation: pathophysiological mechanisms and therapeutic implications","volume":"230","author":"Goudis","year":"2017","journal-title":"Int J Cardiol"},{"key":"2022031300282462400_B33","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1111\/pace.13669","article-title":"Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation","volume":"42","author":"Bavishi","year":"2019","journal-title":"Pacing Clin Electrophysiol"},{"key":"2022031300282462400_B34","doi-asserted-by":"crossref","first-page":"81","DOI":"10.17925\/EE.2015.11.02.81","article-title":"Obstructive sleep apnoea and vascular disease in patients with type 2 diabetes","volume":"11","author":"A Tahrani","year":"2015","journal-title":"Eur Endocrinol"},{"key":"2022031300282462400_B35","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.smrv.2014.07.004","article-title":"Impact of obstructive sleep apnea treatment by continuous positive airway pressure on cardiometabolic biomarkers: a systematic review from sham CPAP randomized controlled trials","volume":"21","author":"Jullian-Desayes","year":"2015","journal-title":"Sleep Med Rev"},{"key":"2022031300282462400_B36","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1056\/NEJMoa1606599","article-title":"CPAP for prevention of cardiovascular events in obstructive sleep apnea","volume":"375","author":"McEvoy","year":"2016","journal-title":"N Engl J Med"},{"key":"2022031300282462400_B37","doi-asserted-by":"crossref","first-page":"967","DOI":"10.5664\/jcsm.5004","article-title":"Effect of CPAP on cardiac function in minimally symptomatic patients with OSA: results from a subset of the MOSAIC randomized trial","volume":"11","author":"Craig","year":"2015","journal-title":"J Clin Sleep Med"},{"key":"2022031300282462400_B38","first-page":"251","article-title":"Generalisability of The Health Improvement Network (THIN) database: demographics, chronic disease prevalence and mortality rates","volume":"19","author":"Blak","year":"2011","journal-title":"Inform Prim Care"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/care.diabetesjournals.org\/syndication\/doi\/10.2337\/dc19-2116","content-type":"unspecified","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/43\/8\/1868\/630045\/dc192116.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/43\/8\/1868\/630045\/dc192116.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T08:32:20Z","timestamp":1696062740000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/43\/8\/1868\/35558\/Obstructive-Sleep-Apnea-a-Risk-Factor-for"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,28]]},"references-count":38,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,4,28]]},"published-print":{"date-parts":[[2020,8,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc19-2116","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,28]]}}}