I’m sleeping my day away. Improving diabetes self-management using CPAP treatment in patients with obstructive sleep apnea and type 2 diabetes: A qualitative explorative study (Preprint)

BACKGROUND There is a high prevalence of unexplained and unexplored obstructive sleep apnea (OSA) in patients with type 2 diabetes. Daytime symptoms of OSA include severe fatigue, cognitive problems, decreased quality of life, and reduced motivation to provide self-care, which impairs the management of both diabetes and daily life. OSA may thereby cause negative implications for diabetes self-management. Treatment for OSA is offered through Continuous Positive Airway Pressure (CPAP) which has the potential to improve sleep quality, insulin resistance and glycemic control. Although the benefits of using CPAP as treatment for OSA are clear, noncompliance is high and there is poor evidence on the perceived effect of CPAP treatment in this group of patients. OBJECTIVE The purpose of this study is to explore the impact of comorbid diabetes and OSA on daily life among older adults, and to investigate the perceived effect of CPAP treatment for OSA on patients’ diabetes self-management. METHODS A qualitative follow-up study, with in-depth semi-structured dyad interviews with couples before and after an intervention with CPAP treatment (N=22). Patients were recruited from Hilleroed Hospital in Denmark and were all diagnosed with type 2 diabetes, age > 18 years and apnea-hypopnea index (AHI) ≥ 15. All interviews were coded and analyzed using thematic analysis. RESULTS Patients and partners do not consider OSA a serious disorder as they consider OSA symptoms similar to the process of aging. Patients experience poor nocturnal sleep, frequent daytime naps, reduced cognitive function, low levels of physical activity, and a high-calorie diet, that all negatively influence their diabetes self-management. Despite the immediate benefit of the CPAP treatment, most patients have technical challenges when using the CPAP. Only patients with severe OSA symptoms inflicting their daily life overcome the challenges of CPAP and thereby improve their diabetes self-management. Patients with less life inflicting symptoms rate the CPAP challenges as more burdensome than their symptoms. CONCLUSIONS If used correctly CPAP has the potential to improve OSA resulting in better sleep quality, improved physical activity, improved diet and a better diabetes self-management. But there are many barriers in CPAP treatment and only few patients manage to overcome the barriers and comply to correct treatment. CLINICALTRIAL The study was approved by the Danish Data Protection Agency (J.nr. 2012-58-0004).