Association of lung function impairment with risk of incident diabetes in patients with obstructive sleep apnea: A prospective cohort study.

OBJECTIVE

Impaired lung function is commonly observed in individuals with obstructive sleep apnea (OSA) and may contribute to the development of diabetes mellitus (DM). This prospective cohort study explores the link between impaired lung function and risk of incident DM in OSA patients and determines which lung dysfunction subtype confers the highest risk.

METHODS

2,454 OSA patients from the Sleep Heart Health Study (SHHS) were included. Baseline demographic and clinical characteristics were recorded. Lung function was assessed using the FEV1% and FVC%. Obstructive physiology (OP), restrictive physiology (RP), and preserved ratio impaired spirometry (PRISm) were further defined based on spirometric data. Logistic regression and mediation analysis were used to assess associations and mediation effects.

RESULTS

DM occurred in 4.2% of participants over a mean follow-up of 5.3 years. After adjusting for confounders, both lower FEV₁% (OR = 1.390, 95% CI: 1.112–1.736,p = 0.004) and lower FVC% (OR = 1.333, 95% CI: 1.057–1.683, p = 0.014) were associated with increased DM risk. These associations remained consistent across all subgroups. Compared with individuals with preserved lung function, OP group exhibited a significantly higher risk of DM (OR = 1.908, 95% CI: 1.144–3.115, p = 0.011), with similar findings observed when compared to the control group (OR = 1.864, 95% CI: 1.124–3.018, p = 0.013). Obesity drove the association, partially mediated by WHtR (FEV₁%: 13.84%; FVC%: 21.97%).

CONCLUSION

Impaired lung function is associated with an increased risk of incident DM in patients with OSA, with this association being partially mediated by WHtR. The risk is particularly elevated in those with OP. This phenomenon may be closely related to intermittent hypoxia and abdominal obesity.