A Structured Narrative Review of the OSA-T2DM Axis
Abstract
Background/Objectives: Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) are two highly prevalent and interconnected conditions with significant implications for morbidity and mortality. Emerging evidence suggests a bidirectional relationship between the two disorders, mediated by shared pathophysiological mechanisms such as intermittent hypoxia, systemic inflammation, and autonomic dysfunction. Methods: A structured narrative review of the literature was conducted using a comprehensive PubMed search of clinical and observational studies published between 2020 and 2024. Studies evaluating the association between OSA and diabetes, including its effects on glycemic control, diabetic complications, and treatment outcomes, were included. Results: Thirty-three studies met our inclusion criteria. OSA is independently associated with impaired glucose metabolism, increased insulin resistance, and a higher risk of diabetic complications, including nephropathy, retinopathy, and neuropathy. Continuous positive airway pressure (CPAP) therapy has shown variable effects on metabolic outcomes, largely dependent on adherence. Traditional OSA severity metrics, such as the apnea-hypopnea index (AHI), did not consistently predict metabolic burden. Factors such as sleep quality, nocturnal hypoxemia, and comorbid insomnia have emerged as the most relevant predictors. Sex-specific differences and the roles of pharmacological and behavioral interventions were also noted.…
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