MON-573 - Anthropometric Effects of Obstructive Sleep Apnea Therapies in Adults with Type 2 Diabetes: A Systematic Review

Background
Obstructive sleep apnea (OSA) is highly prevalent in type 2 diabetes mellitus (T2D) and is associated with insulin resistance and excess adiposity. Several therapeutic strategies for OSA are available, including airway-based and weight-focused interventions. Previous systematic reviews have assessed the impact of OSA therapies on glycemic control and insulin resistance, however, the comparative magnitude of anthropometric effects of OSA therapies in patients with DM2 has not been systematically synthesized.

Methods
We conducted a systematic search of PubMed and Scopus for randomized clinical trials evaluating OSA therapies in adults with T2D. Twelve studies reported changes in body weight, body mass index (BMI), waist and neck circumference were included.

Results
Anthropometric effects differed by intervention type such as intensive lifestyle interventions (ILI), pharmacologic therapy (liraglutide), continuous positive airway pressure (CPAP), or combination of therapies and length of duration.
ILI produced the most durable changes, with mean weight loss ranged from −10.7 kg at 1 year to −7.1 kg at 10 years, compared with −0.5 to −3.5 kg in control groups, yielding consistent between-group differences of −3.6 to −10.2 kg (p ≤ 0.001). Waist circumference decreased by −8.4 to −3.7 cm over follow-up periods of 1 to 10 years, with all reductions significantly greater than controls. Neck circumference decreased by approximately 1.1 cm with intensive lifestyle intervention, with significant between-group differences at 1–2 years that were attenuated by year 4.
Pharmacological therapy with liraglutide combined with CPAP demonstrated moderate short-term effects in a three-month study. In this trial, BMI was lowered by −2.1 kg/m² over 3 months, compared with −0.1 kg/m² with CPAP alone, resulting in a significant between-group difference of −2.0 kg/m² (p = 0.001).
In contrast, CPAP monotherapy was associated with minimal anthropometric changes. Across trials with follow-up durations of 3 to 12 months, changes in BMI ranged from −0.5 to 0.0 kg/m², and no significant between-group differences were observed for waist or neck circumference. Reported CPAP adherence varied across trials, with mean device use ranging from 3.7 ± 0.9 to 4.9 ± 1.8 hours/night, where 56–61% of participants met standard adherence criteria (≥4 h/night).


Conclusions: In adults with T2D and OSA, weight-focused interventions, particularly intensive lifestyle intervention, produce significantly greater and more sustained improvements in anthropometric outcomes than CPAP alone. This systematic synthesis underscores weight management as a central component of OSA treatment in patients with T2D and supports integrating metabolic interventions alongside airway-based therapy in this high-risk population.

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