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People with both type 2 diabetes (T2D) and obstructive sleep apnoea have a higher risk of death, but treatment with continuous positive airway pressure (CPAP) may reduce that risk by around 26%, according to new research being presented at this year’s Annual Meeting of The European Association for the Study of Diabetes (EASD), Vienna (15-19 Sept).

The Swedish researchers said the results underscore the importance of treating sleep apnoea as part of a broader effort to control type 2 diabetes and improve long-term survival.

Obstructive sleep apnoea is when throat muscles relax during sleep, blocking the airway, causing a person to wake up repeatedly to breathe. This disrupted sleep pattern can lower oxygen levels, affecting the brain. If left untreated, it can lead to serious health problems, including high blood pressure, heart trouble, and T2D.

CPAP machines treat sleep apnoea by delivering pressurised air through a mask to keep the airway open during sleep. However, research on the effects of CPAP on survival has produced mixed results.

Obstructive sleep apnoea affects around 1 billion of the world’s adults aged 30-69 years [1], and an estimated 50–80% of adults with T2D [2], most of whom are undiagnosed, increasing the risk of complications. In people with T2D, sleep apnoea is associated with more than a 50% increased risk of cardiovascular disease (including heart failure and stroke) and a 24% higher risk of dying from any cause compared to those without sleep apnoea [3].

“Despite the substantial impact of obstructive sleep apnoea on cardiovascular disease and survival, it often goes undiagnosed in people with type 2 diabetes and is not routinely addressed as part of diabetes management,” said lead author Dr Jonas Aghome from Linköping University in Sweden. “What’s more, the impact of treatment with CPAP on survival in people with T2D hasn’t been clear.”

Previous studies in patients with both T2D and obstructive sleep apnoea have been limited by short follow-up periods and a focus on metabolic endpoints, rather than on longer-term clinical outcomes such as survival.

To answer these questions, Swedish researchers analysed data from five Swedish national registers between 2010 and 2024 to identify 12,388 T2D patients with obstructive sleep apnoea who had been prescribed CPAP and 737,911 T2D patients (whose obstructive sleep apnoea status was unknown) who were never prescribed CPAP, to compare long-term survival.

Dr Agholme explains, “Despite potential dilution from including individuals without obstructive sleep apnoea in the control group, the high prevalence of obstructive sleep apnoea in people with T2D, together with the higher risk of illness associated with having both T2D and obstructive sleep apnoea, should allow any clinically relevant associations of CPAP to be detected.”

The CPAP treatment group included less women ( 31% vs. 43%), was younger (average age 58 years vs. 65 years), but had a higher average body mass index (BMI, 34.7 kg/m² vs. 30.6 kg/m²).

Of those prescribed CPAP, 764 people (6.1%) died within 14 years compared to 212,336 people (28.7%) of those who did not receive CPAP.

After adjusting for potential confounders including age, sex, and prior cardiovascular disease, as well as factors that may vary during follow-up including BMI, smoking, cholesterol, kidney function, blood pressure, and pharmacological treatment, they found that patients who were prescribed CPAP had a 26% lower risk of dying from any cause over the 14-year period, compared with patients who never received CPAP.

“This new study using real-world data highlights the potential benefits of CPAP in people with T2D and obstructive sleep apnoea, a clinical conundrum that has long awaited answers,” said Dr Agholme. “The findings suggest that CPAP may play an important role in improving patient outcomes and survival, and they underline the value of early OSA diagnosis in people with T2D. Still, more rigorous research is needed to determine the causal effect of CPAP treatment. ”

Reference:

Breathing device could have profound impact on survival for people with sleep apnoea and type 2 diabetes, European Association for the Study of Diabetes, Meeting: Annual Meeting of the European Association for the Study of Diabetes (EASD).

Researchers have found in a new study that tooth loss is highly associated with stroke risk, with patients having increased tooth loss having a considerably higher risk of stroke. The research provides robust evidence of the association between tooth loss and stroke, with additional missing teeth increasing risk by 2%. The study was published in the Journal of Stroke and Cerebrovascular Diseases by Dajin Li. and colleagues.

Researchers have discovered in a new study that teenage girls suffering from dysmenorrhoea, painful periods are more likely to experience chronic pain in later life. The results are based on the UK’s large Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort study. The research identified that the adolescents with moderate to severe dysmenorrhoea at 15 years were more likely to be reporting chronic pain at age 26 compared to their peers who did not experience menstrual pain. The study was published in The Lancet: Child & Adolescent Health by Rachel R. and colleagues.

Recent prospective observational study evaluated the effectiveness of ultrasonography (USG) in predicting difficult laryngoscopies through measurements of key parameters such as the tongue-to-oral height ratio (TTOHR) and anterior neck soft tissue distances. The study, involving 120 patients undergoing elective surgery under general anesthesia, focused on assessing four USG parameters: skin-to-hyoid bone distance (SHBD), skin-to-epiglottis distance (SED), skin-to-thyrohyoid membrane distance (STHMD), and TTOHR. The primary outcome was determined using modified Cormack-Lehane (CL) grading post-laryngoscopy.

### Methodology – Patients aged 18-65 years without a known difficult airway were included, while those requiring fiberoptic intubation or with altered neck anatomy were excluded. Airway USG was conducted before anesthesia by an experienced investigator, measuring the four USG parameters in a neutral neck position. Each patient’s laryngoscopy was assessed and graded by an independent anesthesiologist. Statistical analysis included ROC curve analysis, multivariable logistic regression, and comparisons of various predictive models. A cutoff value for each parameter was established to optimize diagnostic performance.

### Results – Out of 120 patients, 11.6% experienced difficult laryngoscopy (DL) while 6.6% had difficult intubation (DI). SED exhibited the highest diagnostic performance with an area under the curve (AUC) of 0.95, 100% sensitivity, and 89% specificity at a cutoff of 1.87 cm. STHMD and TTOHR followed closely with AUCs of 0.94 and 0.92, respectively. Notably, TTOHR showed the highest diagnostic accuracy of 97%, indicating significant predictive value. Combining parameters into models enhanced predictive capabilities, with one model integrating TTOHR, SHBD, and STHMD emerging as the best predictor for DL.

### Limitations – The study’s limitations include a relatively small and homogeneous sample size, limiting generalizability to broader populations or different ethnicities. Additionally, the measurements were conducted by a single investigator, which poses a risk of variability not assessed in the study. The dynamic nature of the tongue and the lack of evaluation of DI accuracy across a larger group further constrain the findings.

### Conclusion – Results demonstrated that USG parameters, particularly SED, STHMD, and TTOHR, are effective in predicting difficult laryngoscopy, with models leveraging these parameters significantly enhancing predictive performance in unexpected difficult airway scenarios.

Key Points

– A prospective observational study evaluated the effectiveness of ultrasonography (USG) in predicting difficult laryngoscopies by measuring parameters such as the tongue-to-oral height ratio (TTOHR) and anterior neck soft tissue distances in 120 elective surgery patients under general anesthesia.

– Key USG parameters assessed included skin-to-hyoid bone distance (SHBD), skin-to-epiglottis distance (SED), skin-to-thyrohyoid membrane distance (STHMD), and TTOHR, with the primary outcome being assessed via modified Cormack-Lehane (CL) grading post-laryngoscopy.

– The study included patients aged 18-65 years without known difficult airways, while excluding those needing fiberoptic intubation or with altered neck anatomy. Measurements were taken by an experienced investigator in a neutral neck position, and laryngoscopies were graded by an independent anesthesiologist.

– Among the 120 participants, 11.6% experienced difficult laryngoscopy (DL) and 6.6% had difficult intubation (DI). SED demonstrated the best diagnostic performance with an AUC of 0.95, achieving 100% sensitivity and 89% specificity at a cutoff of 1.87 cm, while TTOHR showed a diagnostic accuracy of 97%.

– Predictive capabilities improved by combining multiple parameters into models, with a particular model incorporating TTOHR, SHBD, and STHMD identified as the best predictor for difficult laryngoscopy (DL).

– Limitations of the study include a relatively small and homogeneous sample size, the use of a single investigator for measurements, potential variability in tongue dynamics, and the lack of evaluation of DI accuracy across a larger cohort, which may restrict the generalizability of the findings.

Reference –

Nandi S, Panda A, Mishra N, Rao PB, Srinivasan A. Evaluation of the predictive value of tongue height to oral cavity height ratio and anterior neck soft tissue measurements for difficult laryngoscopy in patients with unanticipated difficult airway: A prospective observational study. Indian J Anaesth 2025;69:918-25