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Hyperglycemic Profiles in Obstructive Sleep Apnea: Effects of PAP Therapy (HYPNOS)

3. maj 2021 opdateret af: Johns Hopkins University
This is a randomized control trial in people with diabetes and obstructive sleep apnea who will be randomly assigned for 3 months to PAP therapy along with healthy lifestyle and sleep education or healthy lifestyle and sleep education.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Research over the last decade has shown that obstructive sleep apnea (OSA) is a common condition in people with diabetes. Observational and experimental evidence also indicates that intermittent hypoxemia and recurrent arousals in OSA may alter glucose metabolism and worsen glycemic control. However, the impact of treating OSA with positive airway pressure (PAP) therapy on glycemic variability and control is not well defined. Adequately powered randomized clinical trials have yet to be performed to demonstrate whether PAP therapy for OSA in diabetics can improve glycemic variability (and control), decrease blood pressure, and reverse endothelial dysfunction. The overarching goal of this study is to determine whether PAP therapy for OSA in diabetics leads to improvements in (a) glycemic variability as assessed by self-monitoring of blood glucose and continuous monitoring of glucose; (b) glycosylated hemoglobin; (c) blood pressure; (d) endothelial function; (e) serum and urinary biomarkers; and (f) dyslipidemia.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

184

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Forenede Stater
    • Maryland
      • Baltimore, Maryland, Forenede Stater, 21224
        • Johns Hopkins Bayview Medical Center

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

21 år til 75 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Type 2 diabetics
  • Age > 21 and ≤ 75 years

Exclusion Criteria:

  • Inability to consent or commit to the required visits
  • Use of insulin or other injections for diabetes
  • Weight change of 10% in last six months
  • Use of oral steroids in the last six months
  • Pulmonary disease (i.e., COPD)
  • Renal or hepatic insufficiency
  • Recent MI or stroke (< 3 months)
  • Sleep-related hypoventilation
  • Obesity-hypoventilation syndrome
  • Morbid Obesity
  • Occupation as a commercial driver or operator of heavy machinery
  • Active substance use
  • Untreated thyroid disease
  • Pregnancy
  • Any history of seizures or other neurologic disease
  • Poor sleep hygiene or sleep disorder other than sleep apnea
  • Central sleep apnea
  • Variants of obstructive sleep apnea (e.g., REM-related OSA)
  • Participants not suitable for the study based on the clinical judgment
  • Use of any investigational drug within the past 30 days
  • Participating in another study

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: REMStar Positive Airway Pressure
Positive pressure therapy is the standard of care for managing obstructive sleep apnea.
Enhed: REMStar Positive Airway Pressure
Positive airway pressure therapy is the standard of care for managing obstructive sleep apnea
Andet: LifeStyle Counseling
Lifestyle guidelines developed by the American Diabetes Association for weight loss will be provided to all subjects.
Adfærdsmæssigt: LifeStyle Counseling
Lifestyle guidelines developed by the American Diabetes Association for weight loss will be provided to all subjects.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change in Continuous Glucose Monitoring System Standard Deviation
Tidsramme: Baseline and 3 months
Continuous Glucose Monitoring Metrics - change in standard deviation between baseline and three months.
Baseline and 3 months

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Mean Difference in Systolic Blood Pressure
Tidsramme: Baseline and 3 months
Mean difference between 3 months and baseline systolic blood pressures (in mmHg) by group.
Baseline and 3 months
Change in Endothelial Dysfunction as Assessed by the Reactive Hyperemic Index
Tidsramme: Baseline and 3 months
Endothelial function was measured by the EndoPAT device - difference at 3 months - baseline, by group. The outcome reported is the Reactive Hyperemic Index (RHI). The RHI is a measure of endothelial vasodilator function. The RHI is the post-to-pre occlusion peripheral arterial tone signal ratio in the occluded arm relative to the other arm, which is not occluded. Persons with worse endothelial function have a lower RHI score. Consequently, a low RHI indicates more endothelial dysfunction. A value of 1.67 or less is considered abnormal vascular tone. The reported lower and upper limits in adults with type 2 diabetes is 1.1 - 4.9.
Baseline and 3 months
Heart Rate Variability
Tidsramme: 3 months
3 months
Change in the Epworth Sleepiness Scale
Tidsramme: Baseline and 3 months
The Epworth Sleepiness Scale measures self-reported sleep propensity or daytime sleepiness. The range of the scale is 0 to 24 (integers only), with increasing values corresponding to increasing sleepiness. A cut-point of ≥ 11 is also sometimes used to differentiate those with pathological sleepiness (≥ 11) versus those without < 11. The difference between the three month final visit - the baseline visit score is reported by group
Baseline and 3 months
Change in Post-Pre Meal Blood Glucose Levels
Tidsramme: Baseline and 3 months
The difference from baseline to three months in self-reported in blood glucose levels before and after meals (mg/dL) (post-meal - pre-meal). Data is presented for breakfast, lunch, and dinner.
Baseline and 3 months
Change in Glycosylated Hemoglobin A1c Level
Tidsramme: Baseline and 3 months
Change in point-of-care hemoglobin A1c (%) after three months.
Baseline and 3 months
Continuous Glucose Monitoring System Mean Amplitude Glucose Excursion
Tidsramme: 3 months
Mean Amplitude Glucose Excursion in mg/dL (difference between the peaks and troughs of glucose from continuous glucose monitoring at three months).
3 months
Continuous Glucose Monitoring System Standard Deviation
Tidsramme: 3 months
The standard deviation of the glucose from continuous glucose monitoring at three months.
3 months
Change in Continuous Glucose Monitoring System Mean Glucose
Tidsramme: Baseline and 3 months
Continuous Glucose Monitoring Metric - change in average glucose level (mg/dL) from baseline to three months.
Baseline and 3 months

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Johns Hopkins University

Samarbejdspartnere

National Heart, Lung, and Blood Institute (NHLBI)

Efterforskere

  • Ledende efterforsker: Naresh M Punjabi, MD, PhD, Johns Hopkins University

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

1. december 2014

Primær færdiggørelse (Faktiske)

15. marts 2020

Studieafslutning (Faktiske)

15. marts 2020

Datoer for studieregistrering

Først indsendt

14. januar 2015

Først indsendt, der opfyldte QC-kriterier

26. maj 2015

Først opslået (Skøn)

27. maj 2015

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

25. maj 2021

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

3. maj 2021

Sidst verificeret

1. maj 2021

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • NA_00093188
  • R01HL117167 (U.S. NIH-bevilling/kontrakt)

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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