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

3. mai 2021 oppdatert av: 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.

Studieoversikt

Status

Fullført

Forhold

Intervensjon / Behandling

Detaljert 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.

Studietype

Intervensjonell

Registrering (Faktiske)

184

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

  • Forente stater
    • Maryland
      • Baltimore, Maryland, Forente stater, 21224
        • Johns Hopkins Bayview Medical Center

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

21 år til 75 år (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

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

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

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

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
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
Tiltaksbeskrivelse
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

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Johns Hopkins University

Samarbeidspartnere

National Heart, Lung, and Blood Institute (NHLBI)

Etterforskere

  • Hovedetterforsker: Naresh M Punjabi, MD, PhD, Johns Hopkins University

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Generelle publikasjoner

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

1. desember 2014

Primær fullføring (Faktiske)

15. mars 2020

Studiet fullført (Faktiske)

15. mars 2020

Datoer for studieregistrering

Først innsendt

14. januar 2015

Først innsendt som oppfylte QC-kriteriene

26. mai 2015

Først lagt ut (Anslag)

27. mai 2015

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

25. mai 2021

Siste oppdatering sendt inn som oppfylte QC-kriteriene

3. mai 2021

Sist bekreftet

1. mai 2021

Mer informasjon

Begreper knyttet til denne studien

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

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

Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .

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