STUDY OBJECTIVES: Sleep-disordered breathing and diabetes mellitus (DM) are often concomitant; however, data on the impact of sleep-disordered breathing on mortality in the population with diabetes remain scarce. METHODS: The population from the Sleep Heart Health Study, a multicenter prospective observational study representing 5,780 patients with polysomnography and mortality data, including 453 patients with DM, was analyzed to assess the impact of sleep-disordered breathing variables and the presence of DM on all-cause, cardiovascular disease, and noncardiovascular disease associated mortality. Survival analysis and proportional hazard regression models were used to calculate the adjusted hazard ratios (aHRs) for mortality. RESULTS: Patients with DM and the average oxygen saturation > 91.4% had significantly lower all-cause (aHR 0.52, confidence interval [CI] 0.34-0.80) and cardiovascular disease mortality risk (aHR 0.44, CI 0.22-0.87) as compared with patients with oxygen saturation below this value. Apnea-hypopnea index > 31 (aHR 1.58, CI 1.10-2.28) and oxygen desaturation index > 13.3 (aHR 1.58, CI 1.10-2.25) were associated with increased all-cause mortality in participants with DM on treatment. Sleep efficiency and proportion of rapid eye movement sleep did not have any impact on mortality in patients with DM and thus differed significantly from individuals without DM, where increased all-cause mortality was observed in those with sleep efficiency < 81.4% (aHR 0.77, CI 0.68-0.87) or rapid eye movement sleep < 14.9% (aHR 0.78, CI 0.68-0.89). CONCLUSIONS: Patients with diabetes on treatment and moderate to severe sleep-disordered breathing experience increased all-cause mortality. Reduced average oxygen saturation predicted both all-cause and cardiovascular death in the population with diabetes. CITATION: Vichova T, Petras M, Waldauf P, Westlake K, Vimmerova-Lattova Z, Polak J. Sleep-disordered breathing increases mortality in patients with diabetes. J Clin Sleep Med. 2025;21(1):89-99.

Department of Anaesthesia and Intensive Care Medicine 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Cardiology University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Epidemiology and Biostatistics 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Internal Medicine Thomayer University Hospital Prague Czech Republic

Department of Internal Medicine University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Pathophysiology 3rd Faculty of Medicine Charles University Prague Czech Republic

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