Alongside obesity that has reached epidemic proportions, type 2 diabetes (T2D) has increased and currently represents a major public health problem.T2D is a chronic disease associated with other disorders such as obstructive sleep apnoea (OSA), sharing common risk factors.
OSA is a common treatable disorder characterised by regular partial or complete obstruction of the upper airway during sleep, leading to frequent oxygen desaturation, alternation of blood pressure, and heart rate resulted in general disturbance of sleep. As a result, OSA has been linked to various adverse outcomes such as road traffic accidents, cardiovascular disease, insulin resistance, and T2D.
Our aim is to investigate the risk of OSA in developing non-alcoholic fatty liver disease (NAFLD) and fragility fracture among patients with T2D. Using the primary care database CPRD AURUM, patients with a diagnosis of T2D will be identified. Of these patients with a diagnosis of OSA and without OSA, patients will be selected an a way that they are similar in terms of age, sex, and BMI. After that, the number and proportion of the exposed ( patients with OSA) and unexposed ( patients without OSA) who have developed NAFLD or fragility fracture within the study period will be calculated. The chances of developing the targeted outcomes between two groups (patients with OSA and without) will be compared. The result of this study will add to evidence about the association between OSA and the development of NAFLD or fragility fracture among patients withT2D.
Type 2 Diabetes (T2D) is a chronic metabolic disorder that rarely exists in isolation; 90% of patients with diabetes have another chronic disease. Recent evidence suggests that Obstructive Sleep Apnoea (OSA) and T2D share common risk factors. The primary aim is to investigate the association between exposure to OSA and the risk of non-alcoholic fatty liver disease (NAFLD) and fragility fracture among patients with type 2 diabetes.
A retrospective cohort study will be conducted from 01 Jan 2000 to 01 April 2022. Participants will be selected from CPRD AURUM primary care database. All patients with a T2D diagnosis will be eligible for inclusion in the study.
Patients with OSA diagnosed either before or after the T2D diagnosis will form the exposed cohort and the unexposed patient cohort will be randomly selected from a pool of patients without OSA after matching for age, sex, body mass index, and type 2 diabetes duration.
The primary outcomes include development of (1) Non-Alcoholic Fatty Liver Disease (NAFLD), and (2) Fragility Fracture during follow up period.
The primary analysis, a Cox proportional hazard model will be used to estimate the adjusted hazard ratio for the outcomes among patients with OSA compared to patients without OSA. Adjustment will be made for pre-defined cofounders such as age, sex, BMI, ethnicity, deprivation, and other risk factors.
This study is intended to identify whether OSA acts as an independent risk factor for NAFLD/fragility fracture among patients with type 2 diabetes, if we match all other covariates; age, sex, BMI, and T2D duration. If that is the case, treatment strategies to reduce OSA such as continuous positive airway pressure (CPAP) might contribute to lowering the risk of NAFLD/fragility fracture among patients with type 2 diabetes.
Primary outcome is a SNOMED CT coded diagnosis of:
• Non-alcoholic fatty liver Disease.
• Fragility fracture from any of the following sites: fractures at hip, wrist, spine, and humerus
Krishnarajah Nirantharakumar - Chief Investigator - University of Birmingham
Esraa Makhdom - Corresponding Applicant - University of Birmingham
Anuradhaa Subramanian - Collaborator - University of Birmingham
Nicola Adderley - Collaborator - University of Birmingham
Patient Level Index of Multiple Deprivation