Continuous positive airway pressure (CPAP) therapy may offer major benefits for patients with type 2 diabetes (T2D) and obstructive sleep apnea (OSA), according to a new Bulgarian multicenter study.

This study published in Diabetology, was conducted across three outpatient centers. The prospective cohort consisted of 142 patients with T2D and moderate-to-severe OSA for six months. Out of these, 55 chose to initiate CPAP therapy, while 87 continued with standard care. Patients adhered to CPAP 5.2 hours nightly, and 78% of patients met recommended thresholds.

After six months, CPAP users showed significant improvements in multiple domains compared with non-users. HbA1c fell by an average of 0.8%, a greater reduction than typically reported in international trials. Inflammatory markers such as high-sensitivity C-reactive protein (hsCRP) decreased, alongside improvements in sleep-disordered breathing indices, daytime sleepiness (Epworth Sleepiness Scale), and renal and lipid parameters. Patients also reported better physical and mental quality-of-life scores, highlighting the multidimensional impact of therapy.

Although mortality differences did not reach statistical significance during the short follow-up, the trend favored the CPAP group. It was observed that consistent nightly use deferred metabolic and cardiovascular benefits to the patients..

The study also reveals the economic challenge of CPAP access in Bulgaria, where patients must self-fund treatment. It is also concluded that CPAP could improve adherence and outcomes, aligning with global evidence that it reduces cardiometabolic risk.

These findings provide real-world validation for CPAP’s role in multidisciplinary diabetes care and support calls for healthcare policy reform to improve access and long-term patient outcomes.