A Population-Based Study of the Bidirectional Association Between Obstructive Sleep Apnea and Type 2 Diabetes in Three Prospective U.S. Cohorts

Huang, Tianyi; Lin, Brian M.; Stampfer, Meir J.; Tworoger, Shelley S.; Hu, Frank B.; Redline, Susan

doi:10.2337/dc18-0675

Cited by 97 publications

(78 citation statements)

References 56 publications

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“…OSA may be undiagnosed in many women because their symptoms are fatigue or mood disorders instead of witnessed apneas or heavy snoring. 35 In the subgroup analysis stratified by region, results seemed more stable in American populations, perhaps because the sample size of relevant studies in America was larger than in other regions 12,14,16,22 (Table 1).…”

Section: Discussionmentioning

confidence: 96%

“…This study included a total of 338 912 study 11,18,20 two from Asia 13,19 and another two from Australia. 15,21 Four studies included only men, 12,15,18,20 three only women, 12,20 and seven both sexes. 11,13,14,16,17,19,21,22 OSA and T2DM were assessed by structured surveys, reliable medical records, or objective diagnostic methods.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

“…Sixteen cohort studies [11][12][13][14][15][16][17][18][19][20][21][22] investigating the OSA-T2DM association were included in the binary meta-analysis. The pooled RR for T2DM was 1.40 (95% CI, 1.32-1.48), with low heterogeneity (I 2 = 40.8%, P heterogeneity = .045) ( Figure S1).…”

Section: Binary Meta-analysismentioning

confidence: 99%

“…10 Several cohort studies have explored the OSA-T2DM association. [11][12][13][14][15][16][17][18][19][20][21][22][23] Four cohort studies suggested that the association was only for participants with moderate to severe OSA but not those with mild OSA. 14,15,19,21 One cohort study found that even mild OSA increased the risk of T2DM.…”

Section: Introductionmentioning

confidence: 99%

“…Basic characteristics of included cohort studies and 19 355 incident cases of T2DM over a median follow-up of 10.5 years (range: 3 to 22) 11,21. Five publications were from America,12,14,16,17,22 three from Europe,…”

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confidence: 99%

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Obstructive sleep apnea and risk of type 2 diabetes mellitus: A systematic review and dose‐response meta‐analysis of cohort studies

Qie

Zhang

Liu

et al. 2020

Journal of Diabetes

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Background: This meta-analysis was performed to quantitatively evaluate the dose-response association between obstructive sleep apnea (OSA) and risk of type 2 diabetes mellitus (T2DM).Methods: PubMed, Embase, and Web of Science were searched up to 12 December 2018 for articles that assessed the OSA-T2DM association. Random effects models were used to analyze the quantitative association between OSA and risk of T2DM. Restricted cubic splines were used to model the doseresponse association between apnea-hypopnea index (AHI), used to assess the severity of OSA according to events/h, and risk of T2DM. Results:We included 16 cohort studies in our meta-analysis. During a median follow-up of 10.5 years (range: 3.0-22.0), 19 355 T2DM cases were reported among 338 912 study participants. The pooled relative risk of T2DM was 1.40 (95% CI, 1.32-1.48) for OSA in the binary meta-analysis and 1.08 (1.01-1.14) for each 5-event/h increase in AHI value. We found a positive linear association between OSA and T2DM risk.Conclusions: Our dose-response meta-analysis revealed a linear association between OSA and T2DM. Highlights• Obstructive sleep apnea (OSA) is a treatable chronic sleep disorder characterized by episodes of sleep apneas and hypopneas during sleep, increased oxidative stress, inflammation, and sleep fragmentation and is associated with significant comorbidities. • Our systematic review and meta-analysis shows that people with OSA are at higher risk of type 2 diabetes mellitus (T2DM), which suggests that we should detect and treat OSA early to prevent T2DM.

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Section: Discussionmentioning

confidence: 96%

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Section: Binary Meta-analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Obstructive sleep apnea and risk of type 2 diabetes mellitus: A systematic review and dose‐response meta‐analysis of cohort studies

Qie

Zhang

Liu

et al. 2020

Journal of Diabetes

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Obstructive Sleep Apnea and Risk for Incident Vertebral and Hip Fracture in Women

Huang

Tworoger

Redline

et al. 2020

Journal of Bone and Mineral Research

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Recent studies suggest a positive association between obstructive sleep apnea (OSA), a disorder associated with intermittent hypoxia and sleep fragmentation, and derangements in bone metabolism. However, no prospective study to date has investigated the association between OSA and fracture risk in women. We conducted a prospective study examining the relation between OSA and risk of incident vertebral fracture (VF) and hip fracture (HF) in the Nurses' Health Study. History of physician-diagnosed OSA was assessed by self-reported questionnaires. A previous validation study demonstrated high concordance between self-reports and medical record identification of OSA. OSA severity was further categorized according to the presence or absence of self-reported sleepiness. Selfreports of VF were confirmed by medical record review. Self-reported HF was assessed by biennial questionnaires. Cox proportional-hazards models estimated the hazard ratio for fracture according to OSA status, adjusted for potential confounders, including BMI, physical activity, calcium intake, history of osteoporosis, and falls, and use of sleep medications. Among 55,264 women without prior history of fracture, physician-diagnosed OSA was self-reported in 1.3% in 2002 and increased to 3.3% by 2012. Between 2002 and 2014, 461 incident VF cases and 921 incident HF cases were documented. The multivariable-adjusted hazard ratio (HR) for confirmed VF for women with history of OSA was 2.00 (95% CI, 1.29-3.12) compared with no OSA history, with the strongest association observed for OSA with daytime sleepiness (HR 2.86; 95% CI, 1.31-6.21). No association was observed between OSA history and self-reported HF risk (HR 0.83; 95% CI, 0.49-1.43). History of OSA is independently associated with higher risk of confirmed VF but did not have a statistically significant association with self-reported HF in women. Further research is warranted in understanding the role of OSA and intermittent hypoxia in bone metabolism and health that may differ by fracture site.

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Obstructive Sleep Apnea and Hypertension

Yao

et al. 2019

Secondary Hypertension

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A Population-Based Study of the Bidirectional Association Between Obstructive Sleep Apnea and Type 2 Diabetes in Three Prospective U.S. Cohorts

Cited by 97 publications

References 56 publications

Obstructive sleep apnea and risk of type 2 diabetes mellitus: A systematic review and dose‐response meta‐analysis of cohort studies

Obstructive sleep apnea and risk of type 2 diabetes mellitus: A systematic review and dose‐response meta‐analysis of cohort studies

Obstructive Sleep Apnea and Risk for Incident Vertebral and Hip Fracture in Women

Obstructive Sleep Apnea and Hypertension

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