Nocturnal intermittent hypoxia and the development of type 2 diabetes: the Circulatory Risk in Communities Study (CIRCS)

Abstract

Aims/hypothesis Although the associations between obstructive sleep apnoea and type 2 diabetes mellitus have been reported in cross-sectional design studies, findings on the prospective association between the two conditions are limited. We examined prospectively the association between nocturnal intermittent hypoxia as a surrogate marker of obstructive sleep apnoea and risk of type 2 diabetes. Methods A total of 4,398 community residents aged 40 to 69 years who had participated in sleep investigation studies between 2001 and 2005 were enrolled. Nocturnal intermittent hypoxia was assessed by pulse-oximetry and defined by the number of oxygen desaturation measurements ≤3% per h, with five to <15 per h corresponding to mild and 15 events or more per h corresponding to moderate-to-severe nocturnal intermittent hypoxia, respectively. The development of type 2 diabetes was defined by: (1) fasting serum glucose ≥7.00 mmol/l (126 mg/dl); (2) non-fasting serum glucose ≥11.1 mmol/l (200 mg/dl); and/ or (3) initiation of glucose-lowering medication or insulin therapy. Multivariable model accounted for age, sex, BMI, smoking status, current alcohol intake, community, borderline type 2 diabetes, habitual snoring, excessive daytime sleepiness, sleep duration and (for women) menopausal status.Results By the end of 2007, 92.2% of participants had been followed up (median follow-up duration [interquartile range] 3.0 [2.9-4.0] years) and 210 persons identified as having developed diabetes. The multivariable-adjusted hazard ratio (95% CI) for developing type 2 diabetes was 1.26 (0.91-1.76) among those with mild nocturnal intermittent hypoxia and 1.69 (1.04-2.76) among those with moderate-to-severe nocturnal intermittent hypoxia (p=0.03 for trend). Conclusions/interpretation Nocturnal intermittent hypoxia was associated with increased risk of developing type 2 diabetes among middle-aged Japanese.

Nocturnal Hypoxemia and Severe Obstructive Sleep Apnea are Associated with Incident Type 2 Diabetes in a Population Cohort of Men

“…4,8 There is signifi cant heterogeneity across seven published longitudinal studies 4,[9][10][11][12][13][14][15] of OSA-related diabetes risk in terms of sample sizes, numbers of incident cases, followup periods, and referral bias associated with selected samples. In the Wisconsin cohort, no independent association of ; Peter G. Catcheside, PhD 2,4 ; Robert J. Adams, MBBS, MD 1 1 moderate-severe OSA with incident diabetes was observed, 9 and other studies have demonstrated only modest associations.…”

“…In the Wisconsin cohort, no independent association of ; Peter G. Catcheside, PhD 2,4 ; Robert J. Adams, MBBS, MD 1 1 moderate-severe OSA with incident diabetes was observed, 9 and other studies have demonstrated only modest associations. [10][11][12][13][14][15] Consequently, a recent systematic review found "little published evidence of a longitudinal association between OSA and diabetes." 8 The importance of polysomnography (PSG) indices other than the apnea-hypopnea index (AHI), such as hypoxia, for incident diabetes is unclear.…”

Obstructive Sleep Apnea and Oxygen Therapy: A Systematic Review of the Literature and Meta-Analysis

“…8,9 It has also been associated with an increased risk of diabetes. 10 Indeed, most of the sequelae of obstructive sleep apnea are more strongly linked to the degree and duration of oxygen desaturation than to the numbers of apneas and hypopneas or disruptions in sleep architecture. 11 The resolution of nocturnal intermittent hypoxemia associated with sleep apnea is a major goal of the treatment of patients with obstructive sleep apnea.…”

Effect of continuous positive airway pressure therapy on glucose control

“…A prospective study from Japan that spanned five years, examined nocturnal oximetry in over 4000 patients and calculated that a multivariable-adjusted hazard ratio (95% CI) for developing type 2 diabetes was 1.69 (1.04-2.76) among those with moderate to severe nocturnal intermittent hypoxia [12] . A Veterans Affairs based observational cohort study examined 1233 consecutive patients referred for evaluation of OSA, of whom 544 were free from pre-existing diabetes.…”