Obstructive sleep apnea syndrome is associated with metabolic syndrome rather than insulin resistance

Abstract

The aim of this study was to investigate cross-sectionally the prevalence and covariates of obstructive sleep apnea syndrome (OSAS) and its relationship to metabolic syndrome (MS), insulin resistance (IR), and coronary heart disease (CHD) in a population sample of 1,946 men and women representative of Turkish adults. OSAS was identified when habitual snoring and episodes of apnea were combined with another relevant symptom. MS was diagnosed based on modified criteria of the Adult Treatment Panel III and IR by homeostatic model assessment (HOMA). OSAS was identified in 61 men (6.4%) and 58 women (5.8%), at a similar prevalence, after adjusting for covariates. Among individuals with OSAS, significantly higher odds ratios (ORs), adjusted for age, body mass index (BMI), and waist girth, were observed for MS, hypertension, and prevalent CHD, but not for HOMA or menopause. Significantly higher C-reactive protein existed only in women with OSAS who were also more frequent smokers. In logistic regression models, waist circumference, but not BMI nor hypertension, was significantly associated with OSAS among men. In women, by contrast, current cigarette smoking and hypertension were the significant independent covariates. Regression models controlling for sex, age, and smoking revealed that MS (and not IR per se) was associated significantly with OSAS (OR 1.94) in nondiabetic individuals. To conclude, abdominal rather than overall obesity in men and smoking among women are significant independent determinants of OSAS in Turkish adults. OSAS is associated with MS rather than IR per se. Relatively high prevalence of OSAS is observed in Turkish women in whom it is significantly associated with CHD.

Obstructive sleep apnea syndrome: complaints and housing characteristics in a population in the United States

“…20 On the other hand, rates if 3.5% and 6.1% were reported in France and Turkey, respectively. 1,12 Nevertheless, it should be noted that 90% of individuals with sleep apnea are undiagnosed. 21 The prevalence of habitual snoring was similar to findings from studies conducted in the USA (46%) and Malaysia (47.3%).…”

“…[24][25][26] This has been confirmed in several studies. 1,8,[10][11][12][13]17 For example, obese individuals presented a risk of OSAS that was 10 times higher in the study by Salvador et al 27 There was also a strong relationship between these in the presence of confounding variables. On the basis of several studies, increased body weight can alter the normal upper airway mechanics during sleep through a variety of distinct mechanisms.…”

“…2,10 Many studies have been published in relation to weight and demographic variables, which all have strong relationships with OSAS. [1][2][3]8,[11][12][13] Information on environmental factors affecting this outcome is unavailable. Housing characteristics are an important environmental variable; adverse conditions are preventable and can be dealt with cost-effectively, and thus may be a determinant in decreasing the burden of disease.…”

Sleep, sleep-disordered breathing and metabolic consequences

“…Table 1 summarises current definitions used in clinical studies on glucose metabolism and the MetS [48][49][50]. Table 2 summarises the available epidemiological studies on the association of SDB with IR and diabetes [16,[51][52][53][54][55][56][57][58][59][60][61][62]. In general population studies [25,63], snoring was shown to be a risk factor for the development of diabetes over 10 yrs independent of confounding factors.…”

Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing

“…Snoring has been associated with higher risk of elevated glycosylated haemoglobin in premenopausal females, [4] and obstructive sleep apnoea (OSA) is linked to decreased insulin sensitivity [5]. Associations with the metabolic syndrome have been described [6,7], especially in females with severe OSA [7]. Despite the controversy in the development of new onset hypertension in patients with OSA in the Wisconsin Sleep Cohort Study [8] and the Sleep Heart Health Study [9], the association of OSA with hypertension was described in females [8,10,11].…”