Sleep-disordered Breathing and Insulin Resistance in Middle-aged and Overweight Men

Abstract

Sleep-disordered breathing is a prevalent condition associated with impairment of daytime function and may predispose individuals to metabolic abnormalities independent of obesity. The primary objective of this study was to determine the metabolic consequences and community prevalence of sleep-disordered breathing in mildly obese, but otherwise healthy, individuals. One hundred and fifty healthy men, without diabetes or cardiopulmonary disease, were recruited from the community. Measurements included polysomnography, a multiple sleep latency test, an oral glucose tolerance test, determination of body fat by hydrodensitometry, and fasting insulin and lipids. The prevalence of sleep-disordered breathing, depending on the apnea-hypopnea index (AHI) cutoff, ranged from 40 to 60%. After adjusting for body mass index (BMI) and percent body fat, an AHI gt-or-equal, slanted 5 events/h was associated with an increased risk of having impaired or diabetic glucose tolerance (odds ratio, 2.15; 95% CI, 1.05-4.38). The impairment in glucose tolerance was related to the severity of oxygen desaturation (DeltaSa(O(2))) associated with sleep-disordered breathing. For a 4% decrease in oxygen saturation, the associated odds ratio for worsening glucose tolerance was 1.99 (95% CI, 1.11 to 3.56) after adjusting for percent body fat, BMI, and AHI. Multivariable linear regression analyses revealed that increasing AHI was associated with worsening insulin resistance independent of obesity. Thus, sleep-disordered breathing is a prevalent condition in mildly obese men and is independently associated with glucose intolerance and insulin resistance.

Severity of obstructive sleep apnea and metabolic variables: complex relationship needs comprehensive consideration

“…However, the conclusion of this study differs from previous studies focused on increased BP, lipid profile, insulin resistance and respiratory disturbance index [2][3][4]. This inconsistence may partly be explained by the small sample size in this study, which should be estimated through power calculations (a two-sided confidence level of 99.9% and power of 80%).…”

Relation of habitual snoring with components of metabolic syndrome in Korean adults

“…A more recent study on insulin resistance, visceral obesity, and cytokines in obstructive sleep apnea indicated that mean plasma insulin levels were significantly higher than body mass index-matched controls, suggesting that sleep-disordered breathing is an independent risk factor for hyperinsulinemia [21]. Punjabi et al [9] also demonstrated that sleep-disordered breathing was associated with impaired glucose tolerance and insulin resistance independent of obesity in healthy men, without diabetes or cardiopulmonary disease. Our findings demonstrate that habitual snoring was not significantly associated with high fasting glucose adjusting for age, abdominal obesity, and the other components of the metabolic syndrome.…”

“…Several biochemical alterations including low HDL-cholesterol, elevated serum triglycerides, glucose intolerance, and hyperinsulinemia are independently associated with increased risk of cardiovascular diseases [9,18].…”

“…Although previous studies [9,10] have examined the association between habitual snoring and individual components of the metabolic syndrome, relationships are often explained by coexisting obesity. This is an important consideration since obesity is known to be one of the strongest determinants of habitual snoring.…”

Increased arterial stiffness in obstructive sleep apnea: a systematic review

“…8 Although OSA patients commonly demonstrate one or more established cardiovascular risk factors, there is now a considerable body of evidence indicating that OSA itself is an independent cardiovascular risk factor. 3,[9][10][11][12][13][14][15][16] Arterial stiffness determines how quickly the pulse wave generated by the contracting heart travels to the periphery and is reflected back. The larger arteries of the cardiovascular system are critical in the conduction of blood flow to the periphery.…”