Chest
Volume 142, Issue 4, October 2012, Pages 935-942
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Original Research
Sleep Disorders
Sleep Apnea and Glucose Metabolism: A Long-term Follow-up in a Community-Based Sample

https://doi.org/10.1378/chest.11-1844Get rights and content

Background

It has been suggested that sleep-disordered breathing (SDB) is a risk factor for diabetes, but long-term follow-up studies are lacking. The aim of this community-based study was to analyze the influence of SDB on glucose metabolism after > 10 years.

Methods

Men without diabetes (N = 141; mean age, 57.5 years) were investigated at baseline, including whole-night respiratory monitoring. After a mean period of 11 years and 4 months, they were followed up with an interview, anthropometric measurements, and blood sampling. Insulin resistance was quantified using the homeostasis model assessment of insulin resistance (HOMA-IR). ΔHOMA-IR was calculated as (HOMA-IR at follow-up − HOMA-IR at baseline). An oral glucose tolerance test was performed on 113 men to calculate the insulin sensitivity index.

Results

The mean apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) at baseline were 4.7 and 3.3, respectively. At follow-up, 23 men had diabetes. An ODI > 5 was a predictor of developing diabetes (OR, 4.4; 95% CI, 1.1-18.1, after adjusting for age, BMI, and hypertension at baseline and ΔBMI and years with CPAP during follow-up). The ODI was inversely related to the insulin sensitivity index at follow-up (r = −0.27, P = .003). A deterioration in HOMA-IR was significantly related to all variables of SDB (AHI, AHI > 5; ODI, ODI > 5; minimum arterial oxygen saturation), even when adjusting for confounders. When excluding the variable years with CPAP from the multivariate model, all associations weakened.

Conclusions

SDB is independently related to the development of insulin resistance and, thereby, the risk of manifest diabetes mellitus.

Section snippets

Population

From a population-based sample of men who had responded to postal questionnaires in 1984 and 1994, an age-stratified sample of 232 underwent a whole-night sleep recording during 1996 to 1998 in a study of snoring and SDB in individuals with and without hypertension.17 Their mean age was 60.6 years (range, 43-82 years), and one-half were being treated for hypertension. In 2008, 43 of the men had died, and the remaining 189 men were invited to this longitudinal study. In all, 156 (82.5%) agreed

Results

At the follow-up, 23 men (16.3%) fulfilled the criteria for diabetes mellitus. Eleven were taking oral antidiabetic drugs and one in combination with insulin. The characteristics of the participants and differences between those with and without incident diabetes are presented in Table 1. The men who had developed diabetes were of a similar age and had similar smoking habits to the remaining participants but generally were more obese and more often had hypertension. The groups did not

Discussion

The results of this follow-up study demonstrate that SDB has negative effects on glucose metabolism and insulin sensitivity. At follow-up after > 11 years, all the analyzed variables of SDB were significant, independent predictors of a low ISI and of impairment in insulin sensitivity. SDB reached borderline significance for the development of manifest diabetes.

Cross-sectional studies have clearly shown a link between SDB and abnormal glucose metabolism,3, 4, 5, 6, 7, 8, 9 but the evidence

Acknowledgments

Author contributions: Dr Lindberg had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Lindberg: contributed to the study concept and design; data acquisition, analysis, and interpretation; drafting and revision of the manuscript; and review and approval of the final manuscript.

Dr Theorell-Haglöw: contributed to the study concept and design, data acquisition and interpretation, drafting and revision of

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    Funding/Support: The study was funded by the Swedish Heart Lung Foundation and the Uppsala County Association against Heart and Lung Diseases.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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