Body Fat Indices as Effective Predictors of Insulin Resistance in Obstructive Sleep Apnea: Evidence from a Cross-Sectional and Longitudinal Study

Abstract Introduction Both short sleep duration and obstructive sleep apnea (OSA) seem to be associated with insulin resistance. However, the majority of previous studies addressing the relationship between OSA and insulin resistance did not evaluate short sleep duration, and vice versa. In this study, we used a large-scale hospital-based cross-sectional dataset, including 5,447 participants, to examine 1) whether objectively measured short sleep duration and OSA are independently associated with insulin resistance, and 2) whether the presence of OSA modulates the association between sleep duration and insulin resistance. Methods Participants were consecutively enrolled from our sleep center during the period from 2007 to 2017. The index of homeostasis model assessment insulin resistance (HOMA-IR) was calculated from insulin and glucose. Sleep duration was determined by standard polysomnography. The associations between sleep duration and insulin resistance were estimated by logistic regression analyses. Results A total of 5,447 participants (4507 OSA and 940 primary snorers) were included in the study. In comparison to primary snorers, OSA combined with extremely short sleep duration (< 5 hours) increased the risk of insulin resistance by 34% (OR, 1.34; 95% CI, 1.01-1.77) after adjusting for confounding factors that are frequently associated with insulin resistance and OSA. In subgroup analysis stratified by sleep duration, the risk of insulin resistance in patients with a short sleep duration (5-6 hours or < 5 hours) was increased in those with OSA compared to primary snorers, but not in the other three sleep duration groups (6 - 7, 7 - 8, and > 8 hours). Conclusion OSA, but not short sleep duration, was independently associated with insulin resistance. It is worth noting that OSA combined with extremely short sleep duration showed a greater detrimental effect than OSA itself with regard to insulin resistance. Support This study was supported by grants-in-aid from Shanghai Municipal Commission of Science and Technology (Grant No.18DZ2260200).

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Effect of the Interaction between Obstructive Sleep Apnea and Lipoprotein(a) on Insulin Resistance: A Large-Scale Cross-Sectional Study

Journal of Diabetes Research ◽

10.1155/2019/9583286 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Yupu Liu ◽

Juanjuan Zou ◽

Xinyi Li ◽

Xiaolong Zhao ◽

Jianyin Zou ◽

...

Keyword(s):

Insulin Resistance ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cross Sectional Study ◽

Model Assessment ◽

Sectional Study ◽

Positive Interaction ◽

Cross Sectional ◽

Lipoprotein A ◽

Obstructive Sleep

Both obstructive sleep apnea (OSA) and decreased serum lipoprotein(a) (Lp(a)) concentrations are associated with insulin resistance. However, their interaction effect on insulin resistance has never been investigated. Therefore, we performed a cross-sectional study on OSA-suspected Chinese Han participants. Laboratory-based polysomnographic variables, biochemical indicators, anthropometric measurements, and medical history were collected. Linear regression and binary logistic regression analyses with interaction terms were used to investigate the potential effects of the interaction between the severity of OSA (assessed by the apnea-hypopnea index (AHI)) and Lp(a) concentrations on insulin resistance (assessed by the homeostasis model assessment of insulin resistance (HOMA-IR)), after adjusting for potential confounders including age, gender, body mass index, waist-to-hip circumference ratio, mean arterial pressure, smoking status, drinking status, and lipid profiles. A total of 4,152 participants were enrolled. In the OSA-suspected population, AHI positively correlated with insulin resistance and serum Lp(a) concentrations independently and inversely correlated with insulin resistance. In addition, the interaction analysis showed that the linear association between lgAHI and lgHOMA-IR was much steeper and more significant in subjects with relatively low Lp(a) concentrations, suggesting a significant positive interaction between lgLp(a) and lgAHI on lgHOMA-IR (P=0.013). Furthermore, the interaction on a multiplicative scale also demonstrated a significant positive interaction (P=0.044). A stronger association between AHI quartiles and the presence of insulin resistance (defined as HOMA-IR > 3) could be observed for participants within lower Lp(a) quartiles. In conclusion, a significant positive interaction was observed between OSA and decreased Lp(a) with respect to insulin resistance. This association might be relevant to the assessment of metabolic or cardiovascular disease risk in OSA patients.

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Insulin resistance using HOMA model in obstructive sleep apnea: a cross sectional study

Annals of Saudi Medicine ◽

10.5144/0256-4947.2014.476 ◽

2014 ◽

Vol 34 (6) ◽

pp. 476-481 ◽

Cited By ~ 1

Author(s):

Mawaddah Azman ◽

Abdullah Sani ◽

Nor Azmi Kamaruddin

Keyword(s):

Insulin Resistance ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Obstructive Sleep

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Inverse Cross-sectional and Longitudinal Relationships between Diabetic Retinopathy and Obstructive Sleep Apnea in Type 2 Diabetes

Ophthalmology Science ◽

10.1016/j.xops.2021.100011 ◽

2021 ◽

Vol 1 (1) ◽

pp. 100011

Author(s):

Jakob Grauslund ◽

Lonny Stokholm ◽

Anne S. Thykjær ◽

Sören Möller ◽

Caroline S. Laugesen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Obstructive Sleep Apnea ◽

Diabetic Retinopathy ◽

Sleep Apnea ◽

Cross Sectional ◽

Obstructive Sleep ◽

Longitudinal Relationships

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Obstructive Sleep Apnea as a Risk Factor of Insulin Resistance in Nondiabetic Adults

Life ◽

10.3390/life11010050 ◽

2021 ◽

Vol 11 (1) ◽

pp. 50

Author(s):

Monika Michalek-Zrabkowska ◽

Piotr Macek ◽

Helena Martynowicz ◽

Pawel Gac ◽

Grzegorz Mazur ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Obstructive Sleep Apnea ◽

Risk Factor ◽

Sleep Apnea ◽

Glucose Concentration ◽

Insulin Concentration ◽

Fasting Insulin ◽

Sleep Habits ◽

Obstructive Sleep

Objective: The aim of this research was to assess the relationship between prevalence and severity of obstructive sleep apnea (OSA) and insulin resistance among patients with increased risk of OSA without diabetes mellitus. Method and materials: our study group involved 102 individuals with suspected OSA, mean age 53.02 ± 12.37 years. Data on medical history, medication usage, sleep habits, sleep quality and daytime sleepiness, were obtained using questionnaires. All patients underwent standardized full night polysomnography. Serum fasting insulin and glucose concentration were analyzed, the homeostatic model assessment-insulin resistance (HOMA-IR) index was calculated. Results: polysomnographic study indicated that in the group with OSA mean values of apnea–hypopnea index (AHI), oxygen desaturation index (ODI), duration of SpO2 < 90% and average desaturation drop were significantly higher compared to the group without OSA, while the minimum SpO2 was significantly lower. The carbohydrate metabolism parameters did not differ within those groups. Significantly higher fasting insulin concentration and HOMA-IR index were found in the group with AHI ≥ 15 compared to the group with AHI < 15 and in the group with AHI ≥ 30 compared to the group with AHI < 30. Higher AHI and ODI were independent risk factors for higher fasting insulin concentration and higher HOMA-IR index. Increased duration of SpO2 < 90% was an independent risk factor for higher fasting glucose concentration. Conclusions: Individuals with moderate to severe OSA without diabetes mellitus had a higher prevalence of insulin resistance.

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Stress in obstructive sleep apnea

Scientific Reports ◽

10.1038/s41598-021-91996-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jasmine L. Wong ◽

Fernando Martinez ◽

Andrea P. Aguila ◽

Amrita Pal ◽

Ravi S. Aysola ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Depressive Symptoms ◽

Sleep Apnea ◽

Perceived Stress ◽

Stress Reduction ◽

Psychological Symptoms ◽

Cross Sectional Study ◽

Cross Sectional ◽

General Anxiety Disorder ◽

Obstructive Sleep

AbstractPeople with obstructive sleep apnea (OSA) often have psychological symptoms including depression and anxiety, which are commonly treated with anti-depression or anti-anxiety interventions. Psychological stress is a related symptom with different intervention targets that may also improve mental state, but this symptom is not well characterized in OSA. We therefore aimed to describe stress in relation to other psychological symptoms. We performed a prospective cross-sectional study of 103 people, 44 untreated OSA (mean ± s.d. age: 51.2 ± 13.9 years, female/male 13/31) and 57 healthy control participants (age: 46.3 ± 13.8 years, female/male 34/23). We measured stress (Perceived Stress Scale; PSS), excessive daytime sleepiness (Epworth Sleepiness Scale; ESS), depressive symptoms (Patient Health Questionnaire; PHQ-9), and anxiety symptoms (General Anxiety Disorder; GAD-7). We compared group means with independent samples t-tests and calculated correlations between variables. Mean symptom levels were higher in OSA than control, including PSS (mean ± s.d.: OSA = 15.3 ± 6.9, control = 11.4 ± 5.5; P = 0.002), GAD-7 (OSA = 4.8 ± 5.0, control = 2.1 ± 3.9; P = 0.02), PHQ-9 (OSA = 6.9 ± 6.1, control = 2.6 ± 3.8; P = 0.003) and ESS (OSA = 8.1 ± 5.3, control = 5.0 ± 3.3; P = 0.03). Similar OSA-vs-control differences appeared in males, but females only showed significant differences in PHQ-9 and ESS, not PSS or GAD-7. PSS correlated strongly with GAD-7 and PHQ-9 across groups (R = 0.62–0.89), and moderately with ESS. Perceived stress is high in OSA, and closely related to anxiety and depressive symptoms. The findings support testing stress reduction in OSA.

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