Risk for obstructive sleep apnea in obese, nondiabetic adults varies with insulin resistance status
Open accessAbstract
Purpose Obstructive sleep apnea (OSA) is an increasingly common sleep disorder, especially among obese adults. Early identification of adults at risk for OSA would be of substantial benefit; however, the magnitude of the obesity epidemic requires that screening be performed judiciously. The study's aim was to utilize questionnaires that assess OSA risk and symptoms to test the hypothesis that the most insulin-resistant subset of obese individuals is at highest risk for OSA.Methods Nondiabetic, overweight to obese volunteers underwent direct quantification of insulin sensitivity by measuring steady-state plasma glucose concentrations during the insulin suppression test. Insulin-sensitive and insulin-resistant individuals were administered the Berlin and STOP questionnaires to determine OSA risk status, and Epworth Sleepiness Scale (ESS) to evaluate daytime sleepiness. Fasting insulin and lipid/lipoprotein measurements were performed.Results Insulin-mediated glucose disposal differed threefold (p < 0.001) between equally obese, insulin-resistant (n = 22) and insulin-sensitive (n = 14) individuals, associated with higher fasting insulin and triglyceride and lower high-density lipoprotein cholesterol (HDL-C) concentrations in insulin-resistant individuals. Fourteen (64 %) insulin-resistant as compared with 2 (14 %) insulin-sensitive individuals were found to be at high risk for OSA by both questionnaires (p < 0.01). Whereas half of insulin-resistant individuals met the ESS criteria for excessive daytime sleepiness, only one insulin-sensitive individual did (p = 0.011).Conclusions High risk for OSA and excessive daytime sleepiness is prevalent among the insulin-resistant subgroup of obese individuals. Surrogate estimates of insulin resistance based on fasting insulin, triglycerides, and/or HDL-C can be used to help identify those obese adults who would benefit most from OSA screening and referral for polysomnography.
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The preponderance of self-reported evidence suggests a curvilinear relationship between habitual sleep duration and various medical conditions such that both short and long sleep duration are associated with obesity, hypertension, and diabetes mellitus.
“The preponderance of evidence emanating from self-reported data suggests a curvilinear relationship between habitual sleep duration and various medical conditions (eg, obesity, hypertension, and diabetes mellitus) such that both short sleep duration (SSD) and long sleep duration are associated with those conditions.”
From Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association (2016) · cites this paper as [17]
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- Authors
- Liu, A., Kushida, C. A., & Reaven, G. M.
- Affiliations
- Stanford Medicine (US)
- Corresponding author
- Liu, Alice
- Venue
- Sleep and Breathing
- Published
- 2012-04-07
- Volume
- 17
- Issue
- 1
- Pages
- 333-338
- ISSN
- 1520-9512 (ISSN-L)
- 1522-1709
- PMC
- PMC3654654
- OpenAlex
- W2169025338
- Cited by
- 8
- References
- 31
- Citations by year
- 2016: 1 · 2015: 2 · 2014: 1 · 2013: 3 · 2012: 1
- FWCI
- 1.50
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Sleep And Breathing (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (U01HL108647)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK071309, F32DK079578, K23DK088877, P30DK020579)
- National Center for Research Resources (M-01 RR 00070, M01RR000070)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- obstructive sleep apnea, insulin resistance, obesity, non-diabetic adults, OSA screening, Berlin questionnaire, STOP questionnaire, Epworth Sleepiness Scale, excessive daytime sleepiness, insulin suppression test, fasting insulin, triglycerides, HDL cholesterol, insulin sensitivity
- MeSH terms
- Adult, Aged, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Humans, Disorders of Excessive Somnolence, Insulin, Insulin Resistance, Cholesterol, HDL, Male, Middle Aged, Obesity, Surveys and Questionnaires, Risk Factors, San Francisco, Triglycerides, Comorbidity, Incidence, Sleep Apnea, Obstructive
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