Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study
Abstract
Clinic-based studies suggest that sleep-disordered breathing (SDB) is associated with glucose intolerance and insulin resistance. However, in the available studies, researchers have not rigorously controlled for confounding variables to assess the independent relation between SDB and impaired glucose metabolism. The objective of this study was to determine whether SDB was associated with glucose intolerance and insulin resistance among community-dwelling subjects (n=2,656) participating in the Sleep Heart Health Study (1994-1999). SDB was characterized with the respiratory disturbance index and measurements of oxygen saturation during sleep. Fasting and 2-hour glucose levels measured during an oral glucose tolerance test were used to assess glycemic status. Relative to subjects with a respiratory disturbance index of less than 5.0 events/hour (the reference category), subjects with mild SDB (5.0-14.9 events/hour) and moderate to severe SDB (> or =15 events/hour) had adjusted odds ratios of 1.27 (95% confidence interval: 0.98, 1.64) and 1.46 (95% confidence interval: 1.09, 1.97), respectively, for fasting glucose intolerance (p for trend < 0.01). Sleep-related hypoxemia was also associated with glucose intolerance independently of age, gender, body mass index, and waist circumference. The results of this study suggest that SDB is independently associated with glucose intolerance and insulin resistance and may lead to type 2 diabetes mellitus.
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Insulin resistance has been reported in sleep apnea.
“insulin resistance has been reported in two very different models of disrupted sleep: sleep apnea (23) and experimental disruption of slow-wave sleep (24).”
From Sleep Restriction for 1 Week Reduces Insulin Sensitivity in Healthy Men (2010) · cites this paper as [23]
Obstructive sleep apnea is a highly prevalent syndrome associated with substantial morbidity and increased mortality.
“OBSTRUCTIVE SLEEP APNEA (OSA) IS A HIGHLY PREV-ALENT SYNDROME THAT IS ASSOCIATED WITH SUB-STANTIAL MORBIDITY AND INCREASED MORTALITY. 1-10”
Insulin sensitivity is the parameter most consistently improved by CPAP.
“The parameter most consistently found to be positively impacted by CPAP is SI, which is interesting since OSA has been found to be independently associated with insulin resistance [77, 131].”
From Sleep and metabolic function (2012) · cites this paper as [131]
Obstructive sleep apnea appears to be highly prevalent in patients with type 2 diabetes and is associated with poorer glycemic control.
“which appears to be highly prevalent in patients with type 2 diabetes (23) and is associated with poorer glycemic control (24).”
From Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes (2011) · cites this paper as [24]
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- Authors
- Punjabi, N. M.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Punjabi, N. M.
- ORCID
- Punjabi, N. M.
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-09-15
- Volume
- 160
- Issue
- 6
- Pages
- 521-530
- ISSN
- 0002-9262 (ISSN-L)
- OpenAlex
- W2105727933
- Cited by
- 1,107
- References
- 65
- Citations by year
- 2026: 19 · 2025: 26 · 2024: 31 · 2023: 35 · 2022: 32 · 2021: 37 · 2020: 39 · 2019: 43 · 2018: 68 · 2017: 47 · 2016: 71 · 2015: 65 · 2014: 61 · 2013: 74 · 2012: 77
- FWCI
- 25.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health and Human Services
- National Institutes of Health (5u01hl053940-05, 5u01hl053934-14)
- National Heart, Lung, and Blood Institute (U01 HL 53940, U01HL053941, R01HL075078, UO1HL63463, U01HL053938, UO1HL53937, U01HL053937, UO1HL53934, U01 HL 53941, U01HL053931, U01HL053916, UO1HL63429, UO1HL53938, HL075078, U01HL063463, UO1-HL53916, UO1HL53931, U01HL063429)
- 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
- sleep-disordered breathing, impaired glucose tolerance, insulin resistance, sleep-related hypoxemia, respiratory disturbance index, type 2 diabetes, impaired glucose metabolism, community-dwelling adults, Sleep Heart Health Study
- MeSH terms
- Aged, Blood Gas Analysis, Body Constitution, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Fasting, Female, Glucose Tolerance Test, Humans, Insulin Resistance, Male, Middle Aged, Oxyhemoglobins, Research Design, Risk Factors, Severity of Illness Index, Sleep Apnea Syndromes, Cohort Studies, Confounding Factors, Epidemiologic, Body Mass Index, Multivariate Analysis, Linear Models, Polysomnography, Glucose Intolerance
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