Abstract
Background and objectives: Obstructive sleep apnea (OSA) is closely associated with insulin resistance (IR) and is an independent risk factor for incident type 2 diabetes mellitus (T2DM). Most studies evaluate the correlation between OSA and IR in only obese or T2DM patients. Therefore, we tried to investigate the effect of OSA on metabolic syndrome and IR in the general healthy male population. Materials and Methods: 184 subjects who visited a preventive health examination program were recruited for this study. All subjects received overnight polysomnography by a portable device (Watch-PAT 200). We examined several metabolic parameters and a homeostasis model of assessment for insulin resistance index (HOMA-IR). The subjects were divided into three groups by AHI (Apnea-hyponea index): normal group (AHI < 5), mild OSA group (5 ≤ AHI < 15), and moderate-severe OSA group (AHI ≥ 15). They were also divided into two groups according to minimum oxygen saturation: low group, Min-SpO2 < 88%; and high group, Min-SpO2 ≥ 88%. Results: Parameters of metabolic syndrome, including waist circumference, systolic and diastolic blood pressure, triglyceride, and high-density lipoprotein cholesterol showed significant differences among the AHI groups. Furthermore, HOMA-IR showed significant differences among the AHI groups. Those parameters, including metabolic syndrome and HOMA-IR, also showed differences between Min-SpO2 groups. Conclusions: In summary, this study helps confirm that AHI is associated with HOMA-IR in the general male population. Furthermore, the severity of AHI correlated with the parameters of metabolic syndrome. Therefore, AHI might be an indicator for evaluating both T2DM and metabolic syndrome, even in the general male population.
Highlights
The decrease in physical activity associated with daytime sleepiness and sleep deprivation can cause alterations in metabolic system such as insulin resistance (IR), and the increased pro-inflammatory states and cytokine levels may lead to a severe state of IR in patients with Obstructive sleep apnea (OSA) [3,4]
These disruptions can trigger a series of events related to the activation of the sympathetic system, systemic inflammation, and oxidative stress, all of which can be important in increasing the risk of hypertension, metabolic syndrome, and type 2 diabetes mellitus (T2DM) [6]
Likewise with studies of IP et al and Kritikou et al, our results showed that the relationship between OSA and HOMA-IR differed by weight status with significantly higher HOMA-IR only in the non-obese OSA group, implying that OSA affects insulin sensitivity without preexisting metabolic disturbances of obesity [17]
Summary
One proposed molecular mechanism is through the α-subunit of hypoxia-inducible factor 1 (HIF-1α), as the oxygen-sensitive protein has been suggested to be involved in the regulation of metabolic processes and development of IR [5]. These disruptions can trigger a series of events related to the activation of the sympathetic system, systemic inflammation, and oxidative stress, all of which can be important in increasing the risk of hypertension, metabolic syndrome, and type 2 diabetes mellitus (T2DM) [6]. They were divided into two groups according to minimum oxygen saturation: low group, Min-SpO2 < 88%; and high group, Min-SpO2 ≥ 88%
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