Abstract
BackgroundThe association of obstructive sleep apnea (OSA) with glucose intolerance and the beneficial effect of lifestyle intervention have been poorly investigated in women particularly before menopausal status. The study explored 1) whether OSA is associated with impaired glucose homeostasis in obese non diabetic premenopausal and menopausal women and 2) the effects of a 3- month lifestyle intervention on glucose homeostasis in OSA women.Design and MethodsWe consecutively recruited 98 obese women (39 premenopausal) from those referred for a weight loss intervention. Ambulatory nocturnal polysomnography, body composition, oral glucose tolerance test, insulin sensitivity and β cell function were assessed before and after intervention.Results41% of premenopausal and 64% of menopausal women had OSA which was associated with worse glucose homeostasis before menopausal status. Mean and minimal nocturnal oxygen saturation (SaO2) was associated with neck/height ratio (NHR), independently of total and central obesity. Mean and minimal nocturnal SaO2 and NHR were correlated with insulin sensitivity and fasting glucose. In multivariate analyses, nocturnal mean SaO2 was negatively and independently correlated with fasting glucose (p<0.0001) and NHR with insulin sensitivity (p<0.0001). In OSA women, the intervention induced a 5% weight reduction and a significant increase in minimal nocturnal SaO2, insulin sensitivity and β cell function. Changes in fasting glucose and insulin sensitivity were associated with those in minimal nocturnal SaO2 (p<0.05) and not with weight loss.ConclusionsIn obese women, glucose homeostasis worsens due to nocturnal hypoxia and increased neck circumference through mechanisms partially independent of obesity. OSA is more clearly associated with glucose intolerance in premenopausal than in menopausal women. In OSA women, the improvement of nocturnal hypoxia induced by lifestyle modifications is associated with that of glucose homeostasis.
Highlights
Obstructive sleep apnea (OSA) is a serious widespread disease in which upper airways undergo repeated occlusions and arterial oxygen saturation (SaO2) repeatedly falls during sleep
OSA is more clearly associated with glucose intolerance in premenopausal than in menopausal women
In OSA women, the improvement of nocturnal hypoxia induced by lifestyle modifications is associated with that of glucose homeostasis
Summary
Obstructive sleep apnea (OSA) is a serious widespread disease in which upper airways undergo repeated occlusions and arterial oxygen saturation (SaO2) repeatedly falls during sleep. OSA is a risk factor for cardiovascular disease and type 2 diabetes [2,3] All these diseases are predicted by weight gain [4], but whether the association of OSA with diabetes is due to the coexisting obesity, this remains to be determined [3]. In type 2 diabetic patients with OSA who underwent lifestyle intervention, changes in glucose control were determined by changes in weight rather than in AHI [8] and the beneficial effects of CPAP treatment on glucose tolerance are controversial [3]. The association of obstructive sleep apnea (OSA) with glucose intolerance and the beneficial effect of lifestyle intervention have been poorly investigated in women before menopausal status. The study explored 1) whether OSA is associated with impaired glucose homeostasis in obese non diabetic premenopausal and menopausal women and 2) the effects of a 3- month lifestyle intervention on glucose homeostasis in OSA women
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