Abstract
The aim of the study was to assess potential associations between obstructive sleep apnea (OSA) and the occurrence of diabetes mellitus and insulin resistance in the elderly. Nondiabetic volunteers (n = 549) with undiagnosed or untreated asymptomatic OSA (66.2+/−1 years at the inclusion) were evaluated as an ancillary study of the PROOF cohort study (n = 1,011). After 7 years follow-up, 494 subjects underwent assessment of fasting insulin and glucose levels. OSA was defined by an apnea-hypopnea index (AHI) of ≥15/h using polygraphy. Diabetes mellitus was defined by a fasting glucose ≥ 1.26 g/L and/or when requiring pharmacological treatment, while insulin resistance corresponded to HOMA-IR ≥ 2. Asymptomatic OSA subjects (men or women) did not display increased risk of incident diabetes (2.8 vs. 3.9%, p = 0.51). However, there was a greater frequency of insulin resistance in subjects with severe OSA (AHI > 30) [OR 2.21; 95% CI (1.22–4.02); p = 0.009]. Furthermore, multiple logistic regression showed that triglycerides levels [OR 1.61; 95% CI (1.10–2.36); p = 0.01] and fasting glycaemia [OR 4.69; 95% CI (1.12–192.78); p = 0.04], but not AHI or oxyhemoglobin desaturation index were independently associated with higher rate of insulin resistance. The deleterious metabolic effect of asymptomatic OSA in the population may be indirectly mediated via perturbations in lipids, and is particularly likely to become manifest in severe apneic subjects with higher glycemic levels.
Highlights
Obstructive sleep apnea (OSA) and type 2 diabetes (T2DM), are two chronic conditions that are increasingly prevalent worldwide, affecting the elderly population
Polygraphic assessments revealed the presence of moderate OSA in 34.5%, and 100 subjects met the criteria for severe OSA (18.2%) (Table 1)
Of the 549 subjects free of T2DM at entry and evaluated at the fourth visit, we found a 4% incidence of T2DM in the severe OSA group and only 2.1% in the moderate OSA group when compared to 3.9% (i.e., 10 subjects) in the non-apneic control group (p = 0.51)
Summary
Obstructive sleep apnea (OSA) and type 2 diabetes (T2DM), are two chronic conditions that are increasingly prevalent worldwide, affecting the elderly population. Epidemiological studies have reported a high prevalence of T2DM between 65 and years of age (estimated at 18%), but followed by a decrease in those individual older than years (estimated at 5.5%) (Narayan et al, 2006) Both OSA and T2DM exhibit increased risk of several cardiovascular disease (CVD) and complications, albeit via different pathophysiological mechanisms. Each of these two pathological entities may be a consequence of the other, and their cross-prevalence is very high with the prevalence of OSA in type 2 diabetics reaching 18%, and 15–30% of OSA patients suffering from T2DM Both diseases have common risk factors such as age, male gender, high body mass index (BMI), and genetic predisposition, with likely common underlying pathophysiological processes accounting for this link. Several reviews have been carried out and focused on the reciprocal interactions between OSA syndrome and type 2 diabetes (Pamidi and Tasali, 2012)
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