Abstract
Type 2 diabetes leads to severe nocturnal hypoxemia, with an increase in apnea events and daytime sleepiness. Hence, we assessed sleep breathing parameters in the prediabetes stage. A cross-sectional study conducted on 966 middle-aged subjects without known pulmonary disease (311 patients with prediabetes and 655 controls with normal glucose metabolism) was conducted. Prediabetes was defined by glycated hemoglobin (HbA1c), and a nonattended overnight home sleep study was performed. Participants with prediabetes (n = 311) displayed a higher apnea–hypopnea index (AHI: 12.7 (6.1;24.3) vs. 9.5 (4.2;19.6) events/h, p < 0.001) and hypopnea index (HI: 8.4 (4.0;14.9) vs. 6.0 (2.7;12.6) events/h, p < 0.001) than controls, without differences in the apnea index. Altogether, the prevalence of obstructive sleep apnea was higher in subjects with prediabetes than in controls (78.1 vs. 69.9%, p = 0.007). Additionally, subjects with prediabetes presented impaired measurements of the median and minimum nocturnal oxygen saturation, the percentage of time spent with oxygen saturations below 90%, and the 4% oxygen desaturation index in comparison with individuals without prediabetes (p < 0.001 for all). After adjusting for age, sex, and the presence of obesity, HbA1c correlated with the HI in the entire population (r = 0.141, p < 0.001), and the presence of prediabetes was independently associated with the AHI (B = 2.20 (0.10 to 4.31), p = 0.040) as well as the HI (B = 1.87 (0.61 to 3.14), p = 0.004) in the multiple linear regression model. We conclude that prediabetes is an independent risk factor for an increased AHI after adjusting for age, sex, and obesity. The enhanced AHI is mainly associated with increments in the hypopnea events.
Highlights
In recent years, there has been growing evidence suggesting that type 2 diabetes can lead to the development of sleep breathing disorders (SBD) [1]
The hypopnea index was greater among participants with prediabetes
The prevalence of obstructive sleep apnea (OSA) was higher among participants with prediabetes than in controls (78.1 vs. 69.9%, p = 0.007)
Summary
There has been growing evidence suggesting that type 2 diabetes can lead to the development of sleep breathing disorders (SBD) [1]. The Sweet Sleep study characterized obstructive sleep apnea (OSA) in patients with type 2 diabetes, providing evidence that the composition of their apnea–hypopnea index (AHI) is characterized by an increase in apnea events, with no differences or even reduction in hypopnea episodes [2]. A small interventional study with 35 patients with type 2 diabetes and OSA has recently shown how the improvement of glycemic control without significant weight loss exerts beneficial effects on sleep breathing parameters [6]. This multifaceted relationship between diabetes milieu and sleep breathing is based on several pathophysiological mechanisms that include insulin resistance, inflammatory and oxidative stress-activated signaling pathways, leptin resistance and abnormalities in the autonomic nervous system [1,7]. A recent analysis of 151,194 participants from three prospective U.S cohorts has showed that individuals with insulin-treated diabetes had
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