Abstract
Purpose
Obstructive sleep apnea (OSA) is an increasingly common sleep disorder, especially among obese adults. Early identification of adults at risk for OSA would be of substantial benefit; however, the magnitude of the obesity epidemic requires that screening be performed judiciously. The study’s aim was to utilize questionnaires that assess OSA risk and symptoms to test the hypothesis that the most insulin-resistant subset of obese individuals is at highest risk for OSA.
Methods
Nondiabetic, overweight to obese volunteers underwent direct quantification of insulin sensitivity by measuring steady-state plasma glucose concentrations during the insulin suppression test. Insulin-sensitive and insulin-resistant individuals were administered the Berlin and STOP questionnaires to determine OSA risk status, and Epworth Sleepiness Scale (ESS) to evaluate daytime sleepiness. Fasting insulin and lipid/lipoprotein measurements were performed.
Results
Insulin-mediated glucose disposal differed threefold (p < 0.001) between equally obese, insulin-resistant (n = 22) and insulin-sensitive (n = 14) individuals, associated with higher fasting insulin and triglyceride and lower high-density lipoprotein cholesterol (HDL-C) concentrations in insulin-resistant individuals. Fourteen (64 %) insulin-resistant as compared with 2 (14 %) insulin-sensitive individuals were found to be at high risk for OSA by both questionnaires (p < 0.01). Whereas half of insulin-resistant individuals met the ESS criteria for excessive daytime sleepiness, only one insulin-sensitive individual did (p = 0.011).
Conclusions
High risk for OSA and excessive daytime sleepiness is prevalent among the insulin-resistant subgroup of obese individuals. Surrogate estimates of insulin resistance based on fasting insulin, triglycerides, and/or HDL-C can be used to help identify those obese adults who would benefit most from OSA screening and referral for polysomnography.
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References
Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303(3):235–241
Hiestand DM, Britz P, Goldman M, Phillips B (2006) Prevalence of symptoms and risk of sleep apnea in the US population: results from the national sleep foundation sleep in America 2005 poll. Chest 130(3):780–786
Kapsimalis F, Kryger M (2009) Sleep breathing disorders in the U.S. female population. J Womens Health (Larchmt) 18(8):1211–1219
Shamsuzzaman AS, Gersh BJ, Somers VK (2003) Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 290(14):1906–1914
Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353(19):2034–2041
Reaven GM (2008) Insulin resistance: the link between obesity and cardiovascular disease. Endocrinol Metab Clin North Am 37(3):581–601, vii-viii
Tasali E, Mokhlesi B, Van Cauter E (2008) Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest 133(2):496–506
Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM (2008) STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 108(5):812–821
Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491
Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545
American Diabetes Association (2011) Diagnosis and classification of diabetes mellitus. Diabetes Care 34(Suppl 1):S62–S69
Pei D, Jones C, Bhargava R, Chen Y, Reaven G (1994) Evaluation of octreotide to assess insulin-mediated glucose disposal by the insulin suppression test. Diabetologia 37(8):843–845
Greenfield MS, Doberne L, Kraemer F, Tobey T, Reaven G (1981) Assessment of insulin resistance with the insulin suppression test and the euglycemic clamp. Diabetes 30(5):387–392
Shen SW, Reaven GM, Farquhar JW (1970) Comparison of impedance to insulin-mediated glucose uptake in normal subjects and in subjects with latent diabetes. J Clin Invest 49(12):2151–2160
Yeni-Komshian H, Carantoni M, Abbasi F, Reaven GM (2000) Relationship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy nondiabetic volunteers. Diabetes Care 23(2):171–175
Facchini FS, Hua N, Abbasi F, Reaven GM (2001) Insulin resistance as a predictor of age-related diseases. J Clin Endocrinol Metab 86(8):3574–3578
Yip J, Facchini FS, Reaven GM (1998) Resistance to insulin-mediated glucose disposal as a predictor of cardiovascular disease. J Clin Endocrinol Metab 83(8):2773–2776
McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G (2003) Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med 139(10):802–809
Anonymous (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22(5):667–689
Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL (2002) Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 165(5):677–682
Seicean S, Kirchner HL, Gottlieb DJ, Punjabi NM, Resnick H, Sanders M, Budhiraja R, Singer M, Redline S (2008) Sleep-disordered breathing and impaired glucose metabolism in normal-weight and overweight/obese individuals: the Sleep Heart Health Study. Diabetes Care 31(5):1001–1006
Vgontzas AN (2008) Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance? Arch Physiol Biochem 114(4):211–223
Balkau B, Vol S, Loko S, Andriamboavonjy T, Lantieri O, Gusto G, Meslier N, Racineux JL, Tichet J (2010) High baseline insulin levels associated with 6-year incident observed sleep apnea. Diabetes Care 33(5):1044–1049
Ronksley PE, Hemmelgarn BR, Heitman SJ, Hanly PJ, Faris PD, Quan H, Tsai WH (2009) Obstructive sleep apnoea is associated with diabetes in sleepy subjects. Thorax 64(10):834–839
Barcelo A, Barbe F, de la Pena M, Martinez P, Soriano JB, Pierola J, Agusti AG (2008) Insulin resistance and daytime sleepiness in patients with sleep apnoea. Thorax 63(11):946–950
Nena E, Steiropoulos P, Papanas N, Tsara V, Fitili C, Froudarakis ME, Maltezos E, Bouros D (2012) Sleepiness as a marker of glucose deregulation in obstructive sleep apnea. Sleep Breath 16(1):181–186
Robinson GV, Smith DM, Langford BA, Davies RJ, Stradling JR (2006) Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J 27(6):1229–1235
Li C, Ford ES, Meng YX, Mokdad AH, Reaven GM (2008) Does the association of the triglyceride to high-density lipoprotein cholesterol ratio with fasting serum insulin differ by race/ethnicity? Cardiovasc Diabetol 7:4
Acknowledgments
This research was funded by National Institutes of Health grants 5F32 DK079578, 5K23 DK088877, and 1U01 HL108647, and supported by Human Health Service grant M01-RR00070.
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The authors declare that they have no conflict of interest.
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Liu, A., Kushida, C.A. & Reaven, G.M. Risk for obstructive sleep apnea in obese, nondiabetic adults varies with insulin resistance status. Sleep Breath 17, 333–338 (2013). https://doi.org/10.1007/s11325-012-0696-0
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DOI: https://doi.org/10.1007/s11325-012-0696-0