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Morning cortisol levels and glucose metabolism parameters in moderate and severe obstructive sleep apnea patients

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Abstract

Obstructive sleep apnea (OSA) has been associated with dysregulation of the hypothalamic–pituitary–adrenal axis and alterations in glucose metabolism with increased risk for type 2 diabetes. The aim of the current study was to compare morning plasma cortisol levels and glucose metabolism parameters between moderate (apnea–hypopnea index (AHI): 15–30 events/h) and severe OSA patients (AHI >30 events/h), with respective controls. A total of 56 male OSA patients, 24 moderate (AHI = 21.1 ± 5.3) and 32 severe (AHI = 49.7 ± 18.1), underwent a full-night polysomnography, oral glucose tolerance test (OGTT), and measurement of morning plasma cortisol levels. These groups were compared to 20 matched subjects in a control group. Morning plasma cortisol levels were statistically lower in severe OSA group than in moderate OSA and control groups (303.7 ± 93.5 vs. 423.9 ± 145.1 vs. 417.5 ± 99.8 pmol/L, P < 0.001). Significant negative correlations were found between morning plasma cortisol levels and AHI (r = −0.444, P = 0.002), as well as oxygen desaturation index (r = −0.381, P = 0.011). Fasting plasma glucose (5.0 ± 0.5 vs. 5.4 ± 0.7 vs. 4.9 ± 0.6 mmol/L, P = 0.009) was higher in the severe OSA group compared to moderate OSA and controls. Homeostasis model assessment insulin resistance (HOMA-IR) was higher in the severe OSA group compared to moderate OSA and controls (4.6 ± 3.7 vs. 2.7 ± 2.0 and 2.2 ± 1.8, respectively, P = 0.006). In conclusion, our study showed that morning plasma cortisol levels measured at 8 a.m. were significantly lower in severe OSA patients than those in moderate OSA group and controls. Morning plasma cortisol levels showed a negative correlation with AHI and oxygen desaturation index. Additionally, this study confirmed the evidence of glucose metabolism impairment in moderate and severe OSA patients, with more pronounced effect in the severe OSA patients group.

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Funding

This work was funded by the Croatian Science Foundation Grant #2013-11-5935. This study was performed at the University of Split School of Medicine, Split, Croatia. The funding sources did not have any involvement in study design, writing of the manuscript, and the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, Split, Croatia

    Josko Bozic & Tina Ticinovic Kurir

  2. Study of Dental Medicine, University of Split School of Medicine, Soltanska 2, Split, Croatia

    Tea Galic

  3. Department of Medical Laboratory Diagnostics, University Hospital Split, Spinciceva 1, Split, Croatia

    Daniela Supe-Domic

  4. Split Sleep Medicine Center, University of Split School of Medicine, Soltanska 2, Split, Croatia

    Natalija Ivkovic & Zoran Dogas

  5. Department of Physiology, University of Split School of Medicine, Soltanska 2, Split, Croatia

    Zoran Valic

  6. Departments of Anatomy and Neuroscience, University of Mostar School of Medicine, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina

    Josip Lesko

  7. Department of Neuroscience, University of Split School of Medicine, Soltanska 2, Split, 21000, Croatia

    Zoran Dogas

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  1. Josko Bozic
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Correspondence to Zoran Dogas.

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Bozic, J., Galic, T., Supe-Domic, D. et al. Morning cortisol levels and glucose metabolism parameters in moderate and severe obstructive sleep apnea patients. Endocrine 53, 730–739 (2016). https://doi.org/10.1007/s12020-016-0925-6

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  • DOI: https://doi.org/10.1007/s12020-016-0925-6

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