Sleep-disordered breathing, glucose intolerance, and insulin resistance: The Sleep Heart Health Study

Clinic-based studies suggest that sleep-disordered breathing (SDB) is associated with glucose intolerance and insulin resistance. However, in the available studies, researchers have not rigorously controlled for confounding variables to assess the independent relation between SDB and impaired glucos...

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Bibliographic Details
Published in:	American journal of epidemiology Vol. 160; no. 6; pp. 521 - 530
Main Authors:	PUNJABI, Naresh M, SHAHAR, Eyal, REDLLNE, Susan, GONLLEB, Daniel J, GLVELBE, Rachel, RESNICK, Helalne E
Format:	Journal Article
Language:	English
Published:	Cary, NC Oxford University Press 15-09-2004 Oxford Publishing Limited (England)
Subjects:	Aged Analysis. Health state Biological and medical sciences Blood Gas Analysis Body Constitution Body Mass Index Cohort Studies Confounding Factors (Epidemiology) Cross-Sectional Studies Diabetes Mellitus, Type 2 - etiology Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes Epidemiology Fasting Female General aspects Glucose Glucose Intolerance - diagnosis Glucose Intolerance - etiology Glucose Intolerance - metabolism Glucose Tolerance Test Humans Insulin Insulin resistance Insulin Resistance - physiology Linear Models Male Medical sciences Middle Aged Multivariate Analysis Nervous system (semeiology, syndromes) Neurology Oxyhemoglobins - metabolism Pneumology Polysomnography Public health. Hygiene Public health. Hygiene-occupational medicine Research Design - standards Respiratory system Respiratory system : syndromes and miscellaneous diseases Risk Factors Severity of Illness Index Sleep Apnea Syndromes - complications Sleep Apnea Syndromes - diagnosis Sleep disorders Endocrinopathy Heart Human Pancreatic hormone Nervous system diseases Sleep apnea syndrome type II; glucose intolerance; insulin resistance; respiration; sleep; sleep apnea syndromes Respiratory disease Diabetes mellitus Sleep disorder Glucose Insulin Target tissue resistance Sleep Circulatory system Sleep wake cycle Neurological disorder Respiration Impaired glucose tolerance Public health
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Summary:	Clinic-based studies suggest that sleep-disordered breathing (SDB) is associated with glucose intolerance and insulin resistance. However, in the available studies, researchers have not rigorously controlled for confounding variables to assess the independent relation between SDB and impaired glucose metabolism. The objective of this study was to determine whether SDB was associated with glucose intolerance and insulin resistance among community-dwelling subjects (n=2,656) participating in the Sleep Heart Health Study (1994-1999). SDB was characterized with the respiratory disturbance index and measurements of oxygen saturation during sleep. Fasting and 2-hour glucose levels measured during an oral glucose tolerance test were used to assess glycemic status. Relative to subjects with a respiratory disturbance index of less than 5.0 events/hour (the reference category), subjects with mild SDB (5.0-14.9 events/hour) and moderate to severe SDB (> or =15 events/hour) had adjusted odds ratios of 1.27 (95% confidence interval: 0.98, 1.64) and 1.46 (95% confidence interval: 1.09, 1.97), respectively, for fasting glucose intolerance (p for trend < 0.01). Sleep-related hypoxemia was also associated with glucose intolerance independently of age, gender, body mass index, and waist circumference. The results of this study suggest that SDB is independently associated with glucose intolerance and insulin resistance and may lead to type 2 diabetes mellitus.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9262 1476-6256 0002-9262
DOI:	10.1093/aje/kwh261