Obstructive Sleep Apnea, Glucose Tolerance, and β-Cell Function in Adults With Prediabetes or Untreated Type 2 Diabetes in the Restoring Insulin Secretion (RISE) Study

• Published in: Diabetes care Vol. 44; no. 4; pp. 993 - 1001
• Main Authors: Mokhlesi, Babak, Tjaden, Ashley H, Temple, Karla A, Edelstein, Sharon L, Sam, Susan, Nadeau, Kristen J, Hannon, Tamara S, Manchanda, Shalini, Mather, Kieren J, Kahn, Steven E, Ehrmann, David A, Van Cauter, Eve
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01-04-2021
• Subjects: Adult; Adults; Apnea; Beta cells; Blood Glucose; Body weight; Continuity (mathematics); Cross-Sectional Studies; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2; Female; Glucose; Glucose tolerance; Humans; Insulin; Insulin resistance; Insulin Secretion; Male; Middle Aged; Night; Pancreas; Pathophysiology/Complications; Prediabetic State; Regression analysis; Regression models; Research design; Risk analysis; Risk factors; Sleep; Sleep apnea; Sleep Apnea, Obstructive; Sleep disorders; Wrist
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc20-2127

Obstructive sleep apnea (OSA) is associated with insulin resistance and has been described as a risk factor for type 2 diabetes. Whether OSA adversely impacts pancreatic islet β-cell function remains unclear. We aimed to investigate the association of OSA and short sleep duration with β-cell function in overweight/obese adults with prediabetes or recently diagnosed, treatment-naive type 2 diabetes.
Two hundred twenty-one adults (57.5% men, age 54.5 ± 8.7 years, BMI 35.1 ± 5.5 kg/m
) completed 1 week of wrist actigraphy and 1 night of polysomnography before undergoing a 3-h oral glucose tolerance test (OGTT) and a two-step hyperglycemic clamp. Associations of measures of OSA and actigraphy-derived sleep duration with HbA
, OGTT-derived outcomes, and clamp-derived outcomes were evaluated with adjusted regression models.
Mean ± SD objective sleep duration by actigraphy was 6.6 ± 1.0 h/night. OSA, defined as an apnea-hypopnea index (AHI) of five or more events per hour, was present in 89% of the participants (20% mild, 28% moderate, 41% severe). Higher AHI was associated with higher HbA
(
= 0.007). However, OSA severity, measured either by AHI as a continuous variable or by categories of OSA severity, and sleep duration (continuous or <6 vs. ≥6 h) were not associated with fasting glucose, 2-h glucose, insulin sensitivity, or β-cell responses.
In this baseline cross-sectional analysis of the RISE clinical trial of adults with prediabetes or recently diagnosed, untreated type 2 diabetes, the prevalence of OSA was high. Although some measures of OSA severity were associated with HbA
, OSA severity and sleep duration were not associated with measures of insulin sensitivity or β-cell responses.