The Bidirectional Relationship Between Obstructive Sleep Apnea and Metabolic Disease

Abstract

Obstructive sleep apnea (OSA) is a common sleep disorder, effecting 17% of the total population and 40–70% of the obese population (1, 2). Multiple studies have identified OSA as a critical risk factor for the development of obesity, diabetes, and cardiovascular diseases (3–5). Moreover, emerging evidence indicates that metabolic disorders can exacerbate OSA, creating a bidirectional relationship between OSA and metabolic physiology. In this review, we explore the relationship between glycemic control, insulin, and leptin as both contributing factors and products of OSA. We conclude that while insulin and leptin action may contribute to the development of OSA, further research is required to determine the mechanistic actions and relative contributions independent of body weight. In addition to increasing our understanding of the etiology, further research into the physiological mechanisms underlying OSA can lead to the development of improved treatment options for individuals with OSA.

Vertical sleeve gastrectomy improves ventilatory drive through a leptin-dependent mechanism

“…The effect of VSG on leptin in WT mice. Owing to leptin's involvement in ventilatory drive and HCVR (11,13,30), we examined circulating plasma leptin levels directly following ventilatory testing 4 days and 3 weeks after surgical intervention. As expected, leptin was lowest in lean, WT mice and highest in HFD mice ( Figure 2B).…”

“…through its effect on glucose metabolism (12), as both clinical and preclinical studies have reported links between glycemic control and insulin action on chemosensitivity and disordered breathing (13).…”

Beyond heart health: Consequences of obstructive sleep apnea

“…A recent report describes a bidirectional relationship between metabolic syndrome and OSA. 39 While OSA increases the risk for metabolic syndrome, metabolic syndrome by virtue of body mass index with changes in mechanical load and narrow airway and physiology can predispose for OSA.…”

Upper airway stimulation in obstructive sleep apnea improves glucose metabolism and reduces hedonic drive for food

“…OSA impairs glucose and lipid homeostasis, increasing insulin resistance, systemic inflammation and cardiovascular risk (Marin, Carrizo, Vicente, & Agusti, 2005;Ryan, 2017). Obesity, as commonly found in OSA, contributes both to metabolic dysfunction and worsening of OSA severity (Framnes & Arble, 2018;Lam, Mak, & Ip, 2012).…”