Type 2 diabetes and pre-diabetes are associated with obstructive sleep apnea in extremely obese subjects: A cross-sectional study

Abstract

BackgroundObstructive sleep apnea (OSA) is a common yet underdiagnosed condition. The aim of our study is to test whether prediabetes and type 2 diabetes are associated with obstructive sleep apnea (OSA) in extremely obese (BMI ≥ 40 kg/m2) subjects.MethodsOne hundred and thirty seven consecutive extremely obese patients (99 females) from a controlled clinical trial [MOBIL-study (Morbid Obesity treatment, Bariatric surgery versus Intensive Lifestyle intervention Study) (ClinicalTrials.gov number NCT00273104)] underwent somnography with Embletta® and a 2-hour oral glucose tolerance test (OGTT). OSA was defined by an apnea-hypopnea index (AHI) ≥ 5 events/hour. Patients were categorized into three groups according to criteria from the American Diabetes Association: normal glucose tolerance, pre-diabetes and type 2 diabetes. Multiple logistic regression analysis was used to identify possible determinants of OSA.ResultsThe patients had a mean (SD) age of 43 (11) years and a body mass index (BMI) of 46.9 (5.7) kg/m2. Males had significantly higher AHI than females, 29 (25) vs 12 (17) events/hour, p < 0.001. OSA was observed in 81% of men and in 55% of women, p = 0.008. Twenty-nine percent of subjects had normal glucose tolerance, 42% had pre-diabetes and 29% had type 2 diabetes. Among the patients with normal glucose tolerance 33% had OSA, while 67% of the pre-diabetic patients and 78% of the type 2 diabetic patients had OSA, p < 0.001. After adjusting for age, gender, BMI, high sensitive CRP and HOMA-IR, both pre-diabetes and type 2 diabetes were still associated with OSA, odds ratios 3.18 (95% CI 1.00, 10.07), p = 0.049 and 4.17 (1.09, 15.88), p = 0.036, respectively. Mean serum leptin was significantly lower in the OSA than in the non-OSA group, while other measures of inflammation did not differ significantly between groups.ConclusionsType 2 diabetes and pre-diabetes are associated with OSA in extremely obese subjects.Trial registrationMOBIL-study (Morbid Obesity treatment, Bariatric surgery versus Intensive Lifestyle intervention Study) (ClinicalTrials.gov number NCT00273104)

The Impact of Sleep Debt on Excess Adiposity and Insulin Sensitivity in Patients with Early Type 2 Diabetes Mellitus

“…Nevertheless, it is possible that the observed associations could been confounded by obstructive sleep apnea, given that a substantial proportion of sleep apnea cases have been documented in healthy, pre-diabetes and diabetes populations. [33][34][35][36][37] It is possible that the effects of weekday sleep debt and/or other aspects of sleep may be more powerful prior to the onset of diabetes mellitus, or even contribute to its development, but we were only able to assess the prospective effects of weekday sleep debt subsequent to diabetes diagnoses.…”

The Effect of Sleep Apnea and Insomnia on Blood Levels of Leptin, Insulin Resistance, IP-10, and Hydrogen Sulfide in Type 2 Diabetic Patients

“…Both sleep apnea and insomnia are associated with a higher risk of inflammation and metabolic syndrome and frequently occur in overweight subjects. 5,6 Diabetes causes increased vascular inflammation and is also associated with obesity. 7 This study was originally designed to examine the relationship between the levels of 10-kDa interferon-g-induced protein (IP-10), hydrogen sulfide (H 2 S), insulin resistance, and leptin and body weight in type 2 diabetic patients.…”

Obstructive Sleep Apnea after Weight Loss: A Clinical Trial Comparing Gastric Bypass and Intensive Lifestyle Intervention

“…7 Recently, we demonstrated a much higher prevalence of OSA among the morbidly obese: 55% in women and 80% in men. 2 Despite the close relationship between OSA and obesity, only a few recently published randomized controlled trials have assessed the effect of weight loss on obstructive sleep apnea. [8][9][10] Tuomilehto et al examined the effect of a very low calorie diet followed by lifestyle counseling for one year in overweight and O bstructive sleep apnea (OSA) is a commonly unrecognized condition with an especially high prevalence among morbidly obese subjects.…”

“…[8][9][10] Tuomilehto et al examined the effect of a very low calorie diet followed by lifestyle counseling for one year in overweight and O bstructive sleep apnea (OSA) is a commonly unrecognized condition with an especially high prevalence among morbidly obese subjects. 1,2 OSA is characterized by apneas and hypopneas due to the collapse of upper airways and is defi ned by ≥ 5 apneas or hypopneas per hour during sleep, as measured by the apnea-hypopnea index (AHI). Mild OSA is defi ned as 5-15 episodes of apneas or hypopneas per hour, moderate OSA 15-30, and severe OSA ≥ 30.…”