Abstract
Background: It has been suggested that sleep-disordered breathing (SDB) is a risk factor for diabetes, but long-term follow-ups are lacking.
Objectives: To analyze the influence of SDB on future glucose metabolism.
Methods: Men without diabetes (n=141) were investigated with whole-night respiratory monitoring. After a mean period of 11.3 years, they were followed up with an interview, blood sampling and anthropometric measurements. Insulin resistance was quantified using the homeostasis model assessment (HOMA). Delta-HOMA-IR was calculated as (HOMA-IRfollow-up – HOMA-IRbaseline). An oral glucose tolerance test was performed in 113 men to calculate the insulin sensitivity index. Confounders adjusted for were age, BMI, weight gain, hypertension, treatment for diabetes and years with CPAP during the period.
Main results: At the follow-up, 23 men had diabetes. An apnea-hypopnea index (AHI) of >5 and an oxygen desaturation index (ODI) of >5 were significant predictors of developing diabetes. After adjusting for confounders, the association with ODI remained significant (adj. OR 4.4, 95% CI 1.1-18.1). The ODI at baseline was inversely related to the insulin sensitivity index at the follow-up (r= -0.27, p=0.003). A deterioration in HOMA-IR was significantly related to all measured variables of sleep-disordered breathing (AHI, AHI>5, ODI, ODI>5 and MinSaO2) even when adjusting for confounders. When excluding the variable “years on CPAP” from the multivariate model, all associations weakened.
Conclusions: SDB is independently related to the development of insulin resistance and thereby the risk of manifest diabetes mellitus. The results indicate that CPAP treatment can modify this risk.
- © 2011 ERS