Copyright © 2004 by the Johns Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Sleep-Disordered Breathing, Glucose Intolerance, and Insulin Resistance
The Sleep Heart Health Study
1 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.
2 Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN.
3 Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH.
4 Department of Medicine, School of Medicine, Boston University, Boston, MA.
5 Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
6 MedStar Research Institute, Hyattsville, MD.
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 (
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.
diabetes mellitus, type II; glucose intolerance; insulin resistance; respiration; sleep; sleep apnea syndromes
Abbreviations: Abbreviations: CI, confidence interval; HOMA, homeostasis model assessment; RDI, respiratory disturbance index; SHHS, Sleep Heart Health Study.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. N. Vgontzas, D. Liao, S. Pejovic, S. Calhoun, M. Karataraki, and E. O. Bixler Insomnia With Objective Short Sleep Duration Is Associated With Type 2 Diabetes: A population-based study Diabetes Care, November 1, 2009; 32(11): 1980 - 1985. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P E Ronksley, B R Hemmelgarn, S J Heitman, P J Hanly, P D Faris, H Quan, and W H Tsai Obstructive sleep apnoea is associated with diabetes in sleepy subjects Thorax, October 1, 2009; 64(10): 834 - 839. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. W. Endeshaw, M. L. Unruh, M. Kutner, A. B. Newman, and D. L. Bliwise Sleep-disordered Breathing and Frailty in the Cardiovascular Health Study Cohort Am. J. Epidemiol., July 15, 2009; 170(2): 193 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Levy, M. R. Bonsignore, and J. Eckel Sleep, sleep-disordered breathing and metabolic consequences Eur. Respir. J., July 1, 2009; 34(1): 243 - 260. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Lee, M. E. Woodske, B. Zou, and C. P. O'Donnell Dynamic arterial blood gas analysis in conscious, unrestrained C57BL/6J mice during exposure to intermittent hypoxia J Appl Physiol, July 1, 2009; 107(1): 290 - 294. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. F. Quan Sleep Disturbances and Their Relationship to Cardiovascular Disease American Journal of Lifestyle Medicine, July 1, 2009; 3(1_suppl): 55S - 59S. [Abstract] [PDF]
|
|
|
|
|
|
L. Lavie and P. Lavie Molecular mechanisms of cardiovascular disease in OSAHS: the oxidative stress link Eur. Respir. J., June 1, 2009; 33(6): 1467 - 1484. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Louis and N. M. Punjabi Effects of acute intermittent hypoxia on glucose metabolism in awake healthy volunteers J Appl Physiol, May 1, 2009; 106(5): 1538 - 1544. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Champagne, K. Schwartzman, L. Opatrny, P. Barriga, L. Morin, A. Mallozzi, A. Benjamin, and R. J. Kimoff Obstructive sleep apnoea and its association with gestational hypertension Eur. Respir. J., March 1, 2009; 33(3): 559 - 565. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Sim, S. A. Rasgon, D. A. Kujubu, V. A. Kumar, I. L. A. Liu, J. M. Shi, T. T. Pham, and S. F. Derose Sleep Apnea in Early and Advanced Chronic Kidney Disease: Kaiser Permanente Southern California Cohort Chest, March 1, 2009; 135(3): 710 - 716. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Riha and W. T. McNicholas The genetic and cardiovascular aspects of obstructive sleep apnoea/hypopnoea syndrome Eur. Respir. J., February 1, 2009; 33(2): 233 - 236. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Parish Sleep-Related Problems in Common Medical Conditions Chest, February 1, 2009; 135(2): 563 - 572. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Y. Polotsky, S. P. Patil, V. Savransky, A. Laffan, S. Fonti, L. A. Frame, K. E. Steele, M. A. Schweizter, J. M. Clark, M. S. Torbenson, et al. Obstructive Sleep Apnea, Insulin Resistance, and Steatohepatitis in Severe Obesity Am. J. Respir. Crit. Care Med., February 1, 2009; 179(3): 228 - 234. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Savransky, C. Reinke, J. Jun, S. Bevans-Fonti, A. Nanayakkara, J. Li, A. C. Myers, M. S. Torbenson, and V. Y. Polotsky Chronic intermittent hypoxia and acetaminophen induce synergistic liver injury in mice Exp Physiol, February 1, 2009; 94(2): 228 - 239. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Y. Avidan Sleep and Neurodegenerative Disorders ACCP Sleep Med Brd Rev, January 1, 2009; 4(0): 27 - 44. [Full Text] [PDF]
|
|
|
|
|
|
S. Veasey Peptide amidation: a push me, don't pull you for the morbidities in sleep apnea J Appl Physiol, January 1, 2009; 106(1): 3 - 4. [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Canales, L.-Y. Lui, B. C. Taylor, A. Ishani, R. Mehra, K. L. Stone, S. Redline, K. E. Ensrud, and for the Osteoporotic Fractures in Men (MrOS) Study Renal function and sleep-disordered breathing in older men Nephrol. Dial. Transplant., December 1, 2008; 23(12): 3908 - 3914. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Kezirian, C. E. Kirisoglu, R. W. Riley, E. Chang, C. Guilleminault, and N. B. Powell Resting Energy Expenditure in Adults With Sleep Disordered Breathing Arch Otolaryngol Head Neck Surg, December 1, 2008; 134(12): 1270 - 1275. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Van Cauter and K. L Knutson Sleep and the epidemic of obesity in children and adults Eur. J. Endocrinol., December 1, 2008; 159(suppl_1): S59 - S66. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S M Ip Obstructive sleep apnoea, insulin resistance and sleepiness Thorax, November 1, 2008; 63(11): 939 - 940. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Tasali, E. Van Cauter, L. Hoffman, and D. A. Ehrmann Impact of Obstructive Sleep Apnea on Insulin Resistance and Glucose Tolerance in Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3878 - 3884. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation, September 2, 2008; 118(10): 1080 - 1111. [Full Text] [PDF]
|
|
|
|
 |
|
 V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) J. Am. Coll. Cardiol., August 19, 2008; 52(8): 686 - 717. [Full Text] [PDF]
|
|
|
|
|
|
J. Theorell-Haglow, C. Berne, C. Janson, and E. Lindberg Obstructive sleep apnoea is associated with decreased insulin sensitivity in females Eur. Respir. J., May 1, 2008; 31(5): 1054 - 1060. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. T. McNicholas Diagnosis of Obstructive Sleep Apnea in Adults Proceedings of the ATS, February 15, 2008; 5(2): 154 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Tasali and M. S. M. Ip Obstructive Sleep Apnea and Metabolic Syndrome: Alterations in Glucose Metabolism and Inflammation Proceedings of the ATS, February 15, 2008; 5(2): 207 - 217. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Tasali, B. Mokhlesi, and E. Van Cauter Obstructive Sleep Apnea and Type 2 Diabetes*: Interacting Epidemics Chest, February 1, 2008; 133(2): 496 - 506. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Yokoe, L. C. Alonso, L. C. Romano, T. C. Rosa, Robert. M. O'Doherty, A. Garcia-Ocana, K. Minoguchi, and C. P. O'Donnell Intermittent hypoxia reverses the diurnal glucose rhythm and causes pancreatic {beta}-cell replication in mice J. Physiol., February 1, 2008; 586(3): 899 - 911. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L.-F. M. Taub and N. S. Redeker Sleep Disorders, Glucose Regulation, and Type 2 Diabetes Biol Res Nurs, January 1, 2008; 9(3): 231 - 243. [Abstract] [PDF]
|
|
|
|
|
|
Z. T. Bloomgarden Diabetes and Obesity: Part 2 Diabetes Care, January 1, 2008; 31(1): 176 - 182. [Full Text] [PDF]
|
|
|
|
 |
|
 W. T. McNicholas Cardiovascular outcomes of CPAP therapy in obstructive sleep apnea syndrome Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2007; 293(4): R1666 - R1670. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Parati, C. Lombardi, and K. Narkiewicz Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2007; 293(4): R1671 - R1683. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Redline, A. Storfer-Isser, C. L. Rosen, N. L. Johnson, H. L. Kirchner, J. Emancipator, and A. M. Kibler Association between Metabolic Syndrome and Sleep-disordered Breathing in Adolescents Am. J. Respir. Crit. Care Med., August 15, 2007; 176(4): 401 - 408. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. M. McGinley, S. P. Patil, J. P. Kirkness, P. L. Smith, A. R. Schwartz, and H. Schneider A Nasal Cannula Can Be Used to Treat Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., July 15, 2007; 176(2): 194 - 200. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. Pagel Obstructive Sleep Apnea (OSA) in Primary Care: Evidence-based Practice J Am Board Fam Med, July 1, 2007; 20(4): 392 - 398. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. P. Patil, H. Schneider, A. R. Schwartz, and P. L. Smith Adult Obstructive Sleep Apnea: Pathophysiology and Diagnosis Chest, July 1, 2007; 132(1): 325 - 337. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Basner Continuous Positive Airway Pressure for Obstructive Sleep Apnea N. Engl. J. Med., April 26, 2007; 356(17): 1751 - 1758. [Full Text] [PDF]
|
|
|
|
|
|
N. Iiyori, L. C. Alonso, J. Li, M. H. Sanders, A. Garcia-Ocana, R. M. O'Doherty, V. Y. Polotsky, and C. P. O'Donnell Intermittent Hypoxia Causes Insulin Resistance in Lean Mice Independent of Autonomic Activity Am. J. Respir. Crit. Care Med., April 15, 2007; 175(8): 851 - 857. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. R. Coughlin, L. Mawdsley, J. A. Mugarza, J. P. H. Wilding, and P. M. A. Calverley Cardiovascular and metabolic effects of CPAP in obese males with OSA Eur. Respir. J., April 1, 2007; 29(4): 720 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Sze, C. Schmid, K. E Bloch, R. Bernays, and M. Brandle Effect of transsphenoidal surgery on sleep apnoea in acromegaly Eur. J. Endocrinol., March 1, 2007; 156(3): 321 - 329. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. T. McNicholas, M. R. Bonsignore, and the Management Committee of EU COST ACTION B26 Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities Eur. Respir. J., January 1, 2007; 29(1): 156 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Nakamura, W. Zhang, M. Yanagisawa, Y. Fukuda, and T. Kuwaki Vigilance state-dependent attenuation of hypercapnic chemoreflex and exaggerated sleep apnea in orexin knockout mice J Appl Physiol, January 1, 2007; 102(1): 241 - 248. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Bradshaw, G. A. Ruff, and D. P. Murphy An oral hypnotic medication does not improve continuous positive airway pressure compliance in men with obstructive sleep apnea. Chest, November 1, 2006; 130(5): 1369 - 1376. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. Kaditis, E. I. Alexopoulos, F. Hatzi, E. Kostadima, M. Kiaffas, E. Zakynthinos, and K. Gourgoulianis Overnight change in brain natriuretic Peptide levels in children with sleep-disordered breathing. Chest, November 1, 2006; 130(5): 1377 - 1384. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. C. Zee and F. W. Turek Sleep and health: everywhere and in both directions. Arch Intern Med, September 18, 2006; 166(16): 1686 - 1688. [Full Text] [PDF]
|
|
|
|
|
|
K. L. Knutson, A. M. Ryden, B. A. Mander, and E. Van Cauter Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med, September 18, 2006; 166(16): 1768 - 1774. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. T. Bloomgarden Third Annual World Congress on the Insulin Resistance Syndrome: Associated conditions. Diabetes Care, September 1, 2006; 29(9): 2165 - 2174. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Li, M. Bosch-Marce, A. Nanayakkara, V. Savransky, S. K. Fried, G. L. Semenza, and V. Y. Polotsky Altered metabolic responses to intermittent hypoxia in mice with partial deficiency of hypoxia-inducible factor-1{alpha} Physiol Genomics, May 16, 2006; 25(3): 450 - 457. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. Laposky, J. Shelton, J. Bass, C. Dugovic, N. Perrino, and F. W. Turek Altered sleep regulation in leptin-deficient mice Am J Physiol Regulatory Integrative Comp Physiol, April 1, 2006; 290(4): R894 - R903. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Tasali, E. Van Cauter, and D. A. Ehrmann Relationships between Sleep Disordered Breathing and Glucose Metabolism in Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., January 1, 2006; 91(1): 36 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. I. Pack Advances in Sleep-disordered Breathing Am. J. Respir. Crit. Care Med., January 1, 2006; 173(1): 7 - 15. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. J. Reichmuth, D. Austin, J. B. Skatrud, and T. Young Association of Sleep Apnea and Type II Diabetes: A Population-based Study Am. J. Respir. Crit. Care Med., December 15, 2005; 172(12): 1590 - 1595. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Veasey Obstructive sleep apnea: wreaking havoc with homeostasis J Appl Physiol, November 1, 2005; 99(5): 1634 - 1635. [Full Text] [PDF]
|
|
|
|
|
|
N. M. Punjabi and V. Y. Polotsky Disorders of glucose metabolism in sleep apnea J Appl Physiol, November 1, 2005; 99(5): 1998 - 2007. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Spiegel, K. Knutson, R. Leproult, E. Tasali, and E. V. Cauter Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes J Appl Physiol, November 1, 2005; 99(5): 2008 - 2019. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. S. Sarinas and D. S. Dube The Diabetes Prevention Program and the Metabolic Syndrome Ann Intern Med, October 4, 2005; 143(7): 544 - 545. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Grassi, A. Facchini, F. Q. Trevano, R. Dell'Oro, F. Arenare, F. Tana, G. Bolla, A. Monzani, M. Robuschi, and G. Mancia Obstructive Sleep Apnea-Dependent and -Independent Adrenergic Activation in Obesity Hypertension, August 1, 2005; 46(2): 321 - 325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Shin, J. Kim, J. Kim, S. Lee, J. Shim, K. In, K. Kang, S. Yoo, N. Cho, K. Kimm, et al. Association of Habitual Snoring with Glucose and Insulin Metabolism in Nonobese Korean Adult Men Am. J. Respir. Crit. Care Med., February 1, 2005; 171(3): 287 - 291. [Abstract] [Full Text] [PDF]
|
|