Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Cardiovascular Diabetology
Published in: Cardiovascular Diabetology 1/2011

Open Access 01-12-2011 | Original investigation

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

Authors: Jan Magnus Fredheim, Jan Rollheim, Torbjørn Omland, Dag Hofsø, Jo Røislien, Kristian Vegsgaard, Jøran Hjelmesæth

Published in: Cardiovascular Diabetology | Issue 1/2011

Login to get access

Abstract

Background

Obstructive 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.

Methods

One 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.

Results

The 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.

Conclusions

Type 2 diabetes and pre-diabetes are associated with OSA in extremely obese subjects.

Trial registration

MOBIL-study (Morbid Obesity treatment, Bariatric surgery versus Intensive Lifestyle intervention Study) (ClinicalTrials.gov number NCT00273104)
Appendix
Available only for authorised users
Literature
1.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S: The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993, 328: 1230-1235. 10.1056/NEJM199304293281704.CrossRefPubMed
2.
Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, et al: Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008, 31: 1071-1078.PubMedCentralPubMed
3.
4.
Shah N, Roux F: The relationship of obesity and obstructive sleep apnea. Clin Chest Med. 2009, 30: 455-65. 10.1016/j.ccm.2009.05.012. viiCrossRefPubMed
5.
6.
Ursavas A, Ilcol YO, Nalci N, Karadag M, Ege E: Ghrelin, leptin, adiponectin, and resistin levels in sleep apnea syndrome: Role of obesity. Ann Thorac Med. 2010, 5: 161-165. 10.4103/1817-1737.65050.PubMedCentralCrossRefPubMed
7.
Shaw JE, Punjabi NM, Wilding JP, Alberti KG, Zimmet PZ: Sleep-disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Diabetes Res Clin Pract. 2008, 81: 2-12. 10.1016/j.diabres.2008.04.025.CrossRefPubMed
8.
Chasens ER, Weaver TE, Umlauf MG: Insulin resistance and obstructive sleep apnea: is increased sympathetic stimulation the link?. Biol Res Nurs. 2003, 5: 87-96. 10.1177/1099800403257088.CrossRefPubMed
9.
Pallayova M, Steele KE, Magnuson TH, Schweitzer MA, Hill NR, Bevans-Fonti S, et al: Sleep apnea predicts distinct alterations in glucose homeostasis and biomarkers in obese adults with normal and impaired glucose metabolism. Cardiovasc Diabetol. 2010, 9: 83-10.1186/1475-2840-9-83.PubMedCentralCrossRefPubMed
10.
Rasche K, Keller T, Tautz B, Hader C, Hergenc G, Antosiewicz J, et al: Obstructive sleep apnea and type 2 diabetes. Eur J Med Res. 2010, 15 (Suppl 2): 152-156.PubMedCentralPubMed
11.
Wysocka E, Cofta S, Dziegielewska S, Gozdzik J, Torlinski L, Batura-Gabryel H: Adipocytokines in sleep apnea syndrome. Eur J Med Res. 2009, 14 (Suppl 4): 255-258.PubMedCentralCrossRefPubMed
12.
Guest CB, Park MJ, Johnson DR, Freund GG: The implication of proinflammatory cytokines in type 2 diabetes. Front Biosci. 2008, 13: 5187-5194.CrossRefPubMed
13.
14.
Tantucci C, Scionti L, Bottini P, Dottorini ML, Puxeddu E, Casucci G, et al: Influence of autonomic neuropathy of different severities on the hypercapnic drive to breathing in diabetic patients. Chest. 1997, 112: 145-153. 10.1378/chest.112.1.145.CrossRefPubMed
15.
Bottini P, Redolfi S, Dottorini ML, Tantucci C: Autonomic neuropathy increases the risk of obstructive sleep apnea in obese diabetics. Respiration. 2008, 75: 265-271. 10.1159/000100556.CrossRefPubMed
16.
Soriano-Co M, Vanhecke TE, Franklin BA, Sangal RB, Hakmeh B, McCullough PA: Increased Central Adiposity in Morbidly Obese Patients with Obstructive Sleep Apnea. Intern Med J. 2010
17.
Balkau B, Vol S, Loko S, Andriamboavonjy T, Lantieri O, Gusto G, et al: High baseline insulin levels associated with 6-year incident observed sleep apnea. Diabetes Care. 2010, 33: 1044-1049. 10.2337/dc09-1901.PubMedCentralCrossRefPubMed
18.
Seicean S, Kirchner HL, Gottlieb DJ, Punjabi NM, Resnick H, Sanders M, et al: Sleep-disordered breathing and impaired glucose metabolism in normal-weight and overweight/obese individuals: the Sleep Heart Health Study. Diabetes Care. 2008, 31: 1001-1006. 10.2337/dc07-2003.CrossRefPubMed
19.
Keckeis M, Lattova Z, Maurovich-Horvat E, Beitinger PA, Birkmann S, Lauer CJ, et al: Impaired glucose tolerance in sleep disorders. PLoS One. 2010, 5: e9444-10.1371/journal.pone.0009444.PubMedCentralCrossRefPubMed
20.
Meslier N, Gagnadoux F, Giraud P, Person C, Ouksel H, Urban T, et al: Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J. 2003, 22: 156-160. 10.1183/09031936.03.00089902.CrossRefPubMed
21.
Hofso D, Nordstrand N, Johnson LK, Karlsen TI, Hager H, Jenssen T, et al: Obesity related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass and intensive lifestyle intervention. Eur J Endocrinol. 2010
22.
Hofso D, Ueland T, Hager H, Jenssen T, Bollerslev J, Godang K: Inflammatory mediators in morbidly obese subjects: associations with glucose abnormalities and changes after oral glucose. Eur J Endocrinol. 2009, 161: 451-458. 10.1530/EJE-09-0421.CrossRefPubMed
23.
24.
Levy JC, Matthews DR, Hermans MP: Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care. 1998, 21: 2191-2192. 10.2337/diacare.21.12.2191.CrossRefPubMed
25.
Iber C, Ancoli-Israel S, Chesson A, Quan SF: The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. 2007. for the American Academy of Sleep Medicine. 2007, Westchester, III: American Academy of Sleep Medicine, Ref Type: Report
26.
Douglas NJ: Home diagnosis of the obstructive sleep apnoea/hypopnoea syndrome. Sleep Med Rev. 2003, 7: 53-59. 10.1053/smrv.2001.0205.CrossRefPubMed
27.
Ng SS, Chan TO, To KW, Ngai J, Tung A, Ko FW, et al: Validation of Embletta portable diagnostic system for identifying patients with suspected obstructive sleep apnoea syndrome (OSAS). Respirology. 2010, 15: 336-342. 10.1111/j.1440-1843.2009.01697.x.CrossRefPubMed
28.
Dingli K, Coleman EL, Vennelle M, Finch SP, Wraith PK, Mackay TW, et al: Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. European Respiratory Journal. 2003, 21: 253-259. 10.1183/09031936.03.00298103.CrossRefPubMed
29.
Stepnowsky CJ, Orr WC, Davidson TM: Nightly variability of sleep-disordered breathing measured over 3 nights. Otolaryngol Head Neck Surg. 2004, 131: 837-843. 10.1016/j.otohns.2004.07.011.CrossRefPubMed
30.
Ferri R, Bruni O, Miano S, Smerieri A, Spruyt K, Terzano MG: Inter-rater reliability of sleep cyclic alternating pattern (CAP) scoring and validation of a new computer-assisted CAP scoring method. Clin Neurophysiol. 2005, 116: 696-707. 10.1016/j.clinph.2004.09.021.CrossRefPubMed
31.
Norman RG, Pal I, Stewart C, Walsleben JA, Rapoport DM: Interobserver agreement among sleep scorers from different centers in a large dataset. Sleep. 2000, 23: 901-908.PubMed
32.
Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, et al: Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009, 5: 263-276.PubMed
33.
34.
Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, et al: Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009, 32: 1017-1019. 10.2337/dc08-1776.PubMedCentralCrossRefPubMed
35.
Elmasry A, Lindberg E, Berne C, Janson C, Gislason T, Awad TM, et al: Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med. 2001, 249: 153-161. 10.1046/j.1365-2796.2001.00787.x.CrossRefPubMed
36.
Resta O, Caratozzolo G, Pannacciulli N, Stefano A, Giliberti T, Carpagnano GE, et al: Gender, age and menopause effects on the prevalence and the characteristics of obstructive sleep apnea in obesity. Eur J Clin Invest. 2003, 33: 1084-1089. 10.1111/j.1365-2362.2003.01278.x.CrossRefPubMed
37.
Tiihonen M, Partinen M, Narvanen S: The severity of obstructive sleep apnoea is associated with insulin resistance. J Sleep Res. 1993, 2: 56-61. 10.1111/j.1365-2869.1993.tb00062.x.CrossRefPubMed
38.
Pillar G, Shehadeh N: Abdominal fat and sleep apnea: the chicken or the egg?. Diabetes Care. 2008, 31 (Suppl 2): S303-S309.CrossRefPubMed
39.
Vgontzas AN, Bixler EO, Chrousos GP: Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance. J Intern Med. 2003, 254: 32-44. 10.1046/j.1365-2796.2003.01177.x.CrossRefPubMed
40.
Levy P, Bonsignore MR, Eckel J: Sleep, sleep-disordered breathing and metabolic consequences. Eur Respir J. 2009, 34: 243-260. 10.1183/09031936.00166808.CrossRefPubMed
41.
42.
Zirlik S, Hauck T, Fuchs FS, Neurath MF, Konturek PC, Harsch IA: Leptin, Obestatin and Apelin levels in patients with obstructive sleep apnoea syndrome. Med Sci Monit. 2011, 17: CR159-CR164.PubMedCentralCrossRefPubMed
43.
Kapsimalis F, Varouchakis G, Manousaki A, Daskas S, Nikita D, Kryger M, et al: Association of sleep apnea severity and obesity with insulin resistance, C-reactive protein, and leptin levels in male patients with obstructive sleep apnea. Lung. 2008, 186: 209-217. 10.1007/s00408-008-9082-x.CrossRefPubMed
44.
Metadata
Title
Type 2 diabetes and pre-diabetes are associated with obstructive sleep apnea in extremely obese subjects: A cross-sectional study
Authors
Jan Magnus Fredheim
Jan Rollheim
Torbjørn Omland
Dag Hofsø
Jo Røislien
Kristian Vegsgaard
Jøran Hjelmesæth
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Cardiovascular Diabetology / Issue 1/2011
Electronic ISSN: 1475-2840
DOI
https://doi.org/10.1186/1475-2840-10-84

Other articles of this Issue 1/2011

Cardiovascular Diabetology 1/2011 Go to the issue

Original investigation

Hyperglycemia can delay left ventricular dysfunction but not autonomic damage after myocardial infarction in rodents

Original investigation

Concomitant renal insufficiency and diabetes mellitus as prognostic factors for acute myocardial infarction

Original investigation

Glucagon-like peptide-1 enhances cardiac L-type Ca2+ currents via activation of the cAMP-dependent protein kinase A pathway

Original investigation

Cardiac lipid content is unresponsive to a physical activity training intervention in type 2 diabetic patients, despite improved ejection fraction

Original investigation

Serum uric acid level and its association with metabolic syndrome and carotid atherosclerosis in patients with type 2 diabetes

Original investigation

Plasma osteoprotegerin is related to carotid and peripheral arterial disease, but not to myocardial ischemia in type 2 diabetes mellitus

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits