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Am. J. Respir. Crit. Care Med., Volume 165, Number 5, March 2002, 677-682

Sleep-disordered Breathing and Insulin Resistance in Middle-aged and Overweight Men

NARESH M. PUNJABI, JOHN D. SORKIN, LESLIE I. KATZEL, ANDREW P. GOLDBERG, ALAN R. SCHWARTZ, and PHILIP L. SMITH

Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine; Division of Gerontology, Department of Medicine, University of Maryland School of Medicine; and Baltimore VA Geriatric Research Education and Clinical Center, Baltimore, Maryland

Sleep-disordered breathing is a prevalent condition associated with impairment of daytime function and may predispose individuals to metabolic abnormalities independent of obesity. The primary objective of this study was to determine the metabolic consequences and community prevalence of sleep-disordered breathing in mildly obese, but otherwise healthy, individuals. One hundred and fifty healthy men, without diabetes or cardiopulmonary disease, were recruited from the community. Measurements included polysomnography, a multiple sleep latency test, an oral glucose tolerance test, determination of body fat by hydrodensitometry, and fasting insulin and lipids. The prevalence of sleep-disordered breathing, depending on the apnea-hypopnea index (AHI) cutoff, ranged from 40 to 60%. After adjusting for body mass index (BMI) and percent body fat, an AHI >=  5 events/h was associated with an increased risk of having impaired or diabetic glucose tolerance (odds ratio, 2.15; 95% CI, 1.05-4.38). The impairment in glucose tolerance was related to the severity of oxygen desaturation (Delta SaO2) associated with sleep-disordered breathing. For a 4% decrease in oxygen saturation, the associated odds ratio for worsening glucose tolerance was 1.99 (95% CI, 1.11 to 3.56) after adjusting for percent body fat, BMI, and AHI. Multivariable linear regression analyses revealed that increasing AHI was associated with worsening insulin resistance independent of obesity. Thus, sleep-disordered breathing is a prevalent condition in mildly obese men and is independently associated with glucose intolerance and insulin resistance.




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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.
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 CirculationHome page
I. D. Caterson, V. Hubbard, G. A. Bray, R. Grunstein, B. C. Hansen, Y. Hong, D. Labarthe, J. C. Seidell, and S. C. Smith Jr
Prevention Conference VII: Obesity, a Worldwide Epidemic Related to Heart Disease and Stroke: Group III: Worldwide Comorbidities of Obesity
Circulation, November 2, 2004; 110(18): e476 - e483.
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 Diabetes CareHome page
P. M. Nilsson, M. Roost, G. Engstrom, B. Hedblad, and G. Berglund
Incidence of Diabetes in Middle-Aged Men Is Related to Sleep Disturbances
Diabetes Care, October 1, 2004; 27(10): 2464 - 2469.
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 Am J EpidemiolHome page
N. M. Punjabi, E. Shahar, S. Redline, D. J. Gottlieb, R. Givelber, and H. E. Resnick
Sleep-Disordered Breathing, Glucose Intolerance, and Insulin Resistance: The Sleep Heart Health Study
Am. J. Epidemiol., September 15, 2004; 160(6): 521 - 530.
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L. J. Palmer, S. G. Buxbaum, E. K. Larkin, S. R. Patel, R. C. Elston, P. V. Tishler, and S. Redline
Whole Genome Scan for Obstructive Sleep Apnea and Obesity in African-American Families
Am. J. Respir. Crit. Care Med., June 15, 2004; 169(12): 1314 - 1321.
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K. M. Oltmanns, H. Gehring, S. Rudolf, B. Schultes, S. Rook, U. Schweiger, J. Born, H. L. Fehm, and A. Peters
Hypoxia Causes Glucose Intolerance in Humans
Am. J. Respir. Crit. Care Med., June 1, 2004; 169(11): 1231 - 1237.
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 Eur Heart JHome page
S. R Coughlin, L. Mawdsley, J. A Mugarza, P. M.A Calverley, and J. P.H Wilding
Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome
Eur. Heart J., May 1, 2004; 25(9): 735 - 741.
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T. Young, J. Skatrud, and P. E. Peppard
Risk Factors for Obstructive Sleep Apnea in Adults
JAMA, April 28, 2004; 291(16): 2013 - 2016.
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 CirculationHome page
S. F. Quan and B. J. Gersh
Cardiovascular Consequences of Sleep-Disordered Breathing: Past, Present and Future: Report of a Workshop From the National Center on Sleep Disorders Research and the National Heart, Lung, and Blood Institute
Circulation, March 2, 2004; 109(8): 951 - 957.
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V. Y. Polotsky, M. C. Smaldone, M. T. Scharf, J. Li, C. G. Tankersley, P. L. Smith, A. R. Schwartz, and C. P. O'Donnell
Impact of interrupted leptin pathways on ventilatory control
J Appl Physiol, March 1, 2004; 96(3): 991 - 998.
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 Am. J. Respir. Crit. Care Med.Home page
I. A. Harsch, S. P. Schahin, M. Radespiel-Troger, O. Weintz, H. Jahreiss, F. S. Fuchs, G. H. Wiest, E. G. Hahn, T. Lohmann, P. C. Konturek, et al.
Continuous Positive Airway Pressure Treatment Rapidly Improves Insulin Sensitivity in Patients with Obstructive Sleep Apnea Syndrome
Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 156 - 162.
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Z. F. Udwadia, A. V. Doshi, S. G. Lonkar, and C. I. Singh
Prevalence of Sleep-disordered Breathing and Sleep Apnea in Middle-aged Urban Indian Men
Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 168 - 173.
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G. Sampol, O. Romero, A. Salas, J. L. Tovar, P. Lloberes, T. Sagales, and A. Evangelista
Obstructive Sleep Apnea and Thoracic Aorta Dissection
Am. J. Respir. Crit. Care Med., December 15, 2003; 168(12): 1528 - 1531.
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A. E. Rubin, V. Y. Polotsky, A. Balbir, J. A. Krishnan, A. R. Schwartz, P. L. Smith, R. S. Fitzgerald, C. G. Tankersley, M. Shirahata, and C. P. O'Donnell
Differences in Sleep-induced Hypoxia between A/J and DBA/2J Mouse Strains
Am. J. Respir. Crit. Care Med., December 15, 2003; 168(12): 1520 - 1527.
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 HypertensionHome page
R. Wolk, A. S.M. Shamsuzzaman, and V. K. Somers
Obesity, Sleep Apnea, and Hypertension
Hypertension, December 1, 2003; 42(6): 1067 - 1074.
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A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al.
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Hypertension, December 1, 2003; 42(6): 1206 - 1252.
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A. S. M. Shamsuzzaman, B. J. Gersh, and V. K. Somers
Obstructive Sleep Apnea: Implications for Cardiac and Vascular Disease
JAMA, October 8, 2003; 290(14): 1906 - 1914.
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 Biol Res NursHome page
E. R. Chasens, T. E. Weaver, and M. G. Umlauf
Insulin Resistance and Obstructive Sleep Apnea: Is Increased Sympathetic Stimulation the Link?
Biol Res Nurs, October 1, 2003; 5(2): 87 - 96.
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V. Y Polotsky, J. Li, N. M Punjabi, A. E Rubin, P. L Smith, A. R Schwartz, and C. P O'Donnell
Intermittent Hypoxia Increases Insulin Resistance in Genetically Obese Mice
J. Physiol., October 1, 2003; 552(1): 253 - 264.
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P. Y. Liu, B. Yee, S. M. Wishart, M. Jimenez, D. G. Jung, R. R. Grunstein, and D. J. Handelsman
The Short-Term Effects of High-Dose Testosterone on Sleep, Breathing, and Function in Older Men
J. Clin. Endocrinol. Metab., August 1, 2003; 88(8): 3605 - 3613.
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 Eur Respir JHome page
N. Meslier, F. Gagnadoux, P. Giraud, C. Person, H. Ouksel, T. Urban, and J-L. Racineux
Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome
Eur. Respir. J., July 1, 2003; 22(1): 156 - 160.
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T. Saaresranta and O. Polo
Sleep-disordered breathing and hormones
Eur. Respir. J., July 1, 2003; 22(1): 161 - 172.
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E. Shiloah, S. Witz, Y. Abramovitch, O. Cohen, A. Buchs, Y. Ramot, M. Weiss, A. Unger, and M. J. Rapoport
Effect of Acute Psychotic Stress in Nondiabetic Subjects on {beta}-Cell Function and Insulin Sensitivity
Diabetes Care, May 1, 2003; 26(5): 1462 - 1467.
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H. E. Resnick, S. Redline, E. Shahar, A. Gilpin, A. Newman, R. Walter, G. A. Ewy, B. V. Howard, and N. M. Punjabi
Diabetes and Sleep Disturbances: Findings from the Sleep Heart Health Study
Diabetes Care, March 1, 2003; 26(3): 702 - 709.
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