This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200809-1392OCv1 179/3/235    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Punjabi, N. M. Articles by Beamer, B. A. Search for Related Content PubMed PubMed Citation Articles by Punjabi, N. M. Articles by Beamer, B. A.

Alterations in Glucose Disposal in Sleep-disordered Breathing

¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

Correspondence and requests for reprints should be addressed to Naresh M. Punjabi, M.D., PhD., Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224. E-mail: npunjabi{at}jhmi.edu

Rationale: It is well established that sleep-disordered breathing (SDB) is independently associated with insulin resistance, glucose intolerance, and type 2 diabetes mellitus. However, data on whether SDB alters in vivo kinetics of glucose and insulin are lacking.

Objectives: The primary goal of this study was to use the frequently sampled intravenous glucose tolerance test (FSIVGTT) in subjects with and without SDB to model the in vivo kinetics of glucose and insulin. Minimal model analysis of the FSIVGTT data was used to derive parameters of insulin sensitivity, glucose effectiveness (a measure of the ability of glucose to mediate its own disposal), and pancreatic β-cell function.

Results: A total of 118 nondiabetic subjects underwent polysomnography, the FSIVGTT, and body composition measurements including determination of percent body fat. Compared with normal subjects (apnea-hypopnea index < 5 events/h), those with mild, moderate, and severe SDB displayed a 26.7, 36.5 and 43.7% reduction in insulin sensitivity, respectively, independent of age, sex, race, and percent body fat. The disposition index, an integrated measure of pancreatic β-cell function, was also reduced in patients with moderate to severe SDB. The decrease in insulin sensitivity and the disposition index were correlated with the average degree of oxyhemoglobin desaturation. In contrast, glucose effectiveness was negatively correlated with the frequency of respiratory event–related arousals.

Conclusions: The results of this study suggest that, independent of adiposity, SDB is associated with impairments in insulin sensitivity, glucose effectiveness, and pancreatic β-cell function. Collectively, these defects may increase the risk of glucose intolerance and type 2 diabetes mellitus in SDB.

Key Words: sleep-disordered breathing • sleep apnea • glucose metabolism • insulin resistance • beta-cell function

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Sleep-disordered breathing (SDB) is associated with insulin resistance and type 2 diabetes mellitus. Whether SDB is also associated with alterations in glucose disposal independent of insulin action and in pancreatic insulin secretion is not known. What This Study Adds to the Field Independent of obesity, patients with SDB exhibit impairments in insulin sensitivity, glucose disposal independent of insulin action, and pancreatic insulin secretion.

 

This article has been cited by other articles:

				R. Arens and H. Muzumdar Childhood obesity and obstructive sleep apnea syndrome J Appl Physiol, February 1, 2010; 108(2): 436 - 444. [Abstract] [Full Text] [PDF]

				K. A. Stamatakis and N. M. Punjabi Effects of Sleep Fragmentation on Glucose Metabolism in Normal Subjects Chest, January 1, 2010; 137(1): 95 - 101. [Abstract] [Full Text] [PDF]

				C. J. Leinum, J. M. Dopp, and B. J. Morgan Sleep-Disordered Breathing and Obesity: Pathophysiology, Complications, and Treatment Nutr Clin Pract, December 1, 2009; 24(6): 675 - 687. [Abstract] [Full Text] [PDF]