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Continuous Positive Airway Pressure Treatment Rapidly Improves Insulin Sensitivity in Patients with Obstructive Sleep Apnea Syndrome

Department of Medicine I; Department of Medical Informatics, Biometrics, and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Department of Medicine 3, Klinikum Nürnberg, Nuremberg, Germany

Correspondence and requests for reprints should be addressed to Igor Alexander Harsch, M.D., Department of Medicine I, Friedrich-Alexander University, Division of Respiratory Medicine and Division of Endocrinology and Metabolism, Ulmenweg 18, 91054 Erlangen, Germany. E-mail: igor.harsch{at}med1.imed.uni-erlangen.de

The obstructive sleep apnea syndrome is typically associated with conditions known to increase insulin resistance as hypertension, obesity, and diabetes. We investigated whether obstructive sleep apnea itself is an independent risk factor for increased insulin resistance and whether continuous positive airway pressure (CPAP) treatment improves insulin sensitivity. Forty patients (apnea–hypopnea index > 20) were treated with CPAP. Before, 2 days after, and after 3 months of effective CPAP treatment, hyperinsulinemic euglycemic clamp studies were performed. Insulin sensitivity significantly increased after 2 days (5.75 ± 4.20 baseline versus 6.79 ± 4.91 µmol/kg · min; p = 0.003) and remained stable after 3 months of treatment. The improvement in insulin sensitivity after 2 days was much greater in patients with a body mass index less than 30 kg/m² than in more obese patients. The improved insulin sensitivity after 2 nights of treatment may reflect a decreasing sympathetic activity, indicating that sleep apnea is an independent risk factor for increased insulin resistance. The effect of CPAP on insulin sensitivity is smaller in obese patients than in nonobese patients, suggesting that in obese individuals insulin sensitivity is mainly determined by obesity and, to a smaller extent, by sleep apnea.

Key Words: obstructive sleep apnea syndrome • continuous positive airway pressure treatment • insulin sensitivity • obesity • leptin

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