Published ahead of print on October 26, 2006, doi:10.1164/rccm.200602-270OC
Am. J. Respir. Crit. Care Med., Volume 175, Number 2, January 2007, 190-195
A more recent version of this article appeared on January 15, 2007
Submitted on February 23, 2006
Accepted on October 26, 2006
Metabolic Risk Factors for Vascular Disease in Obstructive Sleep Apnea: A Matched Controlled Study
Nigel McArdle1*, David Hillman2, Lawrie Beilin3, and Gerald Watts3
1 University of Western Australia, Royal Perth Hospital and School of Medicine and Pharmacology, Perth, Australia; Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, Australia,
2 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, Australia,
3 University of Western Australia, Royal Perth Hospital and School of Medicine and Pharmacology, Perth, Australia
* To whom correspondence should be addressed. E-mail: nmcardle{at}cyllene.uwa.edu.au.
Rationale: Obstructive sleep apnea (OSA) is reported to have a metabolic profile predisposing to cardiovascular disease. However, previous case-control studies have not adequately controlled for confounders.
Objectives: To determine whether OSA is associated with increased insulin resistance and related metabolic risk factors.
Methods: We performed a matched case-control study (n=42) examining putative metabolic risks among men attending a sleep clinic with OSA [apnoea/hypopnoea index (AHI)>15] compared with no OSA (AHI<5). Participants were matched for age±5yrs, body mass index (BMI)±10%, and current smoking status. They were free of diabetes, clinically demonstrable cardiovascular disease, marked hypertension and dyslipidemia.
Measurements and Main Results: Mean ±SD AHI was higher in OSA (40 ±27) than controls (3 ±1.3, p=0.02) and median (interquartile range, IQR) nocturnal oxygen saturation was lower [OSA 83 (76-88), control 91 (90-93)%, p<0.001].
OSA patients had higher median (IQR) homeostasis model assessment score for insulin resistance [OSA1.7, (0.8-4.1), control 1.0, (0.7-1.8)mUmmol/L2, p=0.02]; total [OSA 5.6 (4.8-6.2), control 4.8 (4.3-5.4)mmol/L, p=0.049] and Low Density Lipoprotein [OSA 3.8 (2.9-4.2), control 3.1 (2.6-3.6)mmol/L, p=0.04] cholesterol. OSA patients had higher 24hr and nocturnal (12hr) urinary nor-epinephrine excretion and plasma leptin levels, and lower IGF-1 levels (all, p 0.02). Multiple linear regression adjusting for central obesity, age and alcohol consumption confirmed an independent association between OSA and metabolic risks, (all p<0.05), with a trend for IGF-1 (p=0.053).
Conclusions: In a sleep clinic population men with OSA and no identifiable cardiovascular disease have increased insulin resistance and other metabolic changes which act to increase the risk of vascular disease, compared to age and BMI matched attendees without OSA.
Key words: sleep disorders; pathophysiology; vascular disease; insulin resistance
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