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Obstructive sleep apnea is a predictor of abnormal glucose metabolism in chronically sleep deprived obese adults.

ABSTRACT: Sleep abnormalities, including obstructive sleep apnea (OSA), have been associated with insulin resistance.To determine the relationship between sleep, including OSA, and glucose parameters in a prospectively assembled cohort of chronically sleep-deprived obese subjects.Cross-sectional evaluation of a prospective cohort study.Tertiary Referral Research Clinical Center.Sleep duration and quality assessed by actigraphy, sleep diaries and questionnaires, OSA determined by a portable device; glucose metabolism assessed by oral glucose tolerance test (oGTT), and HbA1c concentrations in 96 obese individuals reporting sleeping less than 6.5 h on a regular basis.Sixty % of subjects had an abnormal respiratory disturbance index (RDI?5) and 44% of these subjects had abnormal oGTT results. Severity of OSA as assessed by RDI score was associated with fasting glucose (R?=?0.325, p?=?0.001) and fasting insulin levels (??=?0.217, p?=?0.033). Subjects with moderate to severe OSA (RDI>15) had higher glucose concentrations at 120 min than those without OSA (RDI<5) (p?=?0.017). Subjects with OSA also had significantly higher concentrations of plasma ACTH (p?=?0.009). Several pro-inflammatory cytokines were higher in subjects with OSA (p<0.050). CRP levels were elevated in this sample, suggesting increased cardiovascular risk.OSA is associated with impaired glucose metabolism in obese, sleep deprived individuals. Since sleep apnea is common and frequently undiagnosed, health care providers should be aware of its occurrence and associated risks.This study was conducted under the NIDDK protocol 06-DK-0036 and is listed in ClinicalTrials.gov NCT00261898.

SUBMITTER: Cizza G

PROVIDER: S-EPMC3667085 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Obstructive sleep apnea is a predictor of abnormal glucose metabolism in chronically sleep deprived obese adults.

Cizza Giovanni G Piaggi Paolo P Lucassen Eliane A EA de Jonge Lilian L Walter Mary M Mattingly Megan S MS Kalish Heather H Csako Gyorgy G Rother Kristina I KI

PloS one 20130529 5

<h4>Context</h4>Sleep abnormalities, including obstructive sleep apnea (OSA), have been associated with insulin resistance.<h4>Objective</h4>To determine the relationship between sleep, including OSA, and glucose parameters in a prospectively assembled cohort of chronically sleep-deprived obese subjects.<h4>Design</h4>Cross-sectional evaluation of a prospective cohort study.<h4>Setting</h4>Tertiary Referral Research Clinical Center.<h4>Main outcome measures</h4>Sleep duration and quality assesse ...[more]

PMID: 23734252

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Project description:Sleep deprivation and obesity, are associated with neurocognitive impairments. Effects of sleep deprivation and obesity on cognition are unknown, and the cognitive long-term effects of improvement of sleep have not been prospectively assessed in short sleeping, obese individuals.To characterize neurocognitive functions and assess its reversibility.Prospective cohort study.Tertiary Referral Research Clinical Center.A cohort of 121 short-sleeping (<6.5 h/night) obese (BMI 30-55 kg/m(2)) men and pre-menopausal women.Sleep extension (468±88 days) with life-style modifications.Neurocognitive functions, sleep quality and sleep duration.At baseline, 44% of the individuals had an impaired global deficit score (t-score 0-39). Impaired global deficit score was associated with worse subjective sleep quality (p?=?0.02), and lower urinary dopamine levels (p?=?0.001). Memory was impaired in 33%; attention in 35%; motor skills in 42%; and executive function in 51% of individuals. At the final evaluation (N?=?74), subjective sleep quality improved by 24% (p<0.001), self-reported sleep duration increased by 11% by questionnaires (p<0.001) and by 4% by diaries (p?=?0.04), and daytime sleepiness tended to improve (p?=?0.10). Global cognitive function and attention improved by 7% and 10%, respectively (both p?=?0.001), and memory and executive functions tended to improve (p?=?0.07 and p?=?0.06). Serum cortisol increased by 17% (p?=?0.02). In a multivariate mixed model, subjective sleep quality and sleep efficiency, urinary free cortisol and dopamine and plasma total ghrelin accounted for 1/5 of the variability in global cognitive function.Drop-out rate.Chronically sleep-deprived obese individuals exhibit substantial neurocognitive deficits that are partially reversible upon improvement of sleep in a non-pharmacological way. These findings have clinical implications for large segments of the US population.www.ClinicalTrials.gov NCT00261898. NIDDK protocol 06-DK-0036.

Project description:BACKGROUND:Obesity is prevalent among pregnant women in the United States; obstructive sleep apnea is highly comorbid with obesity and is associated with adverse pregnancy outcomes. Screening for obstructive sleep apnea in pregnant women has remained a challenge because of a lack of validated screening tools. OBJECTIVE:The purpose of this study was to evaluate established obstructive sleep apnea screening tools, a sleepiness scale, and individual component items in a cohort of pregnant women with extreme obesity in mid pregnancy with the use of objective testing to determine obstructive sleep apnea status and to describe the prevalence of obstructive sleep apnea among women with extreme obesity. STUDY DESIGN:Adult pregnant subjects, between 24 and 35 weeks gestation, with a body mass index ?40 kg/m2 at the time of enrollment completed obstructive sleep apnea screening tools (Berlin Questionnaire, American Society of Anesthesiologists checklist, and STOP-BANG questionnaire) and the Epworth Sleepiness Scale; they also underwent physical examination of the neck, mouth, and airway. The published obstructive sleep apnea in pregnancy prediction score was calculated for each subject. Obstructive sleep apnea status for each subject was determined by the results of an overnight, unattended type III home sleep apnea test. RESULTS:Twenty-four percent of pregnant women with extreme obesity had obstructive sleep apnea on home sleep apnea testing in mid pregnancy (Apnea-Hypopnea Index, ?5 events per hour]. Established obstructive sleep apnea screening tools performed very poorly to screen for obstructive sleep apnea in this cohort. Age, body mass index, neck circumference, frequently witnessed apneas, and highly likely to fall asleep while driving were associated most strongly with obstructive sleep apnea status in this cohort. CONCLUSION:We found that 24% of pregnant women with body mass index ?40 kg/m2 between 24 and 35 weeks gestation have obstructive sleep apnea, defined as Apnea-Hypopnea Index ?5 events per hour on an overnight type III home sleep apnea test. We found the Berlin Questionnaire, American Society of Anesthesiologists checklist, STOP-BANG, obstructive sleep apnea in pregnancy score by Facco et al, and the Epworth Sleepiness Scale were not useful screening tools for obstructive sleep apnea in a cohort of obese pregnant women. However, age, body mass index, neck circumference, frequently witnessed apneas, and likely to fall asleep while driving were associated with obstructive sleep apnea in this cohort. Further studies are needed to adjust the criteria and thresholds within the available screening tools to better predict obstructive sleep apnea in pregnant women with obesity.

Dataset Information

Obstructive sleep apnea is a predictor of abnormal glucose metabolism in chronically sleep deprived obese adults.

Publications

Obstructive sleep apnea is a predictor of abnormal glucose metabolism in chronically sleep deprived obese adults.

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