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Sleep apnea severity predicted blood glucose levels
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Adults with obstructive sleep apnea have a heightened risk for diabetes, cardiovascular disease and death based on elevated blood glucose levels, according to study findings published in the European Respiratory Journal.
The multinational European Sleep Apnea Database (ESADA) study, involving 24 sleep clinics across 15 European counties and Israel, evaluated 5,294 participants aged 18 to 80 years without diabetes and with suspected sleep-disordered breathing to assess the relationship between HbA1c and severity of the condition.
In the cross-sectional analysis, researchers compiled key data for each patient, including BMI, waist-to-hip ratio, smoking history and alcohol intake, as well as details of comorbidities and medication use. Blood samples were drawn to measure levels of HbA1c. Cardiorespiratory polygraphy or full polysomnography were performed to record sleep data. Patients were divided into groups based on sleep apnea level.
The results showed levels of glucose concentration were significantly linked to severity of sleep apnea. Adjusted mean HbA1c levels were lower in the lowest apnea-hypopnea index quartile (5.24%; 95% CI, 5.21-5.27) than in the second (5.37%; 95% CI, 5.34-5.4), third (5.44%; 95% CI, 5.41-5.47) or highest (5.5%; 95% CI, 5.46-5.53) quartiles. Participants in the higher quartiles had significantly greater adjusted ORs of HbA1c ≥6% than those in the first quartile.
“This is the largest study of its kind showing a link between sleep apnea severity and glucose levels,” Walter McNicholas, MD, of St. Vincent’s University Hospital in Dublin, said in a press release. “Clinicians need to focus on diabetes as an important coexisting illness when treating people with sleep apnea. Further studies are needed to understand the mechanisms behind these two conditions.”
Funding: One of the researchers is supported by a grant from the Health Research Board, Ireland. Philips Respironics and ResMed provided the ESADA with two unrestricted grants for support of maintenance of the ESADA Project.
Disclosure: Endocrine Today could not confirm disclosures at the time of reporting.
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Marie-Pierre St-Onge, PhD
This is a very interesting study, especially in presenting all of the metabolic risk factors associated with sleep apnea-hypopnea index. This study is showing that as obstructive sleep apnea (OSA) worsens, you have an increased metabolic risk profile and all of the markers for cardiovascular disease and diabetes are worsened. It’s important for clinicians to be cognizant of that and to be able to assess OSA and know that this carries an increased risk for many other metabolic disorders.
There hasn’t been much shown about treatment of OSA and improvement in metabolic risk profiles, and this is very important to learn more about. For example, how does adherence to treatment affect metabolic risk factors? You would think people with poor adherence would have less improvement of metabolic risk factors compared to those that have better adherence.
Also, there’s a recent paper that came out showing that the timing of continuous positive airway pressure (CPAP) at night may be important and looking at how the various sleep stages are involved. They showed that treatment of OSA during REM sleep was more closely associated with HbA1c, a marker of diabetes, compared to other sleep stages. Considering that patients turn on the CPAP machine when they first go to bed and then take it off after a few hours, they miss treating OSA during a lot of the REM stages. This may be a critical sleep stage for OSA treatment and one which is more closely associated with diabetes risk.
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