Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state

Gruber, A.; Horwood, F.; Sithole, J.; Ali, N. J.; Idris, I.
January 2006
Cardiovascular Diabetology;2006, Vol. 5, p22
Academic Journal
Obstructive sleep apnoea (OSA) is a cardio-metabolic disorder. Whether metabolic syndrome (MS), insulin resistance (IR) and albuminuria are independently associated with OSA is unclear, but defining the interactions between OSA and various cardiovascular (CV) risk factors independent of obesity facilitates the development of therapeutic strategies to mitigate their increased CV risks. We prospectively recruited 38 subjects with OSA and 41 controls. Anthropometric measurements, glucose, lipids, insulin and blood pressure (BP) were measured after an overnight fast. IR state was defined as homeostasis model assessment (HOMA) value >3.99 and MS diagnosed according to the International Diabetes Federation (IDF) criteria. Subjects with OSA were more obese, more insulin resistant, more hyperglycaemic, had higher Epworth score (measure of day time somnolence) and systolic blood pressure levels. The prevalence of MS was higher in OSA compared with non-OSA subjects (74% vs 24%, p < 0.001). The prevalence of microalbuminuria in both groups was negligible. Logistic regression adjusted for age, BMI and smoking showed that the patient with OSA was 5.9 (95% CI 2.0-17.6) times more likely to have MS than non-OSA patient. Triglyceride (p = 0.031), glucose (0.023) and Epworth score (0.003) values were independently associated with OSA after adjusting for BMI and other covariates whilst IR status was found not to be significant. Using the ROC curve analysis, we found that a waist circumference of >103 cm would predict MS in patients with OSA at 75-78% sensitivity and 61-64% specificity. The agreement between MS and IR state in this cohort is poor. Thus, OSA is associated with MS independent of obesity predominantly due to increased triglyceride, glucose and Epworth score values but not IR or microalbuminuria status. This observation suggests an alternative pathogenic factor mediating the increased cardiovascular risk in patients with OSA and MS, other than that due to IR. The independent link between Epworth score and MS in patients with OSA implicates the role of daytime sleepiness and chronic hypoxia as a potential mediator. Given the discordant between MS and IR state, measurement of waist is useful for predicting mainly MS but not insulin resistance status in patients with OSA. Appropriate pharmacological intervention targeting these independent factors is important in reducing the increased CV risks among patients with OSA.


Related Articles

  • Influence of snoring on microalbuminuria in diabetic patients. Ozol, Duygu; Carlıoğlu, Ayse; Karamanlı, Harun; Akgedik, Recep; Karakurt, Feridun; Yıldırım, Zeki // Sleep & Breathing;Sep2011, Vol. 15 Issue 3, p295 

    Objective: Obstructive sleep apnea (OSA) and snoring are known independent risk factors for insulin resistance. Microalbuminuria is an early marker of diabetic nephropathy and an independent risk factor for cardiovascular disease. The aim of our study was to search the prevalence of...

  • Nutrition and Cardiovascular Disease in the Asia Pacific Region: Obesity. Sullivan, David; Grunstein, Ron // Asia Pacific Journal of Clinical Nutrition;2002 Supplement, Vol. 11, pS37 

    Obesity contributes to the risk of cardiovascular disease courtesy of the link between central adiposity and the insulin resistance syndrome. There is also a close link between obesity and the risk of obstructive sleep apnoea (OSA). OSA is likely to contribute to cardiovascular disease, and some...

  • T Regulatory Lymphocytes and Endothelial Function in Pediatric Obstructive Sleep Apnea. Tan, Hui-Leng; Gozal, David; Samiei, Arash; Bhattacharjee, Rakesh; Wang, Yang; Ramirez, Helena Molero; Bandla, Hari P. R.; Kulkarni, Richa; Kheirandish-Gozal, Leila // PLoS ONE;Jul2013, Vol. 8 Issue 7, p1 

    Background: Obstructive sleep apnea (OSA) is a low-grade inflammatory disease affecting the cardiovascular and metabolic systems. Increasing OSA severity reduces T-regulatory lymphocytes (Tregs) in OSA children. Since Tregs modulate endothelial activation, and attenuate insulin resistance, we...

  • Metabolic effect of telmisartan and losartan in hypertensive patients with metabolic syndrome. Vitale, Cristiana; Mercuro, Giuseppe; Castiglioni, Carlotta; Cornoldi, Alessandra; Tulli, Arianna; Fini, Massimo; Volterrani, Maurizio; Rosano, Giuseppe M. C. // Cardiovascular Diabetology;2005, Vol. 4, p6 

    Background: Metabolic syndrome is a cluster of common cardiovascular risk factors that includes hypertension and insulin resistance. Hypertension and diabetes mellitus are frequent comorbidities and, like metabolic syndrome, increase the risk of cardiovascular events. Telmisartan, an...

  • Obstructive sleep apnoea syndrome promotes reversal albuminuria during sleep. Daskalopoulou, Euphemia; Liavvas, Christos; Nakas, Christos; Vlachogiannis, Emmanuel; Bouros, Demosthenes; Dombros, Nicholas // Sleep & Breathing;Sep2011, Vol. 15 Issue 3, p589 

    Introduction: Sleep apnoea syndrome (OSAS) may induce albuminuria during sleep which could reflect one of the possible pathogenetic mechanisms regarding cardiovascular risk. Materials and methods: We studied 224 patients with newly diagnosed OSAS, free of any chronic disease, and any regular...

  • Association of Sleep Apnea Severity and Obesity with Insulin Resistance, C-Reactive Protein, and Leptin Levels in Male Patients with Obstructive Sleep Apnea. Kapsimalis, Fotis; Varouchakis, George; Manousaki, Asimina; Daskas, Spiros; Nikita, Dimitra; Kryger, Meir; Gourgoulianis, Konstantinos // Lung;Jul/Aug2008, Vol. 186 Issue 4, p209 

    Obesity is the major confounding factor in the relationship between obstructive sleep apnea and increased risk for cardiovascular disease. The aim of the study was to investigate the association of sleep apnea severity with insulin resistance, leptin, and CRP levels in a cohort of male patients....

  • Factores de riesgo para el síndrome metabólico en una población con apnea del sueño; evaluación en un grupo de pacientes de Granada y provincia; estudio GRANADA. Valenza, Ma. C.; Martín, L. Martín; Jiménez, E. González; Cordero, Ma. J. Aguilar; López, M. Botella; Casaubon, T. Muñoz; Demet, G. Valenza // Nutricion Hospitalaria;2012, Vol. 27 Issue 4, p1255 

    Introduction: The Metabolic Syndrome is one of the first health problems in the public health of the century. It's consider that the beginning of the syndrome is determined by numerous factors that developed two main metabolic disturbances: the insulin resistance and the central obesity. This...

  • Basic mechanisms of cardiovascular diseases in obstructive sleep apnoea syndrome. Ryan, S. // Proceedings of the Physiological Society;2014, p49P 

    An abstract of the article "Basic mechanisms of cardiovascular diseases in obstructive sleep apnoea syndrome" by S. Ryan is presented.

  • Effect of regular obstructive apnea in rats on sleep structure and the cardiovascular effects of awakening. Pansani, A. P.; Rossi, M. V.; Schoorlemmer, G. H.; Cravo, S. L. // Proceedings of the Physiological Society;2013, p652P 

    Objective: Obstructive sleep apnea (OSA) can provoke cardiovascular impairments. Animal models that mimic OSA can help clarify the roles of changes in sleep architecture and direct effects of apnea on these impairments. This study analyzed the effect of obstructive apneas on sleep structure, and...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics