Insulin resistance and daytime sleepiness in patients with sleep apnoea

Barceló, A.; Barbé, F.; de Ia Peña, M.; Martinez, P.; Soriano, J. B.; Piérola,, J.; Agusti, A.G. N.
November 2008
Thorax;Nov2008, Vol. 63 Issue 11, p946
Academic Journal
Background: Excessive daytime sleepiness (EDS), obesity and insulin resistance (IR) occur frequently in patients with obstructive sleep apnoea syndrome (OSAS). We hypothesised that in these patients, EDS is a marker of IR, independent of obesity. Methods: We studied 44 patients with OSAS (22 with and 22 without EDS) matched for age (±5 years), body mass index (BMI ±3 kg/m²) and severity of OSAS (as determined by the apnoea-hypopnoea index (AHI)), and 23 healthy controls. Patients (n = 35) were re-examined after 3 months of effective therapy with continuous positive airway pressure (CPAP). EDS was assessed by both subjective (Epworth Sleepiness Scale) and objective (Multiple Sleep Latency Test) methods. IA was deter- mined by the HOMA index. Serum levels of glucose, triglycerides, cholesterol, cortisol, insulin, thyrotropin, growth hormone and insulin-like growth factor I (IGF-l) were also determined. Results: Despite the fact that age, BMI and AHI were similar, patients with EDS had higher plasma levels of glucose (p<0.05) and insulin (p<0.01), as well as evidence of IR (p<0.01) compared with patients without EDS or healthy controls. CPAP treatment reduced cholesterol, insulin and the HOMA index and increased IGF-1 levels in patients with EDS, but did not modify any of these variables in patients without EDS. Conclusion: EDS in OSAS is associated with IA, independent of obesity. Hence EDS may be a useful clinical marker to identify patients with OSAS at risk of metabolic syndrome.


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