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Obstructive sleep apnea is associated with lower adiponectin and higher cholesterol levels independently of traditional factors and other sleep disorders in middle-aged adults: the ELSA-Brasil cohort

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea (OSA) may contribute to metabolic and inflammatory deregulation but previous studies failed to consider sleep duration, sleep fragmentation, insomnia, and daytime sleepiness as potential confounders.

Methods

Consecutive non-diabetic middle-aged participants from the ELSA-Brasil cohort were invited to perform a clinical evaluation, home sleep study for 1 night, and wrist actigraphy for 7 days. OSA was defined by an apnea-hypopnea index ≥ 15 events/h. Participants were stratified according to the presence of OSA measuring the following markers: fasting glucose, glucose tolerance test, homeostatic model assessment of insulin resistance (HOMA-IR) index, fasting insulin, insulin after 2 h of glucose load, glycated hemoglobin, total cholesterol and their fractions, triglycerides, C-reactive protein, TNF-alpha, interleukin-6, interleukin-10, leptin, adiponectin, E-selectin, ADMA, MCP-1, TGF, apolipoprotein B, fibrinogen, and lipoprotein(a). Differences between groups were identified by chi-square test and ANOVA.

Results

We studied 708 participants (mean age: 46 ± 5 years, men: 44%, BMI 26.1 ± 4.1 kg/m2). Compared to no OSA, participants with OSA presented higher levels while fasting and after 2 h glucose load of insulin, HOMA-IR, cholesterol, triglycerides, and C-reactive protein (all p < 0.001). After linear regression analysis adjusting for traditional risk factors plus sleep duration, fragmentation, insomnia, and daytime sleepiness, OSA was negatively associated with adiponectin (β = − 0.271 CI 95% − 0.456 − 0.085) and positively associated with cholesterol (β = 9.707 CI 95% 2.737 16.678). Sex-stratification revealed that these associations were significant for men but not women.

Conclusions

In non-diabetic middle-age adults, men with OSA presented with lower adiponectin and higher cholesterol levels independently of sleep duration, sleep fragmentation, insomnia, and daytime sleepiness.

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Funding

This work was supported by a research grant from FAPESP [Grant 2012/02953-2]. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) was supported by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science and Technology (Financiadora de Estudos e Projetos and CNPq National Research Council) [Grants01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 060278.00 MG, 01 06 0115.00 SP, 01.10.0773.00 SP, and 01 060071.00 RJ]

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Authors and Affiliations

  1. Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Av. Prof. Lineu Prestes, 2565–4 andar, Cidade Universitária, São Paulo, SP, 05508-000, Brazil

    Wagner A. Silva, Ronaldo B. Santos, Aline N. Aielo, Soraya Giatti, Barbara K. Parise, Silvana P. Souza, Paulo A. Lotufo, Isabela M. Bensenor & Luciano F. Drager

  2. Hypertension Unit, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil

    Wagner A. Silva, Ronaldo B. Santos, Silvana P. Souza & Luciano F. Drager

  3. Department of Epidemiology, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil

    Bianca Almeida-Pititto & Sandra F. Vivolo

  4. Department of Preventive Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil

    Bianca Almeida-Pititto

  5. Hypertension Unit, Renal Division, University of São Paulo, São Paulo, Brazil

    Aline N. Aielo, Soraya Giatti, Barbara K. Parise & Luciano F. Drager

Authors
  1. Wagner A. Silva
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  2. Bianca Almeida-Pititto
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  3. Ronaldo B. Santos
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  4. Aline N. Aielo
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  5. Soraya Giatti
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  6. Barbara K. Parise
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  7. Silvana P. Souza
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  8. Sandra F. Vivolo
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  9. Paulo A. Lotufo
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  10. Isabela M. Bensenor
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  11. Luciano F. Drager
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Contributions

Conceptualization: Wagner A. Silva, Bianca Almeida-Pititto, Luciano F. Drager

Methodology: Wagner A. Silva, Bianca Almeida-Pititto, Ronaldo B. Santos, Luciano F. Drager

Formal analysis and investigation: Wagner A. Silva, Bianca Almeida-Pititto. Ronaldo B. Santos, Aline N. Aielo, Soraya Giatti, Barbara K. Parise, Silvana P. Souza

Writing—original draft preparation: Wagner A. Silva, Bianca Almeida-Pititto, Luciano F. Drager

Writing—review and editing: All authors

Funding acquisition: Sandra F. Vivolo, Paulo A. Lotufo, Isabela M. Bensenor, and Luciano F. Drager

Corresponding author

Correspondence to Luciano F. Drager.

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Ethical approval

This study has been approved by the local Ethics Committee, under number 1478/15, in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Silva, W.A., Almeida-Pititto, B., Santos, R.B. et al. Obstructive sleep apnea is associated with lower adiponectin and higher cholesterol levels independently of traditional factors and other sleep disorders in middle-aged adults: the ELSA-Brasil cohort. Sleep Breath 25, 1935–1944 (2021). https://doi.org/10.1007/s11325-021-02290-7

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