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Characteristics of obstructive sleep apnea related to insulin resistance

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Background

Obstructive sleep apnea (OSA) is associated with multiple comorbidities, including diabetes. Its development is preceded by alterations in the initial phase of carbohydrate metabolism characterized by insulin resistance. This study aims to evaluate the role of intermittent hypoxia and sleep fragmentation characteristic of OSA on the risk of insulin resistance among apneic patients without diabetes.

Methodology

92 consecutive patients with OSA without evidence of diabetes were recruited. Overnight video polysomnography was performed and, the following morning, fasting blood glucose, insulin and glycosylated hemoglobin were determined. Insulin resistance was measured using the HOMA-IR index.

Results

Insulin resistance was present in 52.2% of OSA patients. In these subjects, insulin resistance was independently associated to the apnea index during REM sleep (adjusted odds ratio [aOR] 1.09; 95% CI, 1.03 to 1.16; p = 0.004), desaturation index (aOR 1.08; 95% CI: 1.04 to 1.13; p = 0.027), and sleep time with oxygen saturation below 90% (aOR 1.04; 95% CI 1.00 to 1.08; p = 0.049). Furthermore, the HOMA-IR level was also directly related to the desaturation index (standardized regression coefficient [B] = 0.514, p < 0.001) and to the apnea index during REM sleep (B = 0.344, p = 0.002).

Conclusions

Intermittent hypoxia and disturbances in REM sleep emerge as main contributors to insulin resistance in OSA patients yet to experience diabetes onset.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. We are committed to sharing our research data in accordance with ethical and privacy considerations.

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Acknowledgements

The authors would like to extend their heartfelt appreciation to the individuals who made this research possible. We are particularly grateful to the patients who participated in this study for their invaluable contributions. We also wish to acknowledge the dedicated efforts of the staff at the Sleep Unit of La Paz University Hospital for their assistance in data collection. This research was made possible through the generous support of the Fondo de Investigación Sanitaria (FIS) (Health Research Fund) and the European Regional Development Funds (ERDF) under grant numbers PI16/00201, PI19/01612, and PI22/01262, awarded to F. García-Río. Their financial support was instrumental in advancing this study. Additionally, we want to express our gratitude to all individuals who provided guidance, feedback, and assistance throughout the research process. Your contributions have been indispensable and are deeply appreciated.

Funding

This study was supported by grants from Fondo de Investigación Sanitaria (FIS) (health research fund) and European Regional Development Funds PI16/00201, PI19/01612 and PI22/01262 to F. García-Río.

Author information

Authors and Affiliations

  1. Respiratory Medicine Department, La Paz University Hospital, Paseo de La Castellana 261, 28046, Madrid, Spain

    Alberto Mangas-Moro, Raquel Casitas, Begoña Sánchez-Sánchez, Isabel Fernández-Navarro, Juan Fernández-Lahera, Raúl Galera, Elisabet Martínez-Cerón, Ester Zamarrón & Francisco García-Río

  2. Biomedical Research Networking Center On Respiratory Diseases (CIBERES), Madrid, Spain

    Raquel Casitas, Raúl Galera, Elisabet Martínez-Cerón & Francisco García-Río

  3. Department of Medicine, Autonomous University of Madrid, Madrid, Spain

    Francisco García-Río

Authors
  1. Alberto Mangas-Moro
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  2. Raquel Casitas
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  3. Begoña Sánchez-Sánchez
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  4. Isabel Fernández-Navarro
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  9. Francisco García-Río
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Contributions

FG-R had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. AM-M, RC, EM-C, EZ, and FG-R were responsible for developing the research question. AM-M, RC, BS-S, IF-N, JF-L, RG, EM-C, EZ, and FG-R were responsible for the study design and collection of data. AMM-M, EM-C, EZ, and FG-R were responsible for study management and coordination. AM-M and FG-R drafted the paper. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Alberto Mangas-Moro.

Ethics declarations

Ethics approval

This study was conducted in compliance with ethical standards and received approval from La Paz University Hospital-IdiPAZ Drug Research Ethics Committee (Protocol ID: PI-1857). Informed consent was obtained from all study participants in accordance with the principles of the Declaration of Helsinki.

Patient consent

Informed written consent was obtained from all participants included in the study, ensuring their voluntary participation, understanding of the study's objectives, and awareness of data collection procedures. The confidentiality of their personal information was strictly maintained.

Conflict of interest

The authors declare no conflicts of interest that could influence the interpretation of the results or the presentation of information in this manuscript. This study was conducted in an unbiased manner, and there are no financial or personal relationships with organizations or individuals that could potentially affect the research.

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Mangas-Moro, A., Casitas, R., Sánchez-Sánchez, B. et al. Characteristics of obstructive sleep apnea related to insulin resistance. Sleep Breath (2024). https://doi.org/10.1007/s11325-024-03040-1

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