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Obstructive sleep apnea syndrome is associated with metabolic syndrome rather than insulin resistance

Sleep and Breathing volume 11, pages 23–30 (2007)Cite this article

Abstract

The aim of this study was to investigate cross-sectionally the prevalence and covariates of obstructive sleep apnea syndrome (OSAS) and its relationship to metabolic syndrome (MS), insulin resistance (IR), and coronary heart disease (CHD) in a population sample of 1,946 men and women representative of Turkish adults. OSAS was identified when habitual snoring and episodes of apnea were combined with another relevant symptom. MS was diagnosed based on modified criteria of the Adult Treatment Panel III and IR by homeostatic model assessment (HOMA). OSAS was identified in 61 men (6.4%) and 58 women (5.8%), at a similar prevalence, after adjusting for covariates. Among individuals with OSAS, significantly higher odds ratios (ORs), adjusted for age, body mass index (BMI), and waist girth, were observed for MS, hypertension, and prevalent CHD, but not for HOMA or menopause. Significantly higher C-reactive protein existed only in women with OSAS who were also more frequent smokers. In logistic regression models, waist circumference, but not BMI nor hypertension, was significantly associated with OSAS among men. In women, by contrast, current cigarette smoking and hypertension were the significant independent covariates. Regression models controlling for sex, age, and smoking revealed that MS (and not IR per se) was associated significantly with OSAS (OR 1.94) in nondiabetic individuals. To conclude, abdominal rather than overall obesity in men and smoking among women are significant independent determinants of OSAS in Turkish adults. OSAS is associated with MS rather than IR per se. Relatively high prevalence of OSAS is observed in Turkish women in whom it is significantly associated with CHD.

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References

  1. Parish JM, Somers VK (2004) Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc 79:1036–1046

    PubMed  Article  Google Scholar 

  2. American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research: the report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–689

    Google Scholar 

  3. Guilleminault C, Simmons FB, Motta J et al (1981) Obstructive sleep apnea syndrome and tracheostomy: long-term follow-up experience. Arch Intern Med 141:985–988

    PubMed  Article  CAS  Google Scholar 

  4. Kales A, Bixler EO, Cadieux RJ et al (1984) Sleep apnoea in a hypertensive population. Lancet 2:1005–1008

    PubMed  Article  CAS  Google Scholar 

  5. Lavie P, Herer P, Peled R et al (1995) Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep 18:157–179

    Google Scholar 

  6. Gami AS, Howard DE, Olson EJ, Somers VK (2005) Day–night pattern of sudden death in obstructive sleep apnea. N Engl J Med 352:1206–1214

    PubMed  Article  CAS  Google Scholar 

  7. Shepard JW Jr (1990) Cardiopulmonary consequences of obstructive sleep apnea. Mayo Clin Proc 65:1250–1259

    PubMed  Google Scholar 

  8. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PMA, Wilding JPH (2004) Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 25:735–741

    PubMed  Article  Google Scholar 

  9. Söğüt A, Altın R, Uzun L, Uğur MB, Tomac N, Acun C, Kart L, Can G (2005) Prevalence of obstructive sleep apnea syndrome and associated symptoms in 3–11-year-old Turkish children. Pediatr Pulmonol 39:251–256

    PubMed  Article  Google Scholar 

  10. Onat A, Avcı GŞ, Şenocak M, Örnek E, Gözükara Y (1992) Plasma lipids and their interrelation in Turkish adults. J Epidemiol Community Health 46:470–476

    PubMed  CAS  Article  Google Scholar 

  11. Onat A (2001) Risk factors and cardiovascular disease in Turkey. Atherosclerosis 156:1–10

    PubMed  Article  CAS  Google Scholar 

  12. Duran J, Esnaola S, Rubio R, Iztueta A (2001) Obstructive sleep apnea–hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70yr. Am J Respir Crit Care Med 163(3):685–689 (part 1)

    PubMed  CAS  Google Scholar 

  13. Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Ttreatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285:2486–2497

    Article  Google Scholar 

  14. Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant C (2004) Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 109:433–438

    PubMed  Article  Google Scholar 

  15. Onat A, Hergenç G, Türkmen S, Yazıcı M, Sarı İ, Can G (2006) Discordance between insulin resistance and metabolic syndrome: features and associated cardiovascular risk in adults with normal glucose regulation. Metabolism 55:445–452

    PubMed  Article  CAS  Google Scholar 

  16. Onat A, Hergenç G, Karabulut A, Türkmen S, Doğan Y, Uyarel H, Can G, Sansoy V (2006) Serum gamma glutamyltransferase as a marker of metabolic syndrome and coronary disease likelihood in nondiabetic middle-aged and elderly adults. Prev Med 43:136–139

    PubMed  Article  CAS  Google Scholar 

  17. Mahley RW, Palaoğlu E, Atak Z et al (1995) Turkish heart study: lipids, lipoproteins, and apolipoproteins. J Lipid Res 36:839–859

    PubMed  CAS  Google Scholar 

  18. Wyszynski DF, Waterworth DM, Barter PJ et al (2005) Relation between atherogenic dyslipidemia and the Adult Treatment Program-III definition of metabolic syndrome (Genetic Epidemiology of Metabolic Syndrome Project). Am J Cardiol 95:194–198

    PubMed  Article  Google Scholar 

  19. American Diabetes Association (1997) Cinical practice recommendations 1997. Diabetes Care 20:(Suppl)S1–S70

    Google Scholar 

  20. Rose GA, Blackburn H, Gillum RF, Prineas RJ (1982) Cardiovascular survey methods, 2nd edn. WHO, Geneva, pp 124–127

    Google Scholar 

  21. Mather KJ, Hunt AE, Steinber HO et al (2001) Repeatability characteristics of simple indices of insulin resistance: implications for research applications. J Clin Endocrinol Metab 86:5457–5464

    PubMed  Article  CAS  Google Scholar 

  22. Onat A, Ceyhan K, Başar Ö, Erer B, Toprak S, Sansoy V (2002) Metabolic syndrome: major impact on coronary risk in a population with low cholesterol levels—a prospective and cross-sectional evaluation. Atherosclerosis 165:285–292

    PubMed  Article  CAS  Google Scholar 

  23. Wolk R, Shamsuzzaman ASM, Somers VK (2003) Obesity, sleep apnea, and hypertension. Hypertension 42:1067–1074

    PubMed  Article  CAS  Google Scholar 

  24. Onat A, Özhan H, Esen AM, Albayrak S, Karabulut A, Can G, Hergenç G (2006) Prospective epidemiologic evidence of a “protective” effect of smoking on metabolic syndrome and diabetes among Turkish women—without associated overall health benefit. Atherosclerosis (in press) DOI 10.1016/j.atherosclerosis.2006.07.002

  25. Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea. A population health perspective. Am J Respir Crit Care Med 165:1217–1239

    PubMed  Article  Google Scholar 

  26. Bloom JW, Kaltenborn WT, Quan SF (1988) Risk factors in a general population for snoring: importance of cigarette smoking and obesity. Chest 93:678–683

    PubMed  CAS  Google Scholar 

  27. Jennum P, Sjol A (1993) Snoring, sleep apnea and cardiovascular risk factors: the MONICA II Study. Int J Epidemiol 22:439–444

    PubMed  Article  CAS  Google Scholar 

  28. Wetter DW, Young TB, Bidwell TR, Badr MS, Palta M (1994) Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 154:2219–2224

    PubMed  Article  CAS  Google Scholar 

  29. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384

    PubMed  Article  CAS  Google Scholar 

  30. Lavie P, Herer P, Hoffstein V (2000) Obstructive sleep apnoea as a risk factor for hypertension: population study. BMJ 320:779–782

    Article  Google Scholar 

  31. Gami AS, Somers VK (2004) Obstructive sleep apnea, metabolic syndrome, and cardiovascular outcomes. Eur Heart J 25:709–711

    PubMed  Article  Google Scholar 

  32. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS (2002) Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 165:670–676

    PubMed  Google Scholar 

  33. Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL (2002) Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 165:677–682

    PubMed  Google Scholar 

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Acknowledgements

We thank the Turkish Society of Cardiology and the pharmaceutical companies Astra-Zeneca, SanofiAventis, and Pfizer (Istanbul) for their financial support of the survey 2004/05 of the Turkish Adult Risk Factor Study. We appreciate the dedicated works of Drs. İbrahim Sarı, Ahmet Karabulut, Hakan Özhan, Ali M. Esen, and Serdar Türkmen, and Mr. Mehmet Özmay.

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Affiliations

  1. Turkish Soc Cardiology, Istanbul, Turkey

    Altan Onat

  2. Istanbul Univ. Cerrahpaşa Medical Fac, Istanbul, Turkey

    Altan Onat & Günay Can

  3. Nisbetiye cad. 37/24, Etiler, 34335, Istanbul, Turkey

    Altan Onat

  4. Yıldız Techn. University, Istanbul, Turkey

    Gülay Hergenç

  5. S. Ersek Cardiovascular Surgery Center, Istanbul, Turkey

    Hüseyin Uyarel

  6. I. Baysal Univ. Düzce, Istanbul, Turkey

    Mehmet Yazıcı

  7. Centennial Univ Medical Fac, Van, Turkey

    Mustafa Tuncer

  8. Bakirköy State Hospital, Istanbul, Turkey

    Yüksel Doğan

  9. Kliniken St. Antonius, Acad. Hospital of Heinrich-Heine-University, Düsseldorf, Germany

    Kurt Rasche

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  1. Altan Onat
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  2. Gülay Hergenç
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  3. Hüseyin Uyarel
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  4. Mehmet Yazıcı
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  5. Mustafa Tuncer
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  6. Yüksel Doğan
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  7. Günay Can
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  8. Kurt Rasche
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Correspondence to Altan Onat.

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Onat, A., Hergenç, G., Uyarel, H. et al. Obstructive sleep apnea syndrome is associated with metabolic syndrome rather than insulin resistance. Sleep Breath 11, 23–30 (2007). https://doi.org/10.1007/s11325-006-0077-7

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  • DOI: https://doi.org/10.1007/s11325-006-0077-7

Keywords

  • Sleep apnea
  • Metabolic syndrome
  • Obesity
  • Insulin resistance
  • Hypertension
  • Physical activity