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Sleep-Disordered Breathing and Impaired Glucose Metabolism in Normal-Weight and Overweight/Obese Individuals

The Sleep Heart Health Study

¹ Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
² Geisinger Center for Health Research, Geisinger Health System, Danville, Pennsylvania
³ Boston University School of Medicine and the VA Boston Healthcare System, Boston, Massachusetts
⁴ Department of Epidemiology and the Department of Medicine, Johns Hopkins University, Baltimore, Maryland
⁵ Georgetown University School of Medicine and MedStar Research Institute, Hyattsville, Maryland
⁶ Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
⁷ Southern Arizona VA Healthcare System and the University of Arizona College of Medicine, Tucson, Arizona
⁸ Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio

Corresponding author: Sinziana Seicean MD, MPH, 368 Columbia Rd., Bay Village, OH 44140. E-mail: sxs223{at}case.edu

OBJECTIVE—To characterize the association between sleep-disordered breathing (SDB) and impaired fasting glucose (IFG), impaired glucose tolerance (IGT), combined IFG and IGT, and occult diabetes in individuals of different body habitus.

RESEARCH DESIGN AND METHODS—Cross-sectional analysis of 2,588 participants (aged 52–96 years; 46% men) without known diabetes. SDB was defined as respiratory disturbance index 10 events/h. IFG, IGT, occult diabetes, and body weight were classified according to recent accepted guidelines. Participants with and without SDB were compared on prevalence and odds ratios for measures of impaired glucose metabolism (IGM), adjusting for age, sex, race, BMI, and waist circumference.

RESULTS—SDB was observed in 209 nonoverweight and 1,036 overweight/obese participants. SDB groups had significantly higher adjusted prevalence and adjusted odds of IFG, IFG plus IGT, and occult diabetes. The adjusted odds ratio for all subjects was 1.3 (95% CI 1.1–1.6) for IFG, 1.2 (1.0–1.4) for IGT, 1.4 (1.1–2.7) for IFG plus IGT, and 1.7 (1.1–2.7) for occult diabetes.

CONCLUSIONS—SDB was associated with occult diabetes, IFG, and IFG plus IGT, after adjusting for age, sex, race, BMI, and waist circumference. The magnitude of these associations was similar in nonoverweight and overweight participants. The consistency of associations across all measures of IGM and body habitus groups and the significant association between SDB and IFG plus IGT, a risk factor for rapid progression to diabetes, cardiovascular disease, and mortality, suggests the importance of SDB as a risk factor for clinically important levels of metabolic dysfunction.

Abbreviations: FPG, fasting plasma glucose • IFG, impaired fasting glucose • IGM, impaired glucose metabolism • IGT, impaired glucose tolerance • OGTT, oral glucose tolerance test • RDI, respiratory disturbance index • SDB, sleep-disordered breathing • SHHS, Sleep Heart Health Study

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