title: High baseline insulin levels associated with 6-year incident observed sleep apnea.
abstract: OBJECTIVE
  Obstructive sleep apnea is common in patients with type 2 diabetes, and its association with insulin and insulin resistance has been examined in cross-sectional studies. We evaluate risk factors for incident observed sleep apnea in a general population not selected for sleep disturbances.
  
  
  METHODS
  A total of 1,780 men and 1,785 women, aged 33 to 68 years, from the cohort Data from an Epidemiologic Study on the Insulin Resistance Syndrome (D.E.S.I.R.) responded to the question, "Has someone said to you that you stop breathing during your sleep?" at baseline and 6 years. Anthropometric, clinical, and biological factors were recorded at both time points.
  
  
  RESULTS
  At baseline, 14% of men and 7% of women reported having observed sleep apnea (positive response to question); 6-year incidences were 14 and 6%, respectively. Age, anthropometric parameters, blood pressure, and sleep characteristics were all associated with prevalent, observed apnea episodes, in both sexes. Baseline waist circumference was the strongest predictor of incident apnea: standardized odds ratio (OR), adjusted for age and sex, 1.34 (95% CI 1.19-1.52). After adjustment for age, sex, and waist circumference, the standardized ORs for incident observed apnea were identical for fasting insulin and the homeostasis model assessment of insulin resistance: 1.31 (1.13-1.51) and 1.24 (1.09-1.41) for triglycerides and 1.52 (1.12-2.05) for smoking. Observed apnea at baseline was not associated with changes in anthropometric or biological parameters over the 6-year follow-up.
  
  
  CONCLUSIONS
  The most important baseline risk factor for incident apnea was adiposity. After accounting for adiposity, other risk factors were high insulin, insulin resistance, high triglycerides, and smoking, factors amenable to lifestyle intervention.
authors.affiliation: Institut Nationale de la Santé et de la Recherché Médicale, CESP Centre for Research in Epidemiology and Population Health, Unité 1018, Epidemiology of diabetes, obesity and chronic kidney disease over the lifecourse, Villejuif, France. beverley.balkau@inserm.fr
authors.forename: Beverley
authors.initials: B
authors.lastname: Balkau
authors.forename: Sylviane
authors.initials: S
authors.lastname: Vol
authors.forename: Sandrine
authors.initials: S
authors.lastname: Loko
authors.forename: Tiana
authors.initials: T
authors.lastname: Andriamboavonjy
authors.forename: Olivier
authors.initials: O
authors.lastname: Lantieri
authors.forename: Gaelle
authors.initials: G
authors.lastname: Gusto
authors.forename: Nicole
authors.initials: N
authors.lastname: Meslier
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Racineux
authors.forename: Jean
authors.initials: J
authors.lastname: Tichet
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000097:blood / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
chemical_list: D007328:Insulin; D014280:Triglycerides