title: Sleep apnea and glucose metabolism: a long-term follow-up in a community-based sample.
abstract: BACKGROUND
  It has been suggested that sleep-disordered breathing (SDB) is a risk factor for diabetes, but long-term follow-up studies are lacking. The aim of this community-based study was to analyze the influence of SDB on glucose metabolism after > 10 years.
  
  
  METHODS
  Men without diabetes (N = 141; mean age, 57.5 years) were investigated at baseline, including whole-night respiratory monitoring. After a mean period of 11 years and 4 months, they were followed up with an interview, anthropometric measurements, and blood sampling. Insulin resistance was quantified using the homeostasis model assessment of insulin resistance (HOMA-IR). ΔHOMA-IR was calculated as (HOMA-IR at follow-up − HOMA-IR at baseline). An oral glucose tolerance test was performed on 113 men to calculate the insulin sensitivity index.
  
  
  RESULTS
  The mean apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) at baseline were 4.7 and 3.3, respectively. At follow-up, 23 men had diabetes. An ODI > 5 was a predictor of developing diabetes (OR, 4.4; 95% CI, 1.1-18.1, after adjusting for age, BMI, and hypertension at baseline and ΔBMI and years with CPAP during follow-up). The ODI was inversely related to the insulin sensitivity index at follow-up (r = −0.27, P = .003). A deterioration in HOMA-IR was significantly related to all variables of SDB (AHI, AHI > 5; ODI, ODI > 5; minimum arterial oxygen saturation), even when adjusting for confounders. When excluding the variable years with CPAP from the multivariate model, all associations weakened.
  
  
  CONCLUSIONS
  SDB is independently related to the development of insulin resistance and, thereby, the risk of manifest diabetes mellitus.
authors.affiliation: Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden. Electronic address: eva.lindberg@medsci.uu.se.
authors.forename: Eva
authors.initials: E
authors.lastname: Lindberg
authors.affiliation: Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
authors.forename: Jenny
authors.initials: J
authors.lastname: Theorell-Haglöw
authors.affiliation: Department of Surgical Sciences, Otorhinolaryngology, Uppsala University, Uppsala, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Svensson
authors.affiliation: Department of Respiratory Medicine and Sleep, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors.forename: Thorarinn
authors.initials: T
authors.lastname: Gislason
authors.affiliation: Department of Medical Sciences, Internal Medicine, Uppsala University, Uppsala, Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Berne
authors.affiliation: Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Janson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011159:Population Surveillance; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007328:Insulin