title: Obstructive sleep apnea is a predictor of abnormal glucose metabolism in chronically sleep deprived obese adults.
abstract: BACKGROUND
  Sleep abnormalities, including obstructive sleep apnea (OSA), have been associated with insulin resistance.
  
  
  OBJECTIVE
  To determine the relationship between sleep, including OSA, and glucose parameters in a prospectively assembled cohort of chronically sleep-deprived obese subjects.
  
  
  METHODS
  Cross-sectional evaluation of a prospective cohort study.
  
  
  METHODS
  Tertiary Referral Research Clinical Center.
  
  
  METHODS
  Sleep duration and quality assessed by actigraphy, sleep diaries and questionnaires, OSA determined by a portable device; glucose metabolism assessed by oral glucose tolerance test (oGTT), and HbA1c concentrations in 96 obese individuals reporting sleeping less than 6.5 h on a regular basis.
  
  
  RESULTS
  Sixty % of subjects had an abnormal respiratory disturbance index (RDI≥5) and 44% of these subjects had abnormal oGTT results. Severity of OSA as assessed by RDI score was associated with fasting glucose (R = 0.325, p = 0.001) and fasting insulin levels (ρ = 0.217, p = 0.033). Subjects with moderate to severe OSA (RDI>15) had higher glucose concentrations at 120 min than those without OSA (RDI<5) (p = 0.017). Subjects with OSA also had significantly higher concentrations of plasma ACTH (p = 0.009). Several pro-inflammatory cytokines were higher in subjects with OSA (p<0.050). CRP levels were elevated in this sample, suggesting increased cardiovascular risk.
  
  
  CONCLUSIONS
  OSA is associated with impaired glucose metabolism in obese, sleep deprived individuals. Since sleep apnea is common and frequently undiagnosed, health care providers should be aware of its occurrence and associated risks.
  
  
  BACKGROUND
  This study was conducted under the NIDDK protocol 06-DK-0036 and is listed in ClinicalTrials.gov NCT00261898.
authors.affiliation: Section on Neuroendocrinology of Obesity, National Institute of Diabetes, Digestive, and Kidney Disease, Bethesda, Maryland, USA. cizzag@intra.niddk.nih.gov
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cizza
authors.forename: Paolo
authors.initials: P
authors.lastname: Piaggi
authors.forename: Eliane A
authors.initials: EA
authors.lastname: Lucassen
authors.forename: Lilian
authors.initials: L
authors.lastname: de Jonge
authors.forename: Mary
authors.initials: M
authors.lastname: Walter
authors.forename: Megan S
authors.initials: MS
authors.lastname: Mattingly
authors.forename: Heather
authors.initials: H
authors.lastname: Kalish
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Csako
authors.forename: Kristina I
authors.initials: KI
authors.lastname: Rother
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D005215:Fasting / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000097:blood* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000097:blood* / Q000503:physiopathology; D012892:Sleep Deprivation / Q000097:blood* / Q000503:physiopathology; D011795:Surveys and Questionnaires
chemical_list: D000324:Adrenocorticotropic Hormone; D001786:Blood Glucose; D002097:C-Reactive Protein; D016207:Cytokines; D006442:Glycated Hemoglobin