Sleep apnoea severity independently predicts glycaemic health in nondiabetic subjects: the ESADA study.
Obstructive sleep apnoea (OSA) is associated with increased risk of dysglycaemia but the intimate link of these conditions with obesity makes discerning an independent relationship between them challenging. Glycosylated haemoglobin (HbA1c) levels predict adverse cardiovascular outcomes in nondiabetics but there is a lack of population-level data exploring the relationship of HbA1c with OSA. A cross-sectional analysis of 5294 participants in the multinational European Sleep Apnoea Cohort (European Sleep Apnoea Database) study was performed, assessing the relationship of OSA severity with HbA1c levels in nondiabetic subjects, with adjustment for confounding factors. HbA1c levels correlated significantly with OSA severity in univariate analysis. Following adjustment for confounding factors, apnoea-hypopnoea index (AHI) (standardised β 0.158; p<0.001), along with nocturnal hypoxaemia, predicted HbA1c. Adjusted mean HbA1c levels were lower in the lowest AHI quartile (5.24%, 95% CI 5.21-5.27%) than in the second (5.37%, 95% CI 5.34-5.40%), third (5.44%, 95% CI 5.41-5.47%) or highest (5.50%, 95% CI 5.46-5.53%) quartiles. Subjects in the higher quartiles had significantly greater adjusted odds ratios of HbA1c level ≥6.0% than those in the first quartile. In stratified analyses, OSA severity predicted glycaemic health irrespective of sleep study modality, sex, obesity or daytime sleepiness. OSA severity independently predicts glycaemic health in nondiabetic subjects. Further studies should assess the impact of OSA treatment on glycaemic health and elucidate underlying mechanisms.
School of Medicine and Medical Science, University College Dublin, Dublin Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Dublin, Ireland.
Brian D
BD
Kent
Sleep Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden.
Ludger
L
Grote
DiBiMIS, University of Palermo, Palermo CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy.
Maria R
MR
Bonsignore
Turku University Hospital, Division of Medicine, Department of Pulmonary Diseases and Sleep Research Unit, Department of Physiology, University of Turku, Turku, Finland.
Tarja
T
Saaresranta
Dept of Pulmonary Medicine, Antwerp University Hospital, Antwerp, Belgium.
Johan
J
Verbraecken
Faculté de Médecine, Université Joseph Fourier, INSERM U 1042, Grenoble, France.
Patrick
P
Lévy
Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
Pawel
P
Sliwinski
Dept of Respiratory Medicine, P.J. Safarik University, Kosice L. Pasteur University Hospital, Kosice, Slovakia.
Ruzena
R
Tkacova
ENT Dept, Førde Central Hospital, Førde, Norway.
John-Arthur
JA
Kvamme
Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Ingo
I
Fietze
Sleep Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden.
Jan
J
Hedner
School of Medicine and Medical Science, University College Dublin, Dublin Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Dublin, Ireland Walter.mcnicholas@ucd.ie.
Walter T
WT
McNicholas
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D001786:Blood Glucose / Q000032:analysis*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus; D005060:Europe; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood; D000860:Hypoxia / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D016896:Treatment Outcome; D055815:Young Adult
D001786:Blood Glucose; D006442:Glycated Hemoglobin