title: Sleep-related intermittent hypoxemia and glucose intolerance: a community-based study.
abstract: BACKGROUND
  Intermittent hypoxemia is a fundamental pathophysiological consequence of sleep-disordered breathing and may alter glucose metabolism. To characterize the association between sleep-related intermittent hypoxemia and glucose metabolism, overnight pulse-oximetry and an oral glucose tolerance test were completed in a cohort of middle-aged and older Japanese adults.
  
  
  METHODS
  The study sample consisted of 1836 community-dwelling Japanese (age, 30-79 years; women, 65.5%; mean body mass index, 23.1 kg/m(2)). The oxygen desaturation index (ODI) was quantified during sleep using a ≥3% oxygen desaturation threshold and categorized as normal (<5.0 events/h), mild (5.0-15.0 events/h), and moderate to severe (≥15.0 events/h). The independent associations between the ODI and the prevalence of impaired fasting glucose, impaired glucose tolerance, diabetes, and two metrics of insulin resistance [homeostasis model assessment index for insulin resistance (HOMA-IR) and Matsuda index] were examined.
  
  
  RESULTS
  Compared with subjects with an ODI < 5 events/h, the adjusted odds ratio for prevalent impaired fasting glucose, glucose intolerance, and diabetes for subjects with an ODI ≥15.0 events/h were 1.27 (95% confidence interval, 0.72-2.23), 1.69 (1.03-2.76), and 1.28 (0.59-2.79), respectively. Both HOMA-IR and Matsuda index were significantly associated with the severity of sleep-related intermittent hypoxemia as assessed by the ODI (P for trend = 0.03 and 0.007, respectively).
  
  
  CONCLUSIONS
  Among middle-aged and older Japanese adults, sleep-related intermittent hypoxemia is associated with glucose intolerance and insulin resistance, and may contribute to the development of type 2 diabetes mellitus.
authors.affiliation: Department of Public Health, Ehime University Graduate School of Medicine, Toon, Japan; Center of Sleep Medicine, Ehime University Hospital, Toon, Japan.
authors.forename: Sakurako
authors.initials: S
authors.lastname: Tanno
authors.affiliation: Department of Public Health, Ehime University Graduate School of Medicine, Toon, Japan. Electronic address: tt9178tt9178@gmail.com.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tanigawa
authors.affiliation: Department of Basic Nursing and Health Science, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Saito
authors.affiliation: Department of Molecular and Genetic Medicine, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Nishida
authors.affiliation: Department of Basic Medical Research and Education, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Koutatsu
authors.initials: K
authors.lastname: Maruyama
authors.affiliation: Department of Public Health, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Eri
authors.initials: E
authors.lastname: Eguchi
authors.affiliation: Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Sakurai
authors.affiliation: Department of Molecular and Genetic Medicine, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Osawa
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology; D005260:Female; D018149:Glucose Intolerance / Q000209:etiology*; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D012891:Sleep Apnea Syndromes / Q000150:complications*
keywords: Diabetes mellitus; Epidemiology; Impaired glucose tolerance; Oral glucose tolerance test; Oximetry; Sleep apnea; Sleep-disordered breathing