title: Associations between Obstructive Sleep Apnea, Sleep Duration, and Abnormal Fasting Glucose. The Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  No data exist as to the role of ethnicity in the associations between obstructive sleep apnea (OSA), sleep duration, and metabolic dysfunction.
  
  
  OBJECTIVE
  To examine links between OSA, objectively measured habitual sleep duration, and fasting glucose in U.S. ethnic groups.
  
  
  METHODS
  The Multi-Ethnic Study of Atherosclerosis is a multisite community-based study that conducted polysomnography and wrist actigraphy. In 2,151 subjects (1,839 in fully adjusted models), the apnea-hypopnea index was used to classify OSA as none (0-4.9/h), mild (5-14.9/h), or moderate to severe (≥15/h). Actigraphic sleep duration was classified as short (≤5 h/night), intermediate (>5 and <8 h/night), or long (≥8 h/night). Subjects were classified as having normal fasting glucose (<100 mg/dl and no hypoglycemic medication use) or abnormal fasting glucose (≥100 mg/dl and/or hypoglycemic medication use).
  
  
  RESULTS
  The sample was 45.8% male, age 68.5 ± 9.2 (mean ± SD) years, and 27.3% African American, 37.2% white, 11.8% Chinese, and 23.8% Hispanic. The prevalence of abnormal fasting glucose was 40.2%. Relative to subjects without apnea, moderate-to-severe OSA was significantly associated with abnormal fasting glucose in African Americans (odds ratio, 2.14; 95% confidence interval, 1.12-4.08) and white participants (odds ratio, 2.85; 95% confidence interval, 1.20-6.75), but not among Chinese or Hispanic subjects, after adjusting for site, age, sex, waist circumference, and sleep duration (P = 0.06 for ethnicity-by-OSA severity interaction). In contrast, sleep duration was not significantly associated with abnormal fasting glucose after considering the influence of OSA.
  
  
  CONCLUSIONS
  This large multiethnic study confirmed previous reports of an independent association between OSA and metabolic dysfunction, and suggested that this association may vary by ethnicity.
authors.affiliation: 1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Jessie P
authors.initials: JP
authors.lastname: Bakker
authors.affiliation: 1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Jia
authors.initials: J
authors.lastname: Weng
authors.affiliation: 1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: 1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
authors.affiliation: 1 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Patel
mesh_terms: D056044:Actigraphy; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000150:complications / Q000208:ethnology / Q000503:physiopathology*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001786:Blood Glucose
keywords: ethnicity; insulin resistance; obstructive sleep apnea; type 2 diabetes mellitus