title: Association between Glucose Metabolism and Sleep-disordered Breathing during REM Sleep.
abstract: BACKGROUND
  Sleep-disordered breathing (SDB) has been associated with impaired glucose metabolism. It is possible that the association between SDB and glucose metabolism is distinct for non-REM versus REM sleep because of differences in sleep-state-dependent sympathetic activation and/or degree of hypoxemia.
  
  
  OBJECTIVE
  To characterize the association between REM-related SDB, glucose intolerance, and insulin resistance in a community-based sample.
  
  
  METHODS
  A cross-sectional analysis that included 3,310 participants from the Sleep Heart Health Study was undertaken (53% female; mean age, 66.1 yr). Full montage home-polysomnography and fasting glucose were available on all participants. SDB severity during REM and non-REM sleep was quantified using the apnea-hypopnea index in REM (AHIREM) and non-REM sleep (AHINREM), respectively. Fasting and 2-hour post-challenge glucose levels were assessed during a glucose tolerance test (n = 2,264). The homeostatic model assessment index for insulin resistance (HOMA-IR) was calculated (n = 1,543). Linear regression was used to assess the associations of AHIREM and AHINREM with fasting and post-prandial glucose levels and HOMA-IR.
  
  
  RESULTS
  AHIREM and AHINREM were associated with fasting glycemia, post-prandial glucose levels, and HOMA-IR in models that adjusted for age, sex, race, and site. However, with additional adjustment for body mass index, waist circumference, and sleep duration, AHIREM was only associated with HOMA-IR (β = 0.04; 95% CI, 0.1-0.07; P = 0.01), whereas AHINREM was only associated with fasting (β = 0.93; 95% CI, 0.14-1.72; P = 0.02) and post-prandial glucose levels (β = 3.0; 95% CI, 0.5-5.5; P = 0.02).
  
  
  CONCLUSIONS
  AHIREM is associated with insulin resistance but not with fasting glycemia or glucose intolerance.
authors.affiliation: 1 Department of Medicine, American University of Beirut, Beirut, Lebanon.|2 Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Hassan A
authors.initials: HA
authors.lastname: Chami
authors.affiliation: 3 VA Boston Healthcare System, Boston, Massachusetts.|4 Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Gottlieb
authors.affiliation: 4 Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: 5 Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005260:Female; D044882:Glucose Metabolism Disorders / Q000150:complications*; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000378:metabolism*; D012895:Sleep, REM
chemical_list: D001786:Blood Glucose
keywords: REM sleep; epidemiology; glucose intolerance; insulin resistance; sleep apnea