title: The association of obstructive sleep apnea (OSA) and nocturnal hypoxemia with the development of abnormal HbA1c in a population cohort of men without diabetes.
abstract: OBJECTIVE
  To examine the relationship between indices of undiagnosed OSA and the development of abnormal glycaemic control in community-dwelling men free of diabetes.
  
  
  METHODS
  The Men, Androgens, Inflammation, Lifestyle, Environment, and Stress (MAILES) Study is a population-based cohort study in Adelaide, South Australia. Clinic visits at baseline (2002-06) and follow-up (2007-10) identified abnormal glycaemic metabolism [HbA1c 6.0 to <6.5% (42 to <48mmol/mol)] in men without diabetes. At follow-up (2010-11), n=837 underwent assessment of OSA by full in-home unattended polysomnography (Embletta X100).
  
  
  RESULTS
  Development of abnormal glycaemic metabolism over 4-6 years (n=103 "incident" cases, 17.0%) showed adjusted associations [odds ratio (95% CI)] with the 1st [1.7 (0.8-3.8)], 2nd [2.4 (1.1-4.9)], and 3rd [2.3 (1.1-4.8)] quartiles of mean oxygen saturation (SaO2) compared to the highest quartile. Prevalent abnormal glycaemic metabolism (n=140, 20.8%) was independently associated with the third and fourth quartiles of percentage of sleep time with oxygen saturation <90% and lowest quartile of mean SaO2. Linear regression analysis showed a significant reduction in HbA1c [unstandardized B, 95% CI: -0.02 (-0.04, -0.002), p=0.034] per percentage point increase in mean SaO2. OSA as measured by the apnea-hypopnea index showed no adjusted relationship with abnormal glycaemic metabolism.
  
  
  CONCLUSIONS
  Development of abnormal glycaemic metabolism was associated with nocturnal hypoxemia. Improved management of OSA and glycaemic control may occur if patients presenting with one abnormality are assessed for the other.
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia; Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia. Electronic address: sarah.appleton@adelaide.edu.au.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Appleton
authors.affiliation: Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vakulin
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia; Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Wittert
authors.affiliation: Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Martin
authors.affiliation: Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Janet F
authors.initials: JF
authors.lastname: Grant
authors.affiliation: Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Taylor
authors.affiliation: Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
authors.forename: R Douglas
authors.initials: RD
authors.lastname: McEvoy
authors.affiliation: Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Antic
authors.affiliation: Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Catcheside
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D001786:Blood Glucose; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D000860:Hypoxia / Q000150:complications*; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017286:Polysomnography; D015995:Prevalence; D020181:Sleep Apnea, Obstructive / Q000150:complications*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Cohort study; Glycaemic control; Men; Nocturnal hypoxemia; Obstructive sleep apnea