Pharyngeal collapsibility during sleep is elevated in insulin-resistant females with morbid obesity.
Insulin resistance is associated with sleep apnoea, leading us to hypothesise that it is also associated with elevations in pharyngeal collapsibility, even in the absence of sleep apnoea.90 bariatric patients were characterised for sleep apnoea, pharyngeal collapsibility and insulin resistance. Patients with a respiratory disturbance index (RDI) >10 events·h(-1), diabetes mellitus, tonsillar hypertrophy and pulmonary disease were excluded. The remaining 14 females underwent collapsibility measurements (passive critical pressure, Pcritp ) during non-rapid eye movement sleep. The homeostasis model assessment (HOMA) index, a measure of insulin resistance, was derived from measurements of fasting glucose and insulin levels, and compared to Pcritp Groups with high Pcritp compared to low Pcritp did not differ in age, body mass index or RDI. HOMA and insulin were elevated in the high Pcritp group compared to the low Pcritp group (p<0.02). Pcritp correlated with HOMA (Spearman's ρ=0.565, 95% CI 0.104-0.862; p=0.035) and insulin (Spearman's ρ=0.609 95% CI 0.196-0.835; p=0.021).Obese insulin-resistant subjects without frank diabetes or sleep apnoea demonstrate preclinical elevations in pharyngeal collapsibility, which may increase their susceptibility to sleep apnoea. Our findings suggest that insulin resistance could play a significant role in sleep apnoea pathogenesis by generating requisite elevations in pharyngeal collapsibility.
Dept of Medicine, University of Arkansas, Little Rock, AR, USA.
Oscar L
OL
Llanos
Critical Care Medicine, National Institutes of Health, Bethesda, MD, USA.
Panagis
P
Galiatsatos
Dept of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
Edmarie
E
Guzmán-Vélez
Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Susheel P
SP
Patil
Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Philip L
PL
Smith
Dept of Surgery, Johns Hopkins University, Baltimore, MD, USA.
Thomas
T
Magnuson
Dept of Surgery, Johns Hopkins University, Baltimore, MD, USA.
Michael
M
Schweitzer
Dept of Surgery, Johns Hopkins University, Baltimore, MD, USA.
Kimberley
K
Steele
Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Vsevolod Y
VY
Polotsky
Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA aschwar2@jhmi.edu.
Alan R
AR
Schwartz
D050154:Adiposity; D000328:Adult; D000886:Anthropometry; D050110:Bariatric Surgery; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology*; D010614:Pharynx / Q000503:physiopathology*; D017286:Polysomnography; D011312:Pressure; D012890:Sleep; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology*
D001786:Blood Glucose; D007328:Insulin