title: Does enhanced insulin sensitivity improve sleep measures in patients with obstructive sleep apnea: a randomized, placebo-controlled pilot study.
abstract: High fasting insulin levels have been reported to predict development of observed apneas, suggesting that insulin resistance may contribute to the pathogenesis of obstructive sleep apnea (OSA). The aim of this study was to determine whether enhancing insulin sensitivity in individuals with OSA would improve sleep measures.
  
  
  
  Insulin-resistant, nondiabetic individuals with untreated OSA were randomized (2:1) to pioglitazone (45 mg/day) or placebo for eight weeks in this single-blind study. All individuals had repeat measurements pertaining to sleep (overnight polysomnography and functional outcomes of sleep questionnaire) and insulin action (insulin suppression test).
  
  
  
  A total of 45 overweight/obese men and women with moderate/severe OSA were randomized to pioglitazone (n = 30) or placebo (n = 15). Although insulin sensitivity increased 31% among pioglitazone-treated compared with no change among individuals receiving placebo (p <0.001 for between-group difference), no improvement in quantitative or qualitative sleep measurements was observed.
  
  
  
  Pioglitazone administration increased insulin sensitivity in otherwise untreated individuals with OSA, without any change in polysomnographic sleep measures over an eight-week period. These findings do not support a causal role for insulin resistance in the pathogenesis of OSA.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address: aliceliu@stanford.edu.
authors.forename: Alice
authors.initials: A
authors.lastname: Liu
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Sun H
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Danit
authors.initials: D
authors.lastname: Ariel
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Fahim
authors.initials: F
authors.lastname: Abbasi
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Lamendola
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: James
authors.initials: J
authors.lastname: Cardell
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Shiming
authors.initials: S
authors.lastname: Xu
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Shailja
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Tomasso
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Hafasa
authors.initials: H
authors.lastname: Mojaddidi
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Kaylene
authors.initials: K
authors.lastname: Grove
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Tsao
authors.affiliation: Stanford Sleep Medicine Center, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Clete A
authors.initials: CA
authors.lastname: Kushida
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Reaven
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D005215:Fasting; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology; D010865:Pilot Projects; D000077205:Pioglitazone; D017286:Polysomnography / Q000379:methods; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D045162:Thiazolidinediones / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077205:Pioglitazone
keywords: Insulin resistance; Obstructive sleep apnea; Pioglitazone; Prediabetes