Obstructive sleep apnea and incident type 2 diabetes.
To determine whether severity of obstructive sleep apnea is associated with incident diabetes in middle-aged and older adults.



A prospective analysis of 1453 non-diabetic participants of both the Atherosclerosis Risk in Communities Study and the Sleep Heart Health Study (mean age 63 years, 46% male) had in-home polysomnography (1996-1998) and was followed up for incident diabetes. Using the apnea-hypopnea index derived from home polysomnography, study participants were categorized as follows: <5.0 (normal), 5.0-14.9 (mild), 15.0-29.9 (moderate), and ≥30.0 events/h (severe). Incident diabetes was ascertained during annual follow-up telephone calls through 2013.



During a median follow-up of 13 years, there were 285 incident diabetes cases among the 1453 participants. Participants with severe obstructive sleep apnea were at greater risk of incident diabetes compared to persons classified as normal after adjustment for confounders including body mass index and waist circumference (1.71 [1.08, 2.71]). The association between severe obstructive sleep apnea and incident diabetes was similar when analyses were restricted to obese individuals.



Severe obstructive sleep apnea was associated with greater risk of incident diabetes, independent of adiposity in a community-based sample. Healthcare professionals should be cognizant of the high prevalence of OSA in the general population and the potential link to incident diabetes.
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. Electronic address: mnagayoshi@nagasaki-u.ac.jp.
Mako
M
Nagayoshi
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Naresh M
NM
Punjabi
Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Elizabeth
E
Selvin
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
James S
JS
Pankow
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
Eyal
E
Shahar
Division of Preventive and Environmental Medicine, Osaka University, Osaka, Japan.
Hiroyasu
H
Iso
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
Aaron R
AR
Folsom
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
Pamela L
PL
Lutsey
D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D017286:Polysomnography; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference
Diabetes; Epidemiology; Obesity; Obstructive sleep apnea