Associations between Obstructive Sleep Apnea, Sleep Duration, and Abnormal Fasting Glucose The Multi-Ethnic Study of Atherosclerosis

Rationale: No data exist as to the role of ethnicity in the associations between obstructive sleep apnea (OSA), sleep duration, and metabolic dysfunction. Objectives: To examine links between OSA, objectively measured habitual sleep duration, and fasting glucose in U.S. ethnic groups. Methods: The Multi-Ethnic Study of Atherosclerosis is a multisite community-based study that conducted polysomnography and Wrist actigraphy. In 2,151 subjects (1,839 in fully adjusted models), the apnea-hypopnea index was used to classify OSA as none (0-4.9/h), mild (5-14.9/h), or moderate to severe (>= 15/h). Actigraphic sleep duration was classified as short (<= 5 h/night), intermediate (>5 and <8 h/night), or long (>= 8 h/night). Subjects were classified as having normal fasting glucose (<100 mg/dl and no hypoglycemic medication use) or abnormal fasting glucose (>= 100 mg/dl and/or hypoglycemic medication use). Measurements and Main Results: The sample was 45.8% male, age 68.5 +/- 9.2 (mean +/- SD) years, and 27.3% African American, 37.2% white, 11.8% Chinese, and 23.8% Hispanic. The prevalence of abnormal fasting glucose was 40.2% Relative to subjects without apnea, moderate-to-severe OSA was significantly associated with abnormal fasting glucose in African Americans (odds ratio, 2.14; 95% confidence interval, 1.12-4.08) and white participants (odds ratio, 2.85; 95% confidence interval, 1.20-6.75), but not among Chinese or Hispanic subjects, after adjusting for site, age, sex, waist circumference, and sleep duration (P = 0.06 for ethnicity-by-OSA severity interaction). In contrast, sleep duration was not significantly associated with abnormal fasting glucose after considering the influence of OSA. Conclusions: This large multiethnic study confirmed previous reports of an independent association between OSA and metabolic dysfunction, and suggested that this association may vary by ethnicity.