Sleep Apnea and Glucose Metabolism A Long-term Follow-up in a Community-Based Sample

Background: It has been suggested that sleep-disordered breathing (SDB) is a risk factor for diabetes, but long-term follow-up studies are lacking. The aim of this community-based study was to analyze the influence of SDB on glucose metabolism after >10 years. Methods: Men without diabetes (N = 141; mean age, 57.5 years) were investigated at baseline, including whole-night respiratory monitoring. After a mean period of 11 years and 4 months, they were followed up with an interview, anthropometric measurements, and blood sampling. Insulin resistance was quantified using the homeostasis model assessment of insulin resistance (HOMA-IR). Delta HOMA-IR was calculated as (HOMA-IR at follow-up - HOMA-IR at baseline). An oral glucose tolerance test was performed on 113 men to calculate the insulin sensitivity index. Results: The mean apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) at baseline were 4.7 and 3.3, respectively. At follow-up, 23 men had diabetes. An ODI>5 was a predictor of developing diabetes (OR, 4.4; 95% CI, 1.1-18.1, after adjusting for age, BMI, and hypertension at baseline and Delta BMI and years with CPAP during follow-up). The ODI was inversely related to the insulin sensitivity index at follow-up (r = -0.27, P=.003). A deterioration in HOMA-IR was significantly related to all variables of SDB (AHI, AHI >5; ODI, ODI>5; minimum arterial oxygen saturation), even when adjusting for confounders. When excluding the variable years with CPAP from the multivariate model, all associations weakened. Conclusions: SDB is independently related to the development of insulin resistance and, thereby, the risk of manifest diabetes mellitus. CHEST 2012; 142(4):935-942