CORRELATION OF INSULIN RESISTANCE WITH SEVERITY OF OBSTRUCTIVE SLEEP APNOEA
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Keywords
Obstructive Sleep Apnea, Insulin Resistance, HOMA-IR, Polysomnography, Metabolic Syndrome, Apnea-Hypopnea Index.
Abstract
Background: OSA, or obstructive sleep apnea, is a common but underdiagnosed sleep disorder in which the upper airway gets blocked during sleep, causing periods of low oxygen, sleep fragmentation, and being too sleepy during the day. It has been strongly associated with metabolic disorders, including IR (Insulin Resistance), a key factor in the pathogenesis of type 2 diabetes mellitus and metabolic syndrome. While various studies have postulated a correlation between OSA severity and insulin resistance, conflicting findings necessitate further investigation. This study aims to evaluate the relationship between the severity of OSA and insulin resistance using polysomnographic data and metabolic parameters.
Methods: A hospital-based cross-sectional study was conducted on 60 patients diagnosed with OSA through overnight PSG (Polysomnography). The severity of OSA was classified based on the AHI (Apnea-Hypopnea Index) into mild, moderate, and severe categories. Fasting blood glucose and insulin levels were measured to calculate the HOMA-IR (Homeostasis Model Assessment of Insulin Resistance). Statistical analysis was performed to assess the correlation between OSA severity and insulin resistance, with a p-value <0.05 considered significant.
Results: A significant correlation was observed between increasing OSA severity and higher HOMA-IR values, suggesting a positive association between OSA and insulin resistance. Severe OSA cases demonstrated significantly higher fasting insulin levels and HOMA-IR indices compared to mild and moderate OSA groups. However, no significant association was found between BMI (Body Mass Index) and insulin resistance, indicating that OSA may contribute to metabolic dysfunction independently of obesity.
Conclusion: The study highlights a significant association between OSA severity and insulin resistance, supporting the hypothesis that OSA is an independent risk factor for metabolic dysfunction. These findings emphasize the need for early screening and management of insulin resistance in patients with moderate to severe OSA to mitigate the risk of metabolic syndrome and cardiovascular complications. Further large-scale longitudinal studies are recommended to explore causality and potential therapeutic interventions.
References
[2] Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008;5(2):136-43.
[3] Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177(9):1006-14.
[4] Eckert DJ, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008;5(2):144-53.
[5] Van Helder T, Symons JD, Radomski MW. Effects of sleep deprivation and exercise on glucose tolerance. Aviat Space Environ Med 1993;64(6):487-92.
[6] Dinges DF, Pack F, Williams K, Gillen KA, Powell JW, Ott GE, et al. Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of restricted sleep. Sleep 1997;20(4):267-77.
[7] Van Cauter E, Desir D, Decoster C, Fery F, Balasse EO. Nocturnal decrease in glucose tolerance during constant glucose infusion. J Clin Endocrinol Metab 1989;69(3):604-11.
[8] Spiegel K, Leproult R, L'Hermite-Baleriaux M, Copinschi G, Penev PD, Van Cauter E. Leptin levels are dependent on sleep duration: relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab 2004;89(11):5762-71.
[9] Leproult R, Copinschi G, Buxton O, Van Cauter E. Sleep loss results in an elevation of cortisol levels the next evening. Sleep 1997;20(10):865-70.
[10] Baburao A, Souza GD. Insulin resistance in moderate to severe obstructive sleep apnea in nondiabetics and its response to continuous positive airway pressure treatment. North Am J Med Sci 2014;6(10):500.
[11] Iftikhar IH, Khan MF, Das A, Magalang UJ. Meta-analysis: continuous positive airway pressure improves insulin resistance in patients with sleep apnea without diabetes. Ann Am Thorac Soc 2013;10(2):115-20.
[12] Makino S, Handa H, Suzukawa K, Fujiwara M, Nakamura M, Muraoka S, et al. Obstructive sleep apnea syndrome, plasma adiponectin levels, and insulin resistance. Clin Endocrinol (Oxf) 2006;64(1):12-9.
[13] Ip MSM, Lam B, Ng MMT, Lam WK, Tsang KWT, Lam KSL. Obstructive Sleep Apnea Is Independently Associated with Insulin Resistance. Am J Respir Crit Care Med 2002;165(5):670-6.
[14] Shamsuzzaman A, Szczesniak RD, Fenchel MC, Amin RS. Glucose, insulin, and insulin resistance in normal- weight, overweight and obese children with obstructive sleep apnea. Obes Res Clin Pract 2014;8(6):e584-91.
[15] Bhushan B, Maddalozzo J, Sheldon SH, Haymond S, Rychlik K, Lales GC, et al. Metabolic alterations in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2014;78(5):854–9.
[16] Gruber A, Horwood F, Sithole J, Ali N, Idris I. Obstructive sleep apnea is independently associated with the metabolic syndrome but not insulin resistance state. Cardiovasc Diabetol 2006;5:22.
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Dr. Chinthu Sara Jacob
Assistant Professor, Department of General Medicine, SUT Academy of Medical Sciences,
Vencode, Trivandrum Kerala, India.
Dr. P.G. Vijayamohanan
Associate Professor, Department of General Medicine, SUT Academy of Medical Sciences,
Vencode, Trivandrum Kerala, India.
Dr. Suresh D.
Assistant Professor, Department of General Medicine, SUT Academy of Medical Sciences,
Vencode, Trivandrum Kerala, India.
Dr. Bhaskar M.K.
Professor, Department of General Medicine, SUT Academy of Medical Sciences,
Vencode, Trivandrum Kerala, India.