High Baseline Insulin Levels Associated With 6-Year Incident Observed Sleep Apnea
- Beverley Balkau, PHD1,2,
- Sylviane Vol, MSC3,
- Sandrine Loko, MD1,2,
- Tiana Andriamboavonjy, MD1,2,
- Olivier Lantieri, MD, MPH3,
- Gaelle Gusto, PHD3,
- Nicole Meslier, MD4,
- Jean-Louis Racineux, MD4,
- Jean Tichet, MD3 and
- and the Data from an Epidemiologic Study on the Insulin Resistance Syndrome (D.E.S.I.R.) Study Group*
- 1Institut Nationale de la Santé et de la Recherché Médicale, CESP Centre for research in Epidemiology and Population Health, Unité 1018, Epidemiology of diabetes, obesity and chronic kidney disease over the lifecourse, Villejuif, France;
- 2University Paris Sud 11, Unité Mixte de Recherche en Santé 1018, Villejuif, France;
- 3Institut inter Régional pour la Santé, La Riche, France;
- 4Department of Pneumology, Center Hospitalier Universitaire d'Angers, Angers, France.
- Corresponding author: Beverley Balkau, beverley.balkau{at}inserm.fr.
Abstract
OBJECTIVE Obstructive sleep apnea is common in patients with type 2 diabetes, and its association with insulin and insulin resistance has been examined in cross-sectional studies. We evaluate risk factors for incident observed sleep apnea in a general population not selected for sleep disturbances.
RESEARCH DESIGN AND METHODS A total of 1,780 men and 1,785 women, aged 33 to 68 years, from the cohort Data from an Epidemiologic Study on the Insulin Resistance Syndrome (D.E.S.I.R.) responded to the question, “Has someone said to you that you stop breathing during your sleep?” at baseline and 6 years. Anthropometric, clinical, and biological factors were recorded at both time points.
RESULTS At baseline, 14% of men and 7% of women reported having observed sleep apnea (positive response to question); 6-year incidences were 14 and 6%, respectively. Age, anthropometric parameters, blood pressure, and sleep characteristics were all associated with prevalent, observed apnea episodes, in both sexes. Baseline waist circumference was the strongest predictor of incident apnea: standardized odds ratio (OR), adjusted for age and sex, 1.34 (95% CI 1.19–1.52). After adjustment for age, sex, and waist circumference, the standardized ORs for incident observed apnea were identical for fasting insulin and the homeostasis model assessment of insulin resistance: 1.31 (1.13–1.51) and 1.24 (1.09–1.41) for triglycerides and 1.52 (1.12–2.05) for smoking. Observed apnea at baseline was not associated with changes in anthropometric or biological parameters over the 6-year follow-up.
CONCLUSIONS The most important baseline risk factor for incident apnea was adiposity. After accounting for adiposity, other risk factors were high insulin, insulin resistance, high triglycerides, and smoking, factors amenable to lifestyle intervention.
Footnotes
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↵*A complete list of the members of the Data from an Epidemiologic Study on the Insulin Resistance Syndrome (D.E.S.I.R.) Study Group can be found in the appendix.
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- Received October 13, 2009.
- Accepted February 7, 2010.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
- © 2010 by the American Diabetes Association.
