Independent Association Between Obstructive Sleep Apnea Severity and Glycated Hemoglobin in Adults Without Diabetes

  1. The IRSR Sleep Cohort Group*
  1. 1LUNAM University, Angers, France
  2. 2Department of Respiratory Diseases and INSERM U1063, Angers University Hospital, Angers, France
  3. 3CERMES, CNRS UMR8211, INSERM U988, EHESS, Villejuif, France
  4. 4Department of Respiratory Diseases, Nantes University Hospital, Nantes, France
  5. 5Department of Respiratory Diseases, Cholet Hospital, Cholet, France
  6. 6Department of Respiratory Diseases, Nouvelles Cliniques Nantaises, Nantes, France
  7. 7Department of Respiratory Diseases, Pôle Santé des Olonnes, Olonnes sur Mer, France
  8. 8Department of Respiratory Diseases, La Roche sur Yon Hospital, La Roche sur Yon, France
  9. 9Department of Respiratory Diseases, Le Mans Hospital, Le Mans, France
  1. Corresponding author: Frédéric Gagnadoux, frgagnadoux{at}


OBJECTIVE We tested the hypothesis of an independent cross-sectional association between obstructive sleep apnea (OSA) severity and glycated hemoglobin (HbA1c) in adults without known diabetes.

RESEARCH DESIGN AND METHODS HbA1c was measured in whole-blood samples from 2,139 patients undergoing nocturnal recording for suspected OSA. Participants with self-reported diabetes, use of diabetes medication, or HbA1c value ≥6.5% were excluded from this study. Our final sample size comprised 1,599 patients.

RESULTS A dose-response relationship was observed between apnea-hypopnea index (AHI) and the percentage of patients with HbA1c to >6.0%, ranging from 10.8% for AHI <5 to 34.2% for AHI ≥50. After adjustment for age, sex, smoking habits, BMI, waist circumference, cardiovascular morbidity, daytime sleepiness, depression, insomnia, sleep duration, and study site, odds ratios (95% CIs) for HbA1c >6.0% were 1 (reference), 1.40 (0.84–2.32), 1.80 (1.19–2.72), 2.02 (1.31–3.14), and 2.96 (1.58–5.54) for AHI values <5, 5 to <15, 15 to <30, 30 to <50, and ≥ 50, respectively. Increasing hypoxemia during sleep was also independently associated with the odds of HbA1c >6.0%.

CONCLUSIONS Among adults without known diabetes, increasing OSA severity is independently associated with impaired glucose metabolism, as assessed by higher HbA1c values, which may expose them to higher risks of diabetes and cardiovascular disease.

  • Received December 28, 2011.
  • Accepted April 6, 2011.

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