Obesity, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleep-disordered breathing

doi:10.1016/j.sleep.2006.06.014

Sleep Medicine

Volume 8, Issue 1, January 2007, Pages 12-17

https://doi.org/10.1016/j.sleep.2006.06.014 Get rights and content

Abstract

Objective: To assess the profile of metabolic abnormalities in subjects with obstructive sleep apnea (OSA).

Patients and methods: In a case-control study conducted in two years, from April 2003 to March 2005, data obtained from polysomnography study, lipid profile, fasting blood sugar, serum insulin, insulin resistance, leptin and adiponectin levels, were compared between the various groups. Included in the study were OSA subjects from a sleep laboratory and matched controls from the community. Those with recent myocardial infarction, upper airway surgery, class III/IV heart failure, pregnancy, acromegaly, chronic renal failure, or who were on treatment for hyperthyroidism, on systemic steroid treatment, or on hormonal replacement therapy, were excluded from the study.

Results: Forty apneic obese subjects (AHI = 32.19, range 13–52.75) were compared with 40 non-apneic obese controls (AHI = 1.3, range 0–2.45) and 40 normal weight control subjects (AHI = 0.7, range 0–1). No significant difference was noted in levels of fasting blood sugar, insulin resistance (obese apneics 61.9, obese controls 47.8, non-obese controls 19.1), leptin (obese apneics 10.65 μg/L, obese controls 8.52 μg/L, non-obese controls 2.83 μg/L) or adiponectin (obese apneics 4959.3 ng/ml, obese controls 5706 ng/ml, non-obese controls 7412 ng/ml) in the OSA group compared to obese controls.

Conclusions: OSA has no independent association with lipid abnormalities, insulin resistance, serum leptin and adiponectin levels. In multivariate analysis, obesity was the major determinant of metabolic abnormalities in this cohort.

Introduction

With changing lifestyle and dietary habits, the Indian subcontinent is currently witnessing an epidemic of obesity and metabolic disorders, which were hitherto rarely encountered. The World Health Organization has already sounded a warning for the sweeping epidemic of metabolic disorders in the region [1].

The global burden of obstructive sleep apnea syndrome (OSAS) has been determined to be fairly high with estimated prevalence between 0.3 and 7.5% [2], [3], [4]. In a different study by the same authors, the prevalence of OSAS has been estimated at 3.57% in the same population [5]. Moreover, it has ceased to be a disease of the developed world, as alarming incidence has been reported in the only prevalence study conducted on adult Indian males presenting to a private hospital for routine health check-up [4]. Despite the early recognition of the association between OSA and cardiovascular morbidity and mortality [6], [7], OSA has been treated as a local abnormality and associated with the highly prevalent comorbidity, obesity, in the subjects. However, recent data suggest that OSA might be independently associated with metabolic abnormalities [8], [9].

Considering the sweeping epidemic of metabolic abnormalities in the Southeast Asia region and their close association with OSA, in the current study metabolic variates were analyzed in a subset of subjects who during sleep studies were found to be positive for OSA compared with controls. To the best of our knowledge, this is the first reported attempt to assess the metabolic profile including leptin, adiponectin and insulin resistance in OSA on the Indian subcontinent.

Section snippets

Methodology

The current study was conducted between April 2003 and March 2005 in the Department of Medicine at the All India Institute of Medical Sciences Hospital, New Delhi, India. The Institutional Review Board of the hospital approved the study. Consecutive subjects during sleep studies at the sleep laboratory who were found to have OSAS were included in the study. Healthy controls, matched for age and sex, were recruited from a community-based prevalence study. Written informed consent was obtained

Results

In this study we compared 40 apneic obese subjects (AHI = 32.19, range 13–52.75) with 40 non-apneic obese controls (AHI = 1.3, range 0–2.45) and 40 normal weight control subjects (AHI = 0.7, range 0–1). The demographic and PSG profile of the 120 subjects is presented in Table 1.

The subjects with OSA were found to have more fat distribution around their neck as shown by neck circumference of 39.27 cm and percentage of predicted neck circumference (PPNC) of 98.14. More subjects in the OSA group (25%)

Discussion

Profound changes in behavioral patterns of communities over recent decades have led to a remarkable rise of metabolic disorders in society. Paradoxically, coexisting with undernutrition, an escalating global epidemic of overweight and obesity – “globesity” – is taking over many parts of the world. The epidemic is no longer restricted to industrialized societies; this increase often happens more quickly in developing countries than in the developed world [21]. According to World Health

Acknowledgements

We are indebted to Dr Duncan Smith Rohrberg for enthusiastic support of the collaborative research and intelligent input while we were preparing the final manuscript. We acknowledge the help rendered by Dr Sreenivas for analysis of the raw data and his efforts to give it final shape. We thankfully acknowledge the relentless efforts of the sleep laboratory personnel, technicians Mr Jitender Sharma, Mr Jitender Kumar and the support staff that helped us collect reliable and meaningful information

References (33)

S.K. Sharma et al.
Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India
Chest
(2006)
H. Schafer et al.
Body fat distribution, serum leptin, and cardiovascular risk factors in men with obstructive sleep apnea
Chest
(2002)
M.S. Ip et al.
Serum leptin and vascular risk factors in obstructive sleep apnea
Chest
(2000)
S.K. Sharma et al.
A stepped approach for prediction of obstructive sleep apnea in overtly asymptomatic obese subjects: a hospital based study
Sleep Med
(2004)
A.N. Vgontzas et al.
Sleep apnea is a manifestation of the metabolic syndrome
Sleep Med Rev
(2005)
Inoue S, Zimmet P, et al. February 2000. The Asia-Pacific perspective: Redefining obesity and its treatment....
Z.F. Udwadia et al.
Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men
Am J Respir Crit Care Med
(2004)
T. Young et al.
The occurrence of sleep-disordered breathing among middle-aged adults
N Engl J Med
(1993)
J.R. Stradling et al.
Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men
Thorax
(1991)
E.C. Fletcher
Obstructive sleep apnea and the kidney
J Am Soc Nephrol
(1993)

M.S. Ip et al.

Obstructive sleep apnea is independently associated with insulin resistance

Am J Respir Crit Care Med

(2002)

J. Minami et al.

Effects of smoking cessation on blood pressure and heart rate variability in habitual smokers

Hypertension

(1999)

T. Hauge et al.

Neuropeptides in the duodenal mucosa of chronic alcoholic heavy drinkers

Alcohol Alcohol

(2001)

T.S. Han et al.

Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample

BMJ

(1995)

R.J.O. Davies et al.

The relationship between neck circumference, radiographic pharyngeal anatomy and obstructive sleep apnoea

Eur Respir J

(1990)

A.V. Chobanian et al.

The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure

JAMA

(2003)

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Respiratory complications represented by obstructive sleep apnea (OSA), cardiovascular disease (CVD), and metabolic disorders including insulin resistance (IR) are common in patients with acromegaly. OSA is further associated with a higher risk of IR and CVD in the general population. However, significant information on the effect of OSA on IR and CVD risk for patients with acromegaly remains to be scarce.
This retrospective study included 125 patients with active acromegaly. Medical history, anthropometric parameters, polysomnographic and fasting biochemical measurements were collected. Ten-year Framingham CVD risk scores were calculated and categorized as low, moderate, and high. IR was assessed using the homeostasis model assessment (HOMA-IR).
OSA was confirmed in two thirds of the enrolled patients. Compared with patients without OSA, patients with both OSA and acromegaly were found to have higher proportion of HOMA-IR and moderate-to-high 10-year CVD risk. Logistic regression analysis showed that OSA, HOMA-IR, and low-density lipoprotein cholesterol were all risk factors for moderate-to-high CVD risk. Meanwhile, no mediating effect of HOMA-IR in the association between OSA and Framingham CVD risk was observed in patients with acromegaly.
The coexistence of OSA might increase the CVD risk for patients with acromegaly, and IR might independently contribute to CVD risk in acromegalic patients with OSA.
The serum leptin level in non-obese patients with obstructive sleep apnea
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This study aimed to determine the association between the severity of obstructive sleep apnea (OSA) and the serum leptin level in non-obese OSA patients.
This prospective case-control study included non-obese OSA patients that presented with sleep-related disturbances and underwent polysomnography (PSG) between April 2015 and June 2016. The serum leptin level was measured and its relationship to PSG parameters was investigated.
The study included 73 OSA patients (20 female and 53 male) with a mean age of 41.1 ± 11.5 years and mean body-mass index (BMI) of 26.4 ± 2.7 kg m^–2. The serum leptin level in 44 patients with moderate/severe OSA (AHI ≥15) was 3.4 ± 2.6 ng mL^–1, versus 4.5 ± 3.8 ng mL^–1 in 29 patients with snoring/mild OSA (AHI <15) (P = 0.20). There were not any correlations between any of the PSG parameters and the serum leptin level, but there was a significant correlation between the leptin level and BMI (r = 0.345, P < 0.01).
The serum leptin level does not differ significantly between non-obese OSA patients with moderate/severe and snoring/mild OSA. Obesity is the primary factor associated with the serum leptin level.
Obstructive sleep apnea: Is it a biomarker of metabolic health in obesity
2017, Obesity Medicine
The prevalence of obstructive sleep apnea (OSA) increases with obesity, and OSA has been linked to increased cardiovascular risk via hypoxemia and sleep disruption.
We hypothesized that if OSA contributes to cardio-metabolic risk, then 1) obese individuals with OSA will have more cardio-metabolic disease, and 2) patients with OSA who are non-adherent to CPAP treatment will have a greater incidence of cardio-metabolic abnormalities.
We prospectively recruited obese patients (n = 83; BMI 49 ± 9 kg/m²). All patients had polysomnography and were stratified by 1) the absence/presence of OSA, and 2) metabolic health. Detailed CPAP reports were analyzed for compliance and OSA severity in 38 subjects.
OSA by polysomnography was present in 69% of patients. While 79% of patients with OSA and 54% without OSA were categorized as MAO (χ2 = 5.47, p < 0.02), when adjusted for age, gender and BMI this difference was not significant (p = 0.36). Insulin levels were higher in the OSA group, but when adjusted there was no significant difference (p = 0.350). In patients on CPAP therapy, there was a negative associative trend between OSA control (apnea-hypopnea index) and beta-cell function (HOMA-β) (r = −0.406, p = 0.076), but no association between CPAP compliance and AHI with age, BMI, glucose, insulin, adiponectin, or insulin resistance.
OSA is not independently associated with overall cardio-metabolic health and insulin resistance in obese patients, even when accounting for treatment compliance. The strongest predictors of the obese metabolic healthy phenotype in OSA patients are age, gender and BMI.
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Citation Excerpt :
Several studies provide some indirect evidence that obesity, not OSA, is responsible for dyslipidaemia in patients with sleep-disordered breathing. Sharma et al. reported that the lipid levels between apnoeic obese and nonapnoeic obese patients are similar and significantly higher than non-obese controls (P<0.05) [12]. A Japanese study focussing on lean men found that the HDL-C and triglycerides did not differ between the OSA and control groups [11].
The effect of obesity and medication on the relationship between obstructive sleep apnoea (OSA) and lipidaemia and systemic inflammation is not fully understood for various reasons. The aim of the present study is to determine the effects of 12 months of therapy with continuous positive airway pressure (CPAP) on lipid profiles and high-sensitivity C-reactive protein (hs-CRP) in non-obese patients with coronary artery disease (CAD) and OSA.
We consecutively recruited 78 non-obese subjects with newly diagnosed CAD and moderate-to-severe OSA who were taking lipid-lowering medication. Patients were randomised to CPAP treatment or the control group. The patients’ lipids and the hs-CRP level were measured at baseline and at follow-up.
Seventy patients completed the study. The CPAP and control groups had similar characteristics at baseline. The mean duration of CPAP treatment was 4.2 ± 1.1 h/night. There was no significant difference in the lipids or hs-CRP levels at 12 months (both, P>0.05). The apnoea-hypopnoea index and Epworth Sleepiness Scale were significantly lower in the CPAP treatment group than in the control group (both, P<0.05).
Continuous positive airway pressure treatment in non-obese patients with CAD and OSA who are taking standardised lipid-lowering treatment does not significantly decrease the lipid or hs-CRP levels. In addition, there are no relationships found between the severity of OSA and the lipid profiles. However, the status of OSA and daytime sleepiness improved significantly in the CPAP group.
URL: http://clinicaltrials.gov. Unique identifier: NCT02127177.
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Original articleObesity, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleep-disordered breathing

Abstract

Introduction

Section snippets

Methodology

Results

Discussion

Acknowledgements

Chest

Chest

Chest

Sleep Med

Sleep Med Rev

Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men

Am J Respir Crit Care Med

The occurrence of sleep-disordered breathing among middle-aged adults

N Engl J Med

Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men

Thorax

Obstructive sleep apnea and the kidney

J Am Soc Nephrol

Obstructive sleep apnea is independently associated with insulin resistance

Am J Respir Crit Care Med

Effects of smoking cessation on blood pressure and heart rate variability in habitual smokers

Hypertension

Neuropeptides in the duodenal mucosa of chronic alcoholic heavy drinkers

Alcohol Alcohol

Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample

BMJ

The relationship between neck circumference, radiographic pharyngeal anatomy and obstructive sleep apnoea

Eur Respir J

The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure

JAMA

Original article
Obesity, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleep-disordered breathing