Zou Juanjuan, Liu Yupu, Xu Huajun, Meng Lili, Zou Jianyin, Qian Yingjun, Chen Bin, Yi Hongliang, Guan Jian, Yin Shankai
Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.
Ann Transl Med. 2021 Feb;9(3):243. doi: 10.21037/atm-20-3165.
Obstructive sleep apnea (OSA) is associated with insulin resistance. However, the association between special stages of OSA [rapid eye movement (REM) sleep] and insulin resistance is not clear. This study was designed to assess the association of the frequency of respiratory events during REM sleep with insulin resistance in adults with suspected OSA.
In this cross-sectional study, 4,062 adult participants with suspected OSA who underwent polysomnography in our sleep center between 2009 and 2016 were screened. Polysomnographic variables, biochemical indicators, and physical measurements were collected. Logistic regression analyses were conducted to determine the odds ratios (ORs) and 95% confidence intervals (95% CIs) for insulin resistance as assessed by the presence of hyperinsulinemia, the homeostasis model assessment of insulin resistance (HOMA-IR) index, the fasting insulin resistance index (FIRI), and Bennett's insulin sensitivity index (ISI).
The final analyses included 2,899 adults with suspected OSA. Multivariate adjustments, including the apnea-hypopnea index (AHI) during non-REM sleep (AHI), were performed. The AHI during REM sleep (AHI) was found to be independently associated with insulin resistance across increasing AHI quartiles. For hyperinsulinemia the ORs (95% CIs) followed the order of 1.340 (1.022, 1.757), 1.210 (0.882, 1.660), and 1.632 (1.103, 2.416). For abnormal HOMA-IR, ORs (95% CIs) were 1.287 (0.998, 1.661), 1.263 (0.933, 1.711), and 1.556 (1.056, 2.293). For abnormal FIRI, ORs (95% CIs) were 1.386 (1.048, 1.835), 1.317 (0.954, 1.818), and 1.888 (1.269, 2.807). For abnormal Bennett's ISI, ORs (95% CIs) were 1.297 (1.003, 1.678), 1.287 (0.949, 1.747), and 1.663 (1.127, 2.452). All linear trends were statistically significant (P<0.01). Additionally, the results showed that REM sleep duration was independently associated with hyperinsulinemia (OR =0.777, 95% CI: 0.615-0.982; P<0.05).
AHI was independently associated with hyperinsulinemia and an abnormal HOMA-IR, FIRI, and Bennett's ISI in adults with suspected OSA. Additionally, REM sleep duration was independently associated with hyperinsulinemia.
阻塞性睡眠呼吸暂停（OSA）与胰岛素抵抗相关。然而，OSA的特殊阶段[快速眼动（REM）睡眠]与胰岛素抵抗之间的关联尚不清楚。本研究旨在评估疑似OSA的成年人中REM睡眠期间呼吸事件频率与胰岛素抵抗之间的关联。
在这项横断面研究中，对2009年至2016年间在我们睡眠中心接受多导睡眠图检查的4062名疑似OSA的成年参与者进行了筛查。收集了多导睡眠图变量、生化指标和体格测量数据。进行逻辑回归分析以确定通过高胰岛素血症、胰岛素抵抗稳态模型评估（HOMA-IR）指数、空腹胰岛素抵抗指数（FIRI）和贝内特胰岛素敏感性指数（ISI）评估的胰岛素抵抗的比值比（OR）和95%置信区间（95%CI）。
最终分析纳入了2899名疑似OSA的成年人。进行了多变量调整，包括非快速眼动睡眠期间的呼吸暂停低通气指数（AHI）。发现REM睡眠期间的AHI（AHI）与胰岛素抵抗独立相关，且随着AHI四分位数的增加而增加。对于高胰岛素血症，OR（95%CI）依次为1.340（1.022，1.757）、1.210（0.882，1.660）和1.632（1.103，2.416）。对于异常的HOMA-IR，OR（95%CI）为1.287（0.998，1.661）、1.263（0.933，1.711）和1.556（1.056，2.293）。对于异常的FIRI，OR（95%CI）为1.386（1.048，1.835）、1.317（0.954，1.818）和1.888（1.269，2.807）。对于异常的贝内特ISI，OR（95%CI）为1.297（1.003，1.678）、1.287（0.949，1.747）和1.663（1.127，2.452）。所有线性趋势均具有统计学意义（P<0.01）。此外，结果显示REM睡眠时间与高胰岛素血症独立相关（OR =0.777，95%CI：0.615 - 0.982；P<0.05）。
在疑似OSA的成年人中，AHI与高胰岛素血症以及异常的HOMA-IR、FIRI和贝内特ISI独立相关。此外，REM睡眠时间与高胰岛素血症独立相关。
