Channing Division of Network Medicine, and.
Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts.
Ann Am Thorac Soc. 2022 Oct;19(10):1740-1749. doi: 10.1513/AnnalsATS.202111-1260OC.
Recent prospective studies suggest diabetes as a risk factor for the development of obstructive sleep apnea (OSA). However, the extent to which diabetes-related traits, such as hyperglycemia and insulin resistance, are related to OSA risk remains uncertain. To examine the risk of developing OSA according to baseline concentrations of fasting insulin and hemoglobin A1c (HbA1c). Participants from four prospective U.S. cohorts were included: NHS (Nurses' Health Study; 2002-2012), NHSII (Nurses' Health Study II; 1995-2013), HPFS (Health Professionals Follow-up Study; 1996-2012), and MESA (Multi-Ethnic Study of Atherosclerosis; 2000-2012). OSA was assessed by self-reported clinical diagnosis in NHS/NHSII/HPFS and at-home polysomnography in MESA (defined as Apnea-Hypopnea Index ⩾30). Of 9,283 participants with fasting insulin data, 790 (8.5%) developed OSA over 10 to 18 years of follow-up. After adjusting for sociodemographic, lifestyle, and comorbidity factors, the odds ratio for incident OSA comparing the extreme quintiles of fasting insulin was 3.59 (95% confidence interval, 2.67-4.82; -trend < 0.0001). Of 6,342 participants with HbA1c data, 715 (11.3%) developed OSA. The comparable odds ratio for HbA1c was 2.21 (95% confidence interval, 1.69-2.89; -trend < 0.0001). Additional adjustment for body mass index and waist circumference attenuated the associations for fasting insulin (-trend = 0.005) and HbA1c (-trend = 0.03). In the fully adjusted model simultaneously including both biomarkers, only fasting insulin but not HbA1c was associated with OSA risk. Independent of obesity, insulin resistance may play a more important role than hyperglycemia in the pathogenesis of OSA. Given the limitation of using self-reported diagnosis to exclude baseline prevalent OSA cases, additional studies are needed to further establish the temporal relationship and assess whether improving insulin resistance may reduce OSA risk.
最近的前瞻性研究表明，糖尿病是阻塞性睡眠呼吸暂停（OSA）发生的一个危险因素。然而，糖尿病相关特征（如高血糖和胰岛素抵抗）与 OSA 风险之间的关系仍不确定。
本研究旨在根据空腹胰岛素和糖化血红蛋白（HbA1c）的基线浓度，来检查发生 OSA 的风险。研究纳入了四项美国前瞻性队列研究的参与者：NHS（护士健康研究；2002-2012 年）、NHSII（护士健康研究 II；1995-2013 年）、HPFS（卫生专业人员随访研究；1996-2012 年）和 MESA（动脉粥样硬化多民族研究；2000-2012 年）。在 NHS/NHSII/HPFS 中，通过自我报告的临床诊断和 MESA 中的家庭多导睡眠图（定义为呼吸暂停低通气指数 ⩾30）来评估 OSA。在有空腹胰岛素数据的 9283 名参与者中，有 790 人（8.5%）在 10 至 18 年的随访中发生了 OSA。在校正了社会人口统计学、生活方式和合并症因素后，比较空腹胰岛素极值五分位数的 OSA 发生率的比值比为 3.59（95%置信区间，2.67-4.82；-趋势<0.0001）。在有 HbA1c 数据的 6342 名参与者中，有 715 人（11.3%）发生了 OSA。HbA1c 的可比比值比为 2.21（95%置信区间，1.69-2.89；-趋势<0.0001）。进一步调整体重指数和腰围后，空腹胰岛素（-趋势=0.005）和 HbA1c（-趋势=0.03）的相关性减弱。在同时纳入两种生物标志物的完全调整模型中，只有空腹胰岛素与 OSA 风险相关，而 HbA1c 则不然。胰岛素抵抗可能在 OSA 的发病机制中比高血糖起更重要的作用，而与肥胖无关。鉴于使用自我报告的诊断来排除基线现患 OSA 病例的局限性，需要进一步开展研究以进一步确定时间关系，并评估改善胰岛素抵抗是否可以降低 OSA 风险。
