Insulin Sensitivity and Insulin Resistance in Non-Diabetic Middle-Aged Patients with Obstructive Sleep Apnoea Syndrome



K. Archontogeorgis1, N. Papanas2, *, E. Nena3, A. Tzouvelekis4, C. Tsigalou5, A. Voulgaris6, M. Xanthoudaki6, T. Mouemin6, M. Froudarakis6, P. Steiropoulos1, 6
1 MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
2 Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
3 Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
4 Division of Immunology, Biomedical Sciences Research Center “Alexander Fleming”, Athens, Greece
5 Laboratory of Biopathology, University General Hospital of Evros, Alexandroupolis, Greece
6 Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece


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© 2017 Archontogeorgis et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Second Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; Tel: +306977544337; Fax: +302551074723; E-mail: papanasnikos@yahoo.gr


Abstract

Background:

Obstructive sleep apnoea syndrome (OSAS) has been linked with abnormal glucose metabolism, insulin resistance (IR) and development of diabetes mellitus.

Methods:

Non-diabetic patients (n=69) with OSAS, diagnosed by polysomnography, were prospectively recruited. To evaluate IR among OSAS patients, the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and Insulin sensitivity by Quantitative Insulin sensitivity Check Index (QUICKI) were used.

Results:

HOMA-IR was positively associated with body-mass index (BMI) (ρ=0.364, p=0.002), time with oxyhaemoglobin saturation <90% (ρ=0.291, p=0.015), arousal index (ρ=0.268, p=0.027), Epworth sleepiness scale (ESS) score (ρ=0.293, p=0.019) and negatively with average oxyhaemoglobin saturation (ρ=-0.398, p=0.001) and minimum oxyhaemoglobin saturation (ρ=-0.327, p=0.006). QUICKI was positively associated with forced vital capacity (r=0.301, p=0.014), average oxyhaemoglobin saturation (r=0.443, p<0.001), minimum oxyhaemoglobin saturation (ρ=0.318, p=0.008), and negatively associated with sleep stage transitions (r=-0.266, p=0.032), oxygen desaturation index (r=-0.404, p=0.005), time with oxyhaemoglobin saturation <90% (r=-0.311, p=0.019), arousal index (r=-0.344, p=0.004) and ESS score (r=-0.299, p=0.016). After adjustment for age and BMI, HOMA-IR was associated with sleep stage transitions, time with oxyhaemoglobin saturation <90%, average oxyhaemoglobin saturation, minimum oxyhaemoglobin saturation and arousal index. QUICKI was associated with oxygen desaturation index, sleep stage transitions, ESS score, minimum oxyhaemoglobin saturation and arousal index.

Conclusions:

An independent association between OSAS and IR in patients without pre-existing diabetes mellitus was observed. Recurrent hypoxia and sleep fragmentation in OSAS are associated with IR in these patients.

Keywords: HOMA-IR, Intermittent hypoxia, Insulin resistance, Insulin sensitivity, Obstructive sleep apnoea syndrome, Sleep fragmentation, QUICKI.