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Sleep-Disordered Breathing, Glucose Intolerance, and Insulin Resistance:
The Sleep Heart Health Study.
ABSTRACT
Clinic-based studies suggest that sleep-disordered breathing (SDB) is associated with
glucose intolerance and insulin resistance. However, in the available studies, researchers have not rigorously
controlled for confounding variables to assess the independent relation between SDB and impaired glucose
metabolism. The objective of this study was to determine whether SDB was associated with glucose intolerance
and insulin resistance among community-dwelling subjects (n = 2,656) participating in the Sleep Heart Health
Study (1994–1999). SDB was characterized with the respiratory disturbance index and measurements of oxygen
saturation during sleep. Fasting and 2-hour glucose levels measured during an oral glucose tolerance test
were used to assess glycemic status. Relative to subjects with a respiratory disturbance index of less than
5.0 events/hour (the reference category), subjects with mild SDB (5.0–14.9 events/hour) and moderate to severe
SDB (15 events/hour) had adjusted odds ratios of 1.27 (95% confidence interval: 0.98, 1.64) and 1.46 (95%
confidence interval: 1.09, 1.97), respectively, for fasting glucose intolerance (p for trend < 0.01).
Sleep-related hypoxemia was also associated with glucose intolerance independently of age, gender, body mass
index, and waist circumference. The results of this study suggest that SDB is independently associated with
glucose intolerance and insulin resistance and may lead to type 2 diabetes mellitus.
Keywords: diabetes mellitus, type II; glucose intolerance; insulin resistance; respiration; sleep;
sleep apnea syndromes
Abbreviations: CI, confidence interval; HOMA, homeostasis model assessment; RDI, respiratory
disturbance index; SHHS, Sleep Heart Health Study.
