| Part 1.Independent relationships between cardinal features of obstructive sleep apnea and glycometabolism:a cross-sectional studyObjective:Obstructive sleep apnea hypoxia syndrome(OSAHS)is associated with abnormal glycometabolism;however,the cardinal features of OSA,such as sleep fragmentation and intermittent hypoxia,have yet to show clear,independent associations with glycometabolism.This study aimed to estimate the relationship between.Methods:2396 participants with suspected OSA from the clinical sample library of the Sleep Center of the Shanghai Jiao Tong University Affiliated Sixth Hospital were screened from July 2009 to July 2013,and 1834 participants were finally included in this study.Polysomnographic variables,biochemical indicators,and physical measurements were collected for each participant.The participants were divided into 4 groups according to microarousal index(MAI)and oxygen desaturation index(ODI)quartiles separately.Linear trend tests were used to evaluate the independent associations between cardinal features of OSA and glycometabolism.Logistic regressions were used to determine the odds ratios(ORs)for abnormal glucose metabolism across MAI and ODI quartiles.The effect of the interaction between MAI and ODI on abnormal glycometabolism was also evaluated.Results:There were significant positive linear trends between MAI groups and glycometabolic index such as fasting glucose levels,fasting insulin levels and homeostasis model assessment of insulin resistance(P<0.001).In addition,The odds ratio(95%confidence interval)[OR(95%CI)]for hyperglycemia were 1.081(0.780,1.498),1.349(0.971,1.874),1.656(1.165,2.354)across higher MAI quartiles,compared with the lowest quartile(P=0.015 for a linear trend).Similarly,there also existed significant positive linear trends between ODI groups and glycometabolic index.The ORs(95%CI)for hyperglycemia were 1.362(0.735,2.524),1.231(0.652,2.324),2.184(1.135,4.202);for hyperinsulinemia were 1.496(1.057,2.119),1.236(0.852,1.793),1.723(1.149,2.584);for IR were 1.666(1.192,2.329),1.406(0.982,2.013),2.097(1.399,3.143)across higher ODI quartiles,compared with the lowest quartile(all P<0.05 for a linear trend).In addition,the ORs for hyperinsulinemia and abnormal HOMA-IR across ODI quartiles had the same trends There was no interaction between MAI and ODI with respect to glycometabolism.Conclusion:Sleep fragmentation was independently associated with hyperinsulinemia,and intermittent hypoxia was independently associated with hyperglycemia,hyperinsulinemia,and IR with obvious linear trends.We found no interaction between sleep fragmentation and intermittent hypoxia with respect to OSA-related abnormal glycometabolism.Part 2.Associations of rapid eye movement sleep among obstructive sleep apnea patients with glycometabolismObjective:Obstructive sleep apnea hypoxia syndrome(OSAHS)is associated with abnormal glycometabolism,but the association between rapid eye movement sleep,which was special for OSAHS patients,and glycometabolism is not clear.This cross-sectional study was designed to assess the association of rapid eye movement sleep(frequency of respiratory events and sleep duration)among obstructive sleep apnea patients with glycometabolism.Methods:4062 participants with suspected OSA from the clinical sample library of the Sleep Center of the Shanghai Jiao Tong University Affiliated Sixth Hospital of were screened from July 2009 to January 2016,and 2899 participants were finally included in this study.Polysomnographic variables,biochemical indicators,and physical measurements were collected for each participant.The participants were divided into 4 groups according to apnea and hypoxia index during rapid eye movement sleep(AHIREM.Linear trend tests were used to evaluate the independent associations between AHIREM and abnormal glycometabolism;logistic regressions were used to determine the odds ratio(95%confidence interval)[OR(95%CI)]for abnormal glucose metabolism(hyperglycemia,hyperinsulinemia and insulin resistance)across AHIREM;The participants were divided into non OSAHS,non REM-related OSHAS and REM-related OSHAS,and linear trend tests were also used Then,the association between REM sleep duration and abnormal glycometabolism was evaluated with logistic regressions.Results:There were significant positive linear trends between AHIREM and fasting insulin levels,homeostasis model assessment of insulin resistance(P<0.001).After adjusting for age,gender,AHINREM,BMI,waist circumference and other confounding factors,the OR(95%CI)for hyperinsulinemia across higher AHIREM quartiles were 1.477(1.131,1.929),1.506(1.147,1.977),2.509(1.898,3.317),compared with the lowest quartile,furthermore,there existed a positive linear trend(P<0.05);OR(95%CI)for insulin resistance across higher AHIREM quartiles were 1.384(1.077,1.779),1.555(1.203,2.011)and 2.286(1.739,3.006),compared with the lowest quartile,and there also existed a positive linear trend(P<0.05).The results obtained by subgroup analysis were consistent with above results.Meanwhile,the insulin level and homeostasis model assessment of insulin resistance increased linearly from non OSAHS,non-REM-related OSAHS to REM-related OSAHS,after adjusting for multivariate including abdominal obesity.The risk of hyperinsulinemia reduced by 23%for every hour of REM duration after adjusting for confounding factors such as age,gender,BMI,waist circumference and NREM duration.Conclusion:AHIREM was independently associated with hyperinsulinemia and insulin resistance;fasting insulin level and HOMA-IR were higher among REM-related OSAHS patients;REM sleep duration was independently associated with hyperinsulinemia. |
