Sleep apnea and glucose metabolism: a long-term follow-up in a community-based sample

Chest. 2012 Oct;142(4):935-942. doi: 10.1378/chest.11-1844.


Background: It has been suggested that sleep-disordered breathing (SDB) is a risk factor for diabetes, but long-term follow-up studies are lacking. The aim of this community-based study was to analyze the influence of SDB on glucose metabolism after > 10 years.

Methods: Men without diabetes (N = 141; mean age, 57.5 years) were investigated at baseline, including whole-night respiratory monitoring. After a mean period of 11 years and 4 months, they were followed up with an interview, anthropometric measurements, and blood sampling. Insulin resistance was quantified using the homeostasis model assessment of insulin resistance (HOMA-IR). ΔHOMA-IR was calculated as (HOMA-IR at follow-up − HOMA-IR at baseline). An oral glucose tolerance test was performed on 113 men to calculate the insulin sensitivity index.

Results: The mean apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) at baseline were 4.7 and 3.3, respectively. At follow-up, 23 men had diabetes. An ODI > 5 was a predictor of developing diabetes (OR, 4.4; 95% CI, 1.1-18.1, after adjusting for age, BMI, and hypertension at baseline and ΔBMI and years with CPAP during follow-up). The ODI was inversely related to the insulin sensitivity index at follow-up (r = −0.27, P = .003). A deterioration in HOMA-IR was significantly related to all variables of SDB (AHI, AHI > 5; ODI, ODI > 5; minimum arterial oxygen saturation), even when adjusting for confounders. When excluding the variable years with CPAP from the multivariate model, all associations weakened.

Conclusions: SDB is independently related to the development of insulin resistance and, thereby, the risk of manifest diabetes mellitus.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / metabolism*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / etiology
  • Follow-Up Studies
  • Glucose Tolerance Test
  • Humans
  • Iceland / epidemiology
  • Incidence
  • Insulin / blood
  • Insulin Resistance*
  • Male
  • Middle Aged
  • Polysomnography
  • Population Surveillance*
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Sleep Apnea Syndromes / blood*
  • Sleep Apnea Syndromes / complications
  • Sleep Apnea Syndromes / physiopathology
  • Time Factors


  • Blood Glucose
  • Insulin