Associations between Obstructive Sleep Apnea, Sleep Duration, and Abnormal Fasting Glucose. The Multi-Ethnic Study of Atherosclerosis

Am J Respir Crit Care Med. 2015 Sep 15;192(6):745-53. doi: 10.1164/rccm.201502-0366OC.


Rationale: No data exist as to the role of ethnicity in the associations between obstructive sleep apnea (OSA), sleep duration, and metabolic dysfunction.

Objectives: To examine links between OSA, objectively measured habitual sleep duration, and fasting glucose in U.S. ethnic groups.

Methods: The Multi-Ethnic Study of Atherosclerosis is a multisite community-based study that conducted polysomnography and wrist actigraphy. In 2,151 subjects (1,839 in fully adjusted models), the apnea-hypopnea index was used to classify OSA as none (0-4.9/h), mild (5-14.9/h), or moderate to severe (≥15/h). Actigraphic sleep duration was classified as short (≤5 h/night), intermediate (>5 and <8 h/night), or long (≥8 h/night). Subjects were classified as having normal fasting glucose (<100 mg/dl and no hypoglycemic medication use) or abnormal fasting glucose (≥100 mg/dl and/or hypoglycemic medication use).

Measurements and main results: The sample was 45.8% male, age 68.5 ± 9.2 (mean ± SD) years, and 27.3% African American, 37.2% white, 11.8% Chinese, and 23.8% Hispanic. The prevalence of abnormal fasting glucose was 40.2%. Relative to subjects without apnea, moderate-to-severe OSA was significantly associated with abnormal fasting glucose in African Americans (odds ratio, 2.14; 95% confidence interval, 1.12-4.08) and white participants (odds ratio, 2.85; 95% confidence interval, 1.20-6.75), but not among Chinese or Hispanic subjects, after adjusting for site, age, sex, waist circumference, and sleep duration (P = 0.06 for ethnicity-by-OSA severity interaction). In contrast, sleep duration was not significantly associated with abnormal fasting glucose after considering the influence of OSA.

Conclusions: This large multiethnic study confirmed previous reports of an independent association between OSA and metabolic dysfunction, and suggested that this association may vary by ethnicity.

Keywords: ethnicity; insulin resistance; obstructive sleep apnea; type 2 diabetes mellitus.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Actigraphy
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Glucose / metabolism*
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / ethnology
  • Diabetes Mellitus, Type 2 / etiology
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Polysomnography
  • Prospective Studies
  • Sleep / physiology*
  • Sleep Apnea, Obstructive / blood
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / ethnology
  • Sleep Apnea, Obstructive / physiopathology*
  • Time Factors
  • United States / epidemiology


  • Biomarkers
  • Blood Glucose