Sleep apnea in men is associated with altered lipid metabolism, glucose tolerance, insulin sensitivity, and body fat per
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ORIGINAL ARTICLE
Sleep apnea in men is associated with altered lipid metabolism, glucose tolerance, insulin sensitivity, and body fat percentage Prasad G. Kamble Jan W. Eriksson1
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Jenny Theorell-Haglöw2 Urban Wiklund3 Karl A. Franklin4 Ulf Hammar1 Eva Lindberg2 ●
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Received: 9 April 2020 / Accepted: 25 May 2020 © The Author(s) 2020
Abstract Purpose Obstructive sleep apnea (OSA) is associated with obesity and risk for type 2 diabetes. In this community-based study, we thoroughly investigated fatty acid metabolism, incretin response, glucose tolerance, insulin secretion and insulin sensitivity, and autonomic nerve activity in men with or without OSA. Methods Fifteen men without diabetes but with signs of severe OSA, defined as apnea–hypopnea index (AHI) >30, and 15 age- and BMI-matched men without OSA (AHI < 5) were recruited from a community-based cohort. Assessments included clinical and anthropometric measurements, a 2-h oral glucose tolerance test (OGTT), and autonomic nerve activity using heart rate variability (HRV). Results Men with OSA had higher body fat % than BMI-matched men without OSA (p = 0.046) and it was associated with markers of insulin resistance. The area under the curve for nonesterified fatty acids (NEFA) during OGTT was higher in men with OSA (p = 0.021) and fasting NEFA levels were numerically higher (p = 0.097). The plasma glucose at fasting and during OGTT was higher in men with OSA (p < 0.001). Incretin response was similar between groups. Fasting and OGTTderived indices indicated impaired insulin sensitivity in men with OSA. Compared with men without OSA, Matsuda index (p = 0.068) and Gutt index (p < 0.01) were lower in men with OSA. The HRV measures did not differ between groups. Conclusions Our study suggests that fatty acid handling, glucose tolerance, and insulin sensitivity are impaired in men with severe OSA. This might partly be explained by the increased body fat percentage. Keywords Obstructive sleep apnea Glucose metabolism Lipid metabolism Insulin secretion ●
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Introduction Obstructive sleep apnea (OSA) is characterized by repetitive narrowing causing hypopnea and collapse causing apnea of
* Eva Lindberg [email protected] * Jan W. Eriksson [email protected] 1
Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
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Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
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Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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the upper airway during sleep, leading to oxyhemoglobin desaturation events, recurrent arousal from sleep, and sleep fragmentation [1]. Based on the mean number of apneas and hypopneas per hour of sleep (the apnea–hypopnea index, AHI), OSA is categorized into mild (AHI 5–30, a control subject (man without OSA) matched for age and BMI was selected. In tot
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