Elsevier

Sleep Medicine

Volume 12, Issue 4, April 2011, Pages 329-334
Sleep Medicine

Original Article
The role of obstructive sleep apnea in metabolic syndrome: A population-based study in women

https://doi.org/10.1016/j.sleep.2010.06.014Get rights and content

Abstract

Background

The aim of this study was to assess associations between obstructive sleep apnea (OSA) and metabolic syndrome in a population-based sample of women.

Methods

Four hundred women aged 20–70 years underwent a full-night polysomnography, fasting blood sampling and measurement of anthropometric variables. Metabolic syndrome was defined according to the National Cholesterol Education Program (NCEP) criteria.

Results

The NCEP criteria of metabolic syndrome were fulfilled by 104 (26.0%) of the women. The frequency of metabolic syndrome increased from 10.5% in women with apnea–hypopnea-index (AHI) <5 to 57.1% in women with AHI ⩾30 (p for trend <0.0001). In the multivariate analysis, the severity of OSA measured as AHI, ODI (oxygen desaturation index), minimal saturation or T90 (percentage of time during night with saturation <90%) were associated with metabolic syndrome after adjustment for age, level of physical activity, smoking and alcohol consumption. AHI (adj. OR 1.45; 95% CI 1.11–1.91), ODI (1.37; 1.09–1.73) and minimal saturation level (0.93; 0.87–0.99) remained significantly associated with metabolic syndrome also when adjusting for the waist-to-hip-ratio. The three markers of OSA were independently associated with central obesity, hypertriglyceridemia and reduced HDL cholesterol concentration.

Conclusion

Measures of OSA were closely associated with metabolic syndrome and its components in this population-based sample of women also after adjustments. Therefore, when the health consequences of sleep-disordered breathing are investigated it is important to consider metabolic syndrome. Sleep-disordered breathing should also be considered when treating patients with metabolic syndrome.

Introduction

Metabolic syndrome is a cluster of risk factors for cardiovascular disease and diabetes including abdominal obesity, hyperglycemia, hypertension and dyslipidemia [1]. With the well known increase in the prevalence of obesity [2] metabolic syndrome is becoming more common, which will have future consequences for the incidence of stroke, ischemic heart disease and type 2 diabetes mellitus [1]. Recently the importance of sleep apneas in persons with type 2 diabetes mellitus has been emphasized by the International Diabetes Federation [3].

In obesity fat deposits in pharyngeal soft tissue narrows the pharynx and increases the collapsibility of the upper airways [4], thereby predisposing for obstructive sleep apnea (OSA). But OSA has also been shown to be an independent risk factor for cardiovascular disease [5] and insulin resistance [6], [7] after adjusting for obesity. Both snoring and OSA are also associated with an increased risk of diabetes [8], [9]. OSA and metabolic syndrome, which both are closely related to obesity, often coexist in individuals [10].

Knowledge on the relationship between OSA and the metabolic syndrome in the general female population is still limited. A majority of previous studies has been conducted in male population-based studies or in clinic-based patient materials with full-blown OSA syndrome [10], [11], [12], [13]. Moreover, different variables of OSA have not been separately studied in relation to metabolic syndrome and its separate components. Therefore, we wanted to investigate associations between OSA and metabolic syndrome and its components in a population-based sample of women.

Section snippets

Methods

This study was performed as part of the second phase of the population-based study “Sleep and Health in women.” In the first phase randomly selected women (ages ⩾20 years) from the population registry of the city of Uppsala, Sweden, were sent a questionnaire on sleep disturbances and somatic disorders and 7051 (71.6%) of the women responded. Based on the women’s response to a question on snoring, the participants were categorized into snorers (n = 518) and non-snorers (n = 6515). In the second phase

Results

All of the components of metabolic syndrome were more common in women with OSA than without (Table 1). Further, the women with OSA were older, had higher BMI and had slightly longer total sleep time. But there was no statistical difference in level of physical activity, smoking status, alcohol consumption or prevalence of diabetes between women with and without OSA.

In the whole population, 104 of the women (26.0%) fulfilled the NCEP criteria for metabolic syndrome. The prevalence of metabolic

Discussion

The main result of this population-based study is that there is an association between sleep-disordered breathing and metabolic syndrome in women. Moreover, all separate components of metabolic syndrome were more prevalent in the women with sleep-disordered breathing. Although the relationships can partly be explained by shared risk factors, significant associations remained also after adjusting for confounders, including obesity.

In our female population between 20 and 70 years of age, one in

Funding

By the Swedish Heart Lung Foundation and by the Uppsala County Association against Heart and Lung Diseases.

Conflict of Interest

The authors declare no conflicts of interest.

Acknowledgements

The authors thank Carin Sahlin, PhD, Department of Respiratory Medicine, Umeå University Hospital for her assistance with the polysomnography scoring in this study.

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