Skip to main content
SpringerLink
Log in

Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome in nonobese adults

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

An Erratum to this article was published on 27 August 2011

Abstract

Purpose

The relationship between obstructive sleep apnea (OSA) syndrome and metabolic syndrome is far from conclusion for obesity as a confounding factor. The aim of the present study was to investigate the association between OSA and some components of metabolic abnormality in nonobese patients.

Methods

We consecutively recruited nonobese subjects who underwent polysomnography and analyzed some components of metabolic abnormality in subjects with and without OSA. Multiple linear regression was used to evaluate the independent risk factor of some components of metabolic abnormality.

Results

A total of 154 subjects were enrolled and were divided to control group (45 subjects) and OSA group (113 subjects). Body mass index was no different between groups. Systolic blood pressure, triglycerides, and insulin concentration were significantly higher among OSA group compared with control group (p = 0.000, 0.043, and 0.006, respectively), and the prevalences of dyslipidemia, hypertension, and at least two of the metabolic abnormalities were significantly greater in OSA group (p = 0.003, 0.031, and 0.000, respectively). After adjusting for confounding factors, lowest O2 saturation was the major contributing factor for elevated systolic blood pressure (p = 0.001), and independent associations were found between apnea–hypopnea index and the following parameters of metabolic abnormality: triglycerides and homeostasis model assessment of insulin resistance (all p = 0.000).

Conclusions

Our finding was consistent with previous studies that OSA was independently associated with dyslipidemia, hypertension, and at least two of metabolic abnormalities in nonobese patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig 1
Fig 2
Fig 3

Similar content being viewed by others

References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  PubMed  CAS  Google Scholar 

  2. Coughlin SR, Mawdsley L, Mugarza JA, Wilding JP, Calverley PM (2007) Cardiovascular and metabolic effects of CPAP in obese males with OSA. Eur Respir J 29:720–727

    Article  PubMed  CAS  Google Scholar 

  3. Faccenda JF, Mackay TW, Boon NA, Douglas NJ (2001) Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea–hypopnea syndrome. Am J Respir Crit Care Med 163:344–348

    PubMed  CAS  Google Scholar 

  4. Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O’Connor GT, Resnick HE, Diener-West M, Sanders MH, Wolf PA, Geraghty EM, Ali T, Lebowitz M, Punjabi NM (2010) Obstructive sleep apnea–hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 182:269–277

    Article  PubMed  Google Scholar 

  5. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB (2003) The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 163:427–436

    Article  PubMed  Google Scholar 

  6. Eckel RH, Alberti KG, Grundy SM, Zimmet PZ (2010) The metabolic syndrome. Lancet 375:181–183

    Article  PubMed  Google Scholar 

  7. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP (2004) Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 25:735–741

    Article  PubMed  Google Scholar 

  8. Kono M, Tatsumi K, Saibara T, Nakamura A, Tanabe N, Takiguchi Y, Kuriyama T (2007) Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome. Chest 131:1387–1392

    Article  PubMed  CAS  Google Scholar 

  9. Lam JC, Lam B, Lam CL, Fong D, Wang JK, Tse HF, Lam KS, Ip MS (2006) Obstructive sleep apnea and the metabolic syndrome in community-based Chinese adults in Hong Kong. Respir Med 100:980–987

    Article  PubMed  Google Scholar 

  10. Sharma SK, Kumpawat S, Goel A, Banga A, Ramakrishnan L, Chaturvedi P (2007) Obesity, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleep-disordered breathing. Sleep Med 8:12–17

    Article  PubMed  CAS  Google Scholar 

  11. Barcelo A, Barbe F, Llompart E, Mayoralas LR, Ladaria A, Bosch M, Agusti AG (2004) Effects of obesity on C-reactive protein level and metabolic disturbances in male patients with obstructive sleep apnea. Am J Med 117:118–121

    Article  PubMed  CAS  Google Scholar 

  12. Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL (2002) Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 165:677–682

    PubMed  Google Scholar 

  13. Akahoshi T, Uematsu A, Akashiba T, Nagaoka K, Kiyofuji K, Kawahara S, Hattori T, Kaneita Y, Yoshizawa T, Takahashi N, Uchiyama M, Hashimoto S (2010) Obstructive sleep apnoea is associated with risk factors comprising the metabolic syndrome. Respirology 15:1122–1126

    Article  PubMed  Google Scholar 

  14. WHO Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163

    Article  Google Scholar 

  15. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419

    Article  PubMed  CAS  Google Scholar 

  16. Schulz H (2007) Phasic or transient? Comment on the terminology of the AASM manual for the scoring of sleep and associated events. J Clin Sleep Med 3:752

    PubMed  Google Scholar 

  17. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285:2486–2497

    Article  Google Scholar 

  18. Iiyori N, Alonso LC, Li J, Sanders MH, Garcia-Ocana A, O’Doherty RM, Polotsky VY, O’Donnell CP (2007) Intermittent hypoxia causes insulin resistance in lean mice independent of autonomic activity. Am J Respir Crit Care Med 175:851–857

    Article  PubMed  CAS  Google Scholar 

  19. Ziegler MG, Mills PJ, Loredo JS, Ancoli-Israel S, Dimsdale JE (2001) Effect of continuous positive airway pressure and placebo treatment on sympathetic nervous activity in patients with obstructive sleep apnea. Chest 120:887–893

    Article  PubMed  CAS  Google Scholar 

  20. Carneiro G, Togeiro SM, Hayashi LF, Ribeiro-Filho FF, Ribeiro AB, Tufik S, Zanella MT (2008) Effect of continuous positive airway pressure therapy on hypothalamic–pituitary–adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome. Am J Physiol Endocrinol Metab 295:E380–E384

    Article  PubMed  CAS  Google Scholar 

  21. Shiina K, Tomiyama H, Takata Y, Usui Y, Asano K, Hirayama Y, Nakamura T, Yamashina A (2006) Concurrent presence of metabolic syndrome in obstructive sleep apnea syndrome exacerbates the cardiovascular risk: a sleep clinic cohort study. Hypertens Res 29:433–441

    Article  PubMed  Google Scholar 

  22. Parish JM, Adam T, Facchiano L (2007) Relationship of metabolic syndrome and obstructive sleep apnea. J Clin Sleep Med 3:467–472

    PubMed  Google Scholar 

  23. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D’Agostino RB, Newman AB, Lebowitz MD, Pickering TG (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 283:1829–1836

    Article  PubMed  CAS  Google Scholar 

  24. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384

    Article  PubMed  CAS  Google Scholar 

  25. McNicholas WT, Bonsigore MR (2007) Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J 29:156–178

    Article  PubMed  CAS  Google Scholar 

  26. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling JR, Davies RJ (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 359:204–210

    Article  PubMed  Google Scholar 

  27. Campos-Rodriguez F, Grilo-Reina A, Perez-Ronchel J, Merino-Sanchez M, Gonzalez-Benitez MA, Beltran-Robles M, Almeida-Gonzalez C (2006) Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial. Chest 129:1459–1467

    Article  PubMed  Google Scholar 

  28. Borgel J, Sanner BM, Bittlinsky A, Keskin F, Bartels NK, Buechner N, Huesing A, Rump LC, Mugge A (2006) Obstructive sleep apnoea and its therapy influence high-density lipoprotein cholesterol serum levels. Eur Respir J 27:121–127

    Article  PubMed  CAS  Google Scholar 

  29. Newman AB, Nieto FJ, Guidry U, Lind BK, Redline S, Pickering TG, Quan SF (2001) Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol 154:50–59

    Article  PubMed  CAS  Google Scholar 

  30. Li J, Savransky V, Nanayakkara A, Smith PL, O’Donnell CP, Polotsky VY (2007) Hyperlipidemia and lipid peroxidation are dependent on the severity of chronic intermittent hypoxia. J Appl Physiol 102:557–563

    Article  PubMed  CAS  Google Scholar 

  31. Seicean S, Kirchner HL, Gottlieb DJ, Punjabi NM, Resnick H, Sanders M, Budhiraja R, Singer M, Redline S (2008) Sleep-disordered breathing and impaired glucose metabolism in normal-weight and overweight/obese individuals: the Sleep Heart Health Study. Diabetes Care 31:1001–1006

    Article  PubMed  Google Scholar 

  32. Shin C, Kim J, Lee S, Shim J, In K, Kang K, Yoo S, Cho N, Kimm K, Joo S (2005) Association of habitual snoring with glucose and insulin metabolism in nonobese Korean adult men. Am J Respir Crit Care Med 171:287–291

    Article  PubMed  Google Scholar 

  33. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE (2004) Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol 160:521–530

    Article  PubMed  Google Scholar 

  34. Reichmuth KJ, Austin D, Skatrud JB, Young T (2005) Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med 172:1590–1595

    Article  PubMed  Google Scholar 

  35. Harsch IA, Schahin SP, Radespiel-Troger M, Weintz O, Jahreiss H, Fuchs FS, Wiest GH, Hahn EG, Lohmann T, Konturek PC, Ficker JH (2004) Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patients with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 169:156–162

    Article  PubMed  Google Scholar 

  36. Polotsky VY, Li J, Punjabi NM, Rubin AE, Smith PL, Schwartz AR, O’Donnell CP (2003) Intermittent hypoxia increases insulin resistance in genetically obese mice. J Physiol 552:253–264

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This word was supported by grant C07100008 for natural science foundation from Fujian province of China. The authors acknowledge the help by Bin Yang for blood analysis. Juan Wu and Xiao-Lan Lai are thanked for their help in statistics.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Respiratory Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fuzhou, Fujian Province, 350005, People’s Republic of China

    Qi-Chang Lin, Xiao-Bin Zhang, Gong-Ping Chen, Dou-Yu Huang, Hai-Bo Din & Ai-Zhong Tang

Authors
  1. Qi-Chang Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiao-Bin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gong-Ping Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dou-Yu Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hai-Bo Din
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ai-Zhong Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qi-Chang Lin.

Additional information

X. Zhang and X.-B. Zhang contributed equally to this work.

An erratum to this article can be found at http://dx.doi.org/10.1007/s11325-011-0563-4.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lin, QC., Zhang, XB., Chen, GP. et al. Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome in nonobese adults. Sleep Breath 16, 571–578 (2012). https://doi.org/10.1007/s11325-011-0544-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-011-0544-7

Keywords

Search

Navigation