Abstract
Background:
Sleep apnea has been associated with diabetes in many cross-sectional studies, but prospective data is sparse. Most prior studies defined sleep apnea by self-reported sleep symptoms.
Hypothesis:
Objectively measured obstructive sleep apnea is associated with greater risk of incident diabetes.
Design:
We conducted a prospective cohort study of 1,465 non-diabetic participants of the Sleep Heart Health-Atherosclerosis Risk in Communities Study with in-home polysomnography conducted in 1996-1998 (baseline). Participants were categorized into four groups according to number of events per hour, as defined by the apnea-hypopnea index: <5.0 (normal), 5.0-14.9 (mild sleep apnea), 15.0-29.9 (moderate sleep apnea), and ≥30.0 (severe sleep apnea). Incident diagnosed diabetes or diabetes medication use was ascertained during annual follow-up calls through 2010. Cox proportional hazards models were used to examine the association between sleep apnea severity and incident diagnosed diabetes.
Results:
During a median follow-up of 12 years, there were 279 incident self-reported diabetes cases among the study participants (mean age 63 years, 99% white, 47% male). The risk of diabetes among those with moderate or severe sleep apnea was significantly higher than in those without sleep apnea after adjustment for demographics measures and other confounders. The association persisted among those with severe sleep apnea even after adjustment for body mass index and waist circumference. Across all models there was evidence of a dose-response association between the sleep apnea severity and the risk of incident diabetes (
Table
). There was no evidence for an interaction by sex.
Conclusions:
In this community-based study, persons with objectively measured obstructive severe sleep apnea were at higher risk of diabetes compared to persons without sleep apnea, independent of body mass index and waist circumference. Screening and treatment of sleep apnea may be beneficial for the prevention of diabetes.