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Prediabetes Is Associated with Increased Prevalence of Sleep-Disordered Breathing.

Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, 25198 Lleida, Spain. Obesity, Diabetes and Metabolism (ODIM) Research Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain. University of Lleida, 25003 Lleida, Spain. Respiratory Department, University Hospital Arnau de Vilanova and Santa María, 25198 Lleida, Spain. Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. Amalfi Analytics, Polytechnic University of Catalonia, 08034 Barcelona, Spain. Vascular and Renal Translational Research Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain. Red de Investigación Renal, Instituto de Salud Carlos III (RedinRen-ISCIII), 28029 Madrid, Spain. Stroke Unit, University Hospital Arnau de Vilanova, 25198 Lleida, Spain. Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain. Applied Epidemiology Research Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain. Lleida Research Support Unit, Jordi Gol i Gurina University Institute for Research in Primary Health Care (IDIAPJGol), 25007 Lleida, Spain. Department of Experimental Medicine, Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain. Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain. Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. Grupo de Investigación Epidemiológica en Diabetes des de Atención Primaria (DAP_Cat Group), Unitat de Suport a la Recerca de Barcelona, Jordi Gol i Gurina University Institute for Research in Primary Health Care (IDIAPJGol), 08007 Barcelona, Spain. Endocrinology and Nutrition Department, University Hospital Vall d'Hebron, 08024 Barcelona, Spain. Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), 08024 Barcelona, Spain. Autonomous University of Barcelona, 08024 Barcelona, Spain.

Journal of clinical medicine. 2022;(5)
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Abstract

Type 2 diabetes leads to severe nocturnal hypoxemia, with an increase in apnea events and daytime sleepiness. Hence, we assessed sleep breathing parameters in the prediabetes stage. A cross-sectional study conducted on 966 middle-aged subjects without known pulmonary disease (311 patients with prediabetes and 655 controls with normal glucose metabolism) was conducted. Prediabetes was defined by glycated hemoglobin (HbA1c), and a nonattended overnight home sleep study was performed. Participants with prediabetes (n = 311) displayed a higher apnea−hypopnea index (AHI: 12.7 (6.1;24.3) vs. 9.5 (4.2;19.6) events/h, p < 0.001) and hypopnea index (HI: 8.4 (4.0;14.9) vs. 6.0 (2.7;12.6) events/h, p < 0.001) than controls, without differences in the apnea index. Altogether, the prevalence of obstructive sleep apnea was higher in subjects with prediabetes than in controls (78.1 vs. 69.9%, p = 0.007). Additionally, subjects with prediabetes presented impaired measurements of the median and minimum nocturnal oxygen saturation, the percentage of time spent with oxygen saturations below 90%, and the 4% oxygen desaturation index in comparison with individuals without prediabetes (p < 0.001 for all). After adjusting for age, sex, and the presence of obesity, HbA1c correlated with the HI in the entire population (r = 0.141, p < 0.001), and the presence of prediabetes was independently associated with the AHI (B = 2.20 (0.10 to 4.31), p = 0.040) as well as the HI (B = 1.87 (0.61 to 3.14), p = 0.004) in the multiple linear regression model. We conclude that prediabetes is an independent risk factor for an increased AHI after adjusting for age, sex, and obesity. The enhanced AHI is mainly associated with increments in the hypopnea events.