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Effect of mild hyperglycemia on autonomic function in obstructive sleep apnea

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Abstract

Introduction

Obstructive sleep apnea (OSA) has been hypothesized to cause a hypersympathetic state, which may be the mechanism for the increased incidence of cardiovascular disease in OSA. However, there is a high prevalence of hyperglycemia in OSA patients, which may also contribute to autonomic dysfunction.

Methods

Thirty-five patients with OSA and 11 controls with average body mass index (BMI) of 32.0 ± 4.6 underwent polysomnography, glucose tolerance testing, autonomic function tests, lying and standing catecholamines, overnight urine collection, and baseline ECG and continuous blood pressure measurements for spectral analysis. A linear regression model adjusting for age and BMI was used to analyze spectral data, other outcome measures were analyzed with Kruskal–Wallis test.

Results

Twenty-three OSA patients and two control patients had hyperglycemia (based on 2001 American Diabetes Association criteria). Apnea–hypopnea index (AHI) correlated with total power and low frequency (LF) power (r = 0.138, 0.177, p = 0.031; and r = 0.013) but not with the LF/high frequency (HF) ratio (p = 0.589). Glucose negatively correlated with LF systolic power (r = −0.171, p = 0.038) but not AHI (p = 0.586) and was marginally associated with pnn50, total power, LF, and HF power (p ranged from 0.07 to 0.08).

Conclusion

These data suggest that patients with OSA and mild hyperglycemia have a trend towards lower heart rate variability and sympathetic tone. Hyperglycemia is an important confounder and should be evaluated in studies of OSA and autonomic function.

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References

  1. Sica AL, Greenberg HE, Ruggiero DA, Scharf SM (2000) Chronic-intermittent hypoxia: a model of sympathetic activation in the rat. Respir Physiol 121(2-3):173–184

    Article  PubMed  CAS  Google Scholar 

  2. Fletcher EC (1995) An animal model of the relationship between systemic hypertension and repetitive episodic hypoxia as seen in sleep apnoea. J Sleep Res 4(S1):71–77

    Article  PubMed  Google Scholar 

  3. Lesske J, Fletcher EC, Bao G, Unger T (1997) Hypertension caused by chronic intermittent hypoxia—influence of chemoreceptors and sympathetic nervous system. J Hypertens 15(12 Pt 2):1593–1603

    PubMed  CAS  Google Scholar 

  4. Khoo MC, Kim TS, Berry RB (1999) Spectral indices of cardiac autonomic function in obstructive sleep apnea. Sleep22(4):443–451

  5. Wang W, Tretriluxana S, Redline S, Surovec S, Gottlieb DJ, Khoo MC (2008) Association of cardiac autonomic function measures with severity of sleep-disordered breathing in a community-based sample. J Sleep Res 17(3):251–262

    Article  PubMed  Google Scholar 

  6. Park DH, Shin CJ, Hong SC et al (2008) Correlation between the severity of obstructive sleep apnea and heart rate variability indices. J Korean Med Sci 23(2):226–231

    Article  PubMed  Google Scholar 

  7. Peltier AC, Consens FB, Sheikh K, Wang L, Song Y, Russell JW (2007) Autonomic dysfunction in obstructive sleep apnea is associated with impaired glucose regulation. Sleep Med 8(2):149–155

    Article  PubMed  Google Scholar 

  8. 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(5):677–682

    Google Scholar 

  9. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS (2002) Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 165(5):670–676

    Google Scholar 

  10. Mahmood K, Akhter N, Eldeirawi K et al (2009) Prevalence of type 2 diabetes in patients with obstructive sleep apnea in a multi-ethnic sample. J Clin Sleep Med 5(3):215–221

    Google Scholar 

  11. Smith AG, Russell J, Feldman EL et al (2006) Lifestyle intervention for pre-diabetic neuropathy. Diabetes Care 29(6):1294–1299

    Article  PubMed  Google Scholar 

  12. Smulders YM, Jager A, Gerritsen J et al (2000) Cardiovascular autonomic function is associated with (micro-)albuminuria in elderly Caucasian sujects with impaired glucose tolerance or type 2 diabetes: the Hoorn Study. Diabetes Care 23(9):1369–1374

    Article  PubMed  CAS  Google Scholar 

  13. Grandinetti A, Chow DC, Sletten DM et al (2007) Impaired glucose tolerance is associated with postganglionic sudomotor impairment. Clin Auton Res 17(4):231–233

    Article  PubMed  Google Scholar 

  14. Jacob G, Costa F, Biaggioni I (2003) Spectrum of autonomic cardiovascular neuropathy in diabetes. Diabetes Care 26(7):2174–2180

    Article  PubMed  Google Scholar 

  15. American Academy of Sleep Medicine (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications.American Academy of Sleep Medicine, Westchester

  16. (2005) Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 28(suppl_1):S37–S42

  17. Penaz J, Voigt A, Teichmann W (1976) Contribution to the continuous indirect blood pressure measurement. Z Gesamte Inn Med 31(24):1030–1033

    Google Scholar 

  18. Low PA, Denq JC, Opfer-Gehrking TL, Dyck PJ, O’Brien PC, Slezak JM (1997) Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects. Muscle Nerve 20(12):1561–1568

    Article  PubMed  CAS  Google Scholar 

  19. (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93(5):1043–1065

  20. Oppenheim A, Schafer RW (1996) Digital signal processing. Prentice-Hall, New Jersey

    Google Scholar 

  21. Tank J, Baevski RM, Fender A et al (2000) Reference values of indices of spontaneous baroreceptor reflex sensitivity. Am J Hypertens 13(3):268–275

    Article  PubMed  CAS  Google Scholar 

  22. Kesek M, Franklin KA, Sahlin C, Lindberg E (2009) Heart rate variability during sleep and sleep apnoea in a population based study of 387 women. Clin Physiol Funct Imaging 29(4):309–315

    Article  PubMed  Google Scholar 

  23. 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(7):412–419

    Article  PubMed  CAS  Google Scholar 

  24. Haffner SM, Kennedy E, Gonzalez C, Stern MP, Miettinen H (1996) A prospective analysis of the HOMA model. The Mexico City Diabetes Study. Diabetes Care 19(10):1138–1141

    Article  PubMed  CAS  Google Scholar 

  25. Matsuda M, DeFronzo RA (2000) Insulin sensitivity indexes calculated from oral glucose tolerance test data—response. Diabetes Care 23(10):1595–1596

    Article  Google Scholar 

  26. Shibao C, Gamboa A, Diedrich A et al (2007) Autonomic contribution to blood pressure and metabolism in obesity. Hypertension 49(1):27–33

    Article  PubMed  CAS  Google Scholar 

  27. Singleton JR, Smith AG, Bromberg MB (2001) Painful sensory polyneuropathy associated with impaired glucose tolerance. Muscle Nerve 24(9):1225–1228

    Article  PubMed  CAS  Google Scholar 

  28. Sumner CJ, Sheth S, Griffin JW, Cornblath DR, Polydefkis M (2003) The spectrum of neuropathy in diabetes and impaired glucose tolerance. Neurology 60(1):108–111

    Google Scholar 

  29. Pop-Busui R, Evans GW, Gerstein HC et al (2010) Effects of cardiac autonomic dysfunction on mortality risk in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Diabetes Care 33(7):1578–1584

    Article  PubMed  CAS  Google Scholar 

  30. Berntson GG, Bigger JT Jr, Eckberg DL et al (1997) Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology 34(6):623–648

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Supported by NIH 1K23 NS056009-01A1 (Peltier PI), Vanderbilt CTSA grant 1 UL1 RR024975. This work was also supported in part by National Institutes of Health grants 1PO1 HL56693.

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Authors and Affiliations

  1. Division of Neuromuscular Disorders, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA

    Amanda C. Peltier

  2. Division of Sleep Medicine, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA

    Kanika Bagai & Beth A. Malow

  3. Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA

    Kay Artibee & David Robertson

  4. Division Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN, USA

    André Diedrich, Emily Garland & David Robertson

  5. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Thomas Elasy

  6. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Yaping Shi & Lily Wang

  7. Department of Neurology, University of Michigan, Ann Arbor, MI, USA

    Eva L. Feldman

Authors
  1. Amanda C. Peltier
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  2. Kanika Bagai
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  3. Kay Artibee
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  4. André Diedrich
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  5. Emily Garland
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  6. Thomas Elasy
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  7. Yaping Shi
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  8. Lily Wang
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  9. Eva L. Feldman
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  10. David Robertson
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  11. Beth A. Malow
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Correspondence to Amanda C. Peltier.

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Peltier, A.C., Bagai, K., Artibee, K. et al. Effect of mild hyperglycemia on autonomic function in obstructive sleep apnea. Clin Auton Res 22, 1–8 (2012). https://doi.org/10.1007/s10286-011-0131-9

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  • DOI: https://doi.org/10.1007/s10286-011-0131-9

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