Purpose

To examine whether or not associations between sleep-disordered breathing (SDB) and impaired fasting glucose and type 2 diabetes are mediated by obesity.

Methods

We used cross-sectional data including participants from the Multi-Ethnic Study of Atherosclerosis (MESA). SDB, including obstructive sleep apnea (OSA), hypoxia and sleep fragmentation, was evaluated by polysomnography. Further, five obesity measures related to overall obesity and central obesity were assessed. Mediation analysis was conducted to explore the mediating effect of obesity on these relationships between SDB and impaired fasting glucose and type 2 diabetes.

Results

Among 1615 participants, OSA and hypoxia, including apnea hypopnea index (AHI) ≥ 15, percent of total sleep time (TST) with SaO₂ < 90% (TST90), oxygen desaturation index (ODI), and lowest oxygen saturation (SaO₂), were significantly associated with impaired fasting glucose and type 2 diabetes. In addition, mean SaO₂ was also associated with impaired fasting glucose. Mediation analysis showed that these relationships were significantly mediated by all five obesity measures, where central obesity had greater mediating effect than overall obesity. Proportion of mediation of obesity ranged from 21.5 to 62.5% for impaired fasting glucose and 25.85 to 71.6% for type 2 diabetes, with substantial differences found in the subgroup analysis by gender or race/ethnicity. The consistency of the mediating effect was demonstrated across multiple measures of SDB, obesity, and glucose metabolism.

Conclusion

Obesity, especially central obesity, may play a critical role in the pathway where SDB, including OSA and hypoxia, increases the occurrence of impaired fasting glucose and type 2 diabetes. Weight management is important for patients with SDB to prevent type 2 diabetes.

中文翻译：

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肥胖作为将睡眠呼吸障碍与空腹血糖受损和 2 型糖尿病联系起来的中介

目的

旨在检查睡眠呼吸障碍 (SDB) 与空腹血糖受损和 2 型糖尿病之间的关联是否由肥胖介导。

方法

我们使用的横断面数据包括来自动脉粥样硬化多种族研究 (MESA) 的参与者。通过多导睡眠图评估 SDB，包括阻塞性睡眠呼吸暂停 (OSA)、缺氧和睡眠片段化。此外，还评估了与整体肥胖和向心性肥胖相关的五项肥胖指标。进行中介分析以探讨肥胖对 SDB 与空腹血糖受损和 2 型糖尿病之间这些关系的中介作用。

结果

_{在 1615 名参与者中，OSA 和缺氧，包括呼吸暂停低通气指数 (AHI) ≥ 15、SaO 2}  < 90% 的总睡眠时间百分比 (TST) ( TST90)、氧饱和度指数 (ODI) 和最低氧饱和度 (SaO ₂ ), 与空腹血糖受损和 2 型糖尿病显着相关。此外，平均 SaO ₂也与空腹血糖受损有关。中介分析表明，这些关系由所有五种肥胖指标显着调节，其中中心性肥胖比整体肥胖具有更大的调节作用。空腹血糖受损的肥胖介导比例为 21.5% 至 62.5%，2 型糖尿病的介导比例为 25.85% 至 71.6%，在按性别或种族/民族进行的亚组分析中发现存在显着差异。在 SDB、肥胖和葡萄糖代谢的多种测量中证明了中介效应的一致性。

结论

肥胖，尤其是向心性肥胖，可能在 SDB（包括 OSA 和缺氧）增加空腹血糖受损和 2 型糖尿病发生的途径中发挥关键作用。体重管理对于 SDB 患者预防 2 型糖尿病很重要。