In the Journals

Apolipoprotein levels, insulin resistance influence obstructive sleep apnea

In a cohort of adults assessed for sleep issues, those in the highest quartile of apolipoprotein B to apolipoprotein A-I ratio were at the greatest risk for obstructive sleep apnea and insulin resistance, according to findings published in Nutrition, Metabolism & Cardiovascular Diseases.

“The ApoB/ApoA-I ratio is positively associated with the risk of prediabetes, diabetes, metabolic syndrome, nonalcoholic fatty liver disease and CVD,” Jian Guan MD, PhD, of the department of otorhinolaryngology-head and neck surgery at Shanghai Jiao Tong University Affiliated Sixth People’s Hospital in Shanghai, and colleagues wrote. “Considering that [obstructive sleep apnea] may promote dyslipidemia, we hypothesized a positive association between severity of [obstructive sleep apnea] and the ApoB/ApoA-I.”

Guan and colleagues recorded height, weight, neck circumference, waist circumference, hip circumference and blood pressure and collected blood samples from 4,010 adults who took part in the Shanghai Sleep Health Study between 2007 and 2016. The blood samples were used to assess levels of triglycerides, total cholesterol, HDL cholesterol, LDL cholesterol, ApoB, ApoA-I, blood glucose and insulin. Questionnaires and polysomnography were used to identify the presence of obstructive sleep apnea and other sleep-related issues, and the researchers tabulated 10-year CVD risk using the Framingham CVD risk score.

Among the participants, 1,950 (mean age, 41 years; 9.4% women) had severe obstructive sleep apnea, which was defined by the occurrence of 30 or more events of apnea and hypopnea per hour when sleeping using the apnea-hypopnea index. In addition, 637 participants had 15 to 29.9 events per hour (mean age, 43 years; 19.2% women), 647 had five to 14.9 events per hour (mean age, 40 years; 23.6% women) and 776 had fewer than five events per hour and were, thus, without obstructive sleep apnea (mean age, 37 years; 40.7% women).

Older woman sleeping 
In a cohort of adults assessed for sleep issues, those in the highest quartile of apolipoprotein B to apolipoprotein A-I ratio were at the greatest risk for obstructive sleep apnea and insulin resistance.
Source: Adobe Stock

The 10-year CVD risk factors included the ApoB/ApoA-I ratio (OR = 5.365; 95% CI, 3.361-8.564), insulin resistance as measured by homeostasis model assessment (HOMA-IR; OR = 1.094; 95% CI, 1.063-1.127) and the apnea-hypopnea index (OR = 1.01; 95% CI, 1.007-1.014). The researchers noted that all three metrics maintained their risk factor status in men and women.

In fully adjusted models, those in the highest quartile of the ApoB/ApoA-I ratio were more likely to develop obstructive sleep apnea (OR = 1.679; 95% CI, 1.253-2.249) compared with those in the first quartile. Participants in the third quartile were also more at risk (OR = 1.471; 95% CI, 1.122-1.929) as were those in the second quartile, although not to a significant degree in the second. The researchers observed similarly elevated risk profiles across the quartiles regardless of sex. In addition, nearly 10% of the effect the ApoB/ApoA-I ratio had on events of apnea and hypopnea per hour was mediated by insulin resistance (9.7%), according to the researchers, who noted that insulin resistance mediated 4.7% of the ratio’s effect on hourly oxygen desaturation events of at least 3% and 10.8% of the ratio’s effect on hourly micro-arousals.

Participants in highest quartile of the ApoB/ApoA-I ratio were also nearly twice as likely to have insulin resistance compared with those in the lowest quartile (OR = 1.941; 95% CI, 1.548-2.433), and this likelihood was also elevated for those in the third quartile (OR = 1.644; 95% CI, 1.316-2.053) and the second quartile (OR = 1.39; 955 CI, 1.112-1.737); these findings held in analyses of men only and women only. – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.

In a cohort of adults assessed for sleep issues, those in the highest quartile of apolipoprotein B to apolipoprotein A-I ratio were at the greatest risk for obstructive sleep apnea and insulin resistance, according to findings published in Nutrition, Metabolism & Cardiovascular Diseases.

“The ApoB/ApoA-I ratio is positively associated with the risk of prediabetes, diabetes, metabolic syndrome, nonalcoholic fatty liver disease and CVD,” Jian Guan MD, PhD, of the department of otorhinolaryngology-head and neck surgery at Shanghai Jiao Tong University Affiliated Sixth People’s Hospital in Shanghai, and colleagues wrote. “Considering that [obstructive sleep apnea] may promote dyslipidemia, we hypothesized a positive association between severity of [obstructive sleep apnea] and the ApoB/ApoA-I.”

Guan and colleagues recorded height, weight, neck circumference, waist circumference, hip circumference and blood pressure and collected blood samples from 4,010 adults who took part in the Shanghai Sleep Health Study between 2007 and 2016. The blood samples were used to assess levels of triglycerides, total cholesterol, HDL cholesterol, LDL cholesterol, ApoB, ApoA-I, blood glucose and insulin. Questionnaires and polysomnography were used to identify the presence of obstructive sleep apnea and other sleep-related issues, and the researchers tabulated 10-year CVD risk using the Framingham CVD risk score.

Among the participants, 1,950 (mean age, 41 years; 9.4% women) had severe obstructive sleep apnea, which was defined by the occurrence of 30 or more events of apnea and hypopnea per hour when sleeping using the apnea-hypopnea index. In addition, 637 participants had 15 to 29.9 events per hour (mean age, 43 years; 19.2% women), 647 had five to 14.9 events per hour (mean age, 40 years; 23.6% women) and 776 had fewer than five events per hour and were, thus, without obstructive sleep apnea (mean age, 37 years; 40.7% women).

Older woman sleeping 
In a cohort of adults assessed for sleep issues, those in the highest quartile of apolipoprotein B to apolipoprotein A-I ratio were at the greatest risk for obstructive sleep apnea and insulin resistance.
Source: Adobe Stock

The 10-year CVD risk factors included the ApoB/ApoA-I ratio (OR = 5.365; 95% CI, 3.361-8.564), insulin resistance as measured by homeostasis model assessment (HOMA-IR; OR = 1.094; 95% CI, 1.063-1.127) and the apnea-hypopnea index (OR = 1.01; 95% CI, 1.007-1.014). The researchers noted that all three metrics maintained their risk factor status in men and women.

In fully adjusted models, those in the highest quartile of the ApoB/ApoA-I ratio were more likely to develop obstructive sleep apnea (OR = 1.679; 95% CI, 1.253-2.249) compared with those in the first quartile. Participants in the third quartile were also more at risk (OR = 1.471; 95% CI, 1.122-1.929) as were those in the second quartile, although not to a significant degree in the second. The researchers observed similarly elevated risk profiles across the quartiles regardless of sex. In addition, nearly 10% of the effect the ApoB/ApoA-I ratio had on events of apnea and hypopnea per hour was mediated by insulin resistance (9.7%), according to the researchers, who noted that insulin resistance mediated 4.7% of the ratio’s effect on hourly oxygen desaturation events of at least 3% and 10.8% of the ratio’s effect on hourly micro-arousals.

Participants in highest quartile of the ApoB/ApoA-I ratio were also nearly twice as likely to have insulin resistance compared with those in the lowest quartile (OR = 1.941; 95% CI, 1.548-2.433), and this likelihood was also elevated for those in the third quartile (OR = 1.644; 95% CI, 1.316-2.053) and the second quartile (OR = 1.39; 955 CI, 1.112-1.737); these findings held in analyses of men only and women only. – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.