Megan Brooks

June 19, 2017

BOSTON — Mild-to-moderate obstructive sleep apnea (OSA) is associated with an increased risk for hypertension and diabetes, preliminary data from two studies suggest.

"We found that even mild sleep apnea was strongly associated with increased risk of developing hypertension by 4 times compared to individuals without sleep apnea," principal investigator, Alexandros N. Vgontzas, MD, from the Sleep Research & Treatment Center, Penn State University College of Medicine, Hershey, Pennsylvania, said in a news release.

"Similarly, moderate sleep apnea was associated with increased risk of developing diabetes by almost 3 times compared to individuals without sleep apnea."

"Early detection and treatment of mild-to-moderate sleep apnea is warranted in order to prevent future cardiometabolic diseases in young and middle-aged adults," study presenter, Yun Li, MD, postdoctoral scholar at Penn State University, told attendees here at SLEEP 2017: 31st Annual Meeting of the Associated Professional Sleep Societies.

"Given the stronger association of sleep apnea with metabolic abnormalities in this age group, emphasis should be placed on yearly monitoring of indices of metabolic symptoms and lifestyle interventions, such as weight control, healthy diet, regular exercise, and stress management," she added.

Both studies involved the Penn State Adult Cohort, a random general population sample of 1741 adults. Participants completed a detailed medical history interview at baseline and spent one night in the sleep lab. Those with an apnea-hypopnea index (AHI) less than 30 and no hypertension (n = 787) or diabetes (n  =1250) at baseline were reassessed at 10 years. 

Mild OSA was defined as an AHI of 5 to 14.9 and moderate OSA as an AHI of 15 to 29.9.

The incidence rates of hypertension and diabetes were 25.2% and 10.2%, respectively.

In multivariate-adjusted analysis, both mild and moderate OSA, even when asymptomatic, were associated with increased risk for hypertension. The association between OSA and hypertension was significantly stronger in younger adults than elderly (OSA × age interaction; P = .01).

The risk for diabetes was significantly increased with moderate, but not mild OSA, after adjustment for multiple factors.

Table. Risk for Incident Hypertension or Diabetes With OSA

Group Odds Ratio: Incident Hypertension (95% Confidence Interval) Odds Ratio: Incident Diabetes (95% Confidence Interval)
Mild OSA 4.35 (2.25 - 8.39) 0.47 (0.18 - 1.19)
Moderate OSA 3.80 (1.41 - 10.30) 2.78 (1.17 - 6.63)

Commenting on the findings, Shalini Paruthi, MD, spokesperson for the American Academy of Sleep Medicine, said, "There looks like there is more of an association between sleep apnea in adults — even if it is mild sleep apnea, AHI between 5 and 15 — and hypertension.

"We are seeing a lot more studies on this association, but I think the jury is still out on the association between sleep apnea and diabetes."

"Studies have shown differences in glucose regulation with sleep apnea but whether that translates all the way to diabetes, we don't know that yet," Dr Paruthi told Medscape Medical News.

"Primary care doctors will check blood pressure and screen for diabetes, but sleep specialists need to be aware of these associations," she said. "And when I talk to my patients about sleep apnea and the risks associated with sleep apnea, I also tell them that if we treat sleep apnea there is a pretty good chance that we will see some improvements in the high blood pressure if they have it or in the glucose if that is high."

The study had no commercial funding, and the authors have disclosed no relevant financial relationships.

SLEEP 2017: 31st Annual Meeting of the Associated Professional Sleep Societies. Abstracts 0424 and 0426. Presented June 5, 2017. 

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