Copyright © 2004 by the European Society of Cardiology.
Clinical research
Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome
Department of Medicine, Clinical Sciences Centre, University of Liverpool, Lower Lane, Liverpool L9 7AL, UK
Received November 10, 2003;
revised February 9, 2004;
accepted February 16, 2004
* Corresponding author. Tel.: +44-1515295885; fax: +44-1515295888
E-mail address: j.p.h.wilding{at}liv.ac.uk
See page 709 for the editorial comment on this article1
Aims Obstructive sleep apnoea (OSA) is associated with increased cardiovascular morbidity and mortality. Although it was previously assumed that this was due to its relation with obesity, recent data suggest that OSA is independently associated with the cardiovascular risk factors that comprise metabolic syndrome, including hypertension, insulin resistance, impaired glucose tolerance, and dyslipidaemia. However, as previous studies have only considered these variables individually, it has not been possible to determine the overall association of OSA with this syndrome. Methods and results We recruited 61 male subjects with OSA and 43 controls. Glucose, insulin, lipids, and blood pressure (BP) were measured following an overnight fast. Insulin resistance was estimated using homeostasis model assessment (HOMA). Metabolic syndrome was diagnosed according to National Cholesterol Education Program (NCEP) criteria. Subjects with OSA were more obese, had higher BP and fasting insulin, were more insulin resistant, had lower HDL cholesterol, and an increased incidence of metabolic syndrome (87% vs. 35%, 
). In order to determine whether these associations were independent of obesity and other known covariates, a regression analysis adjusted for age, BMI, smoking, and alcohol consumption was performed. This demonstrated that OSA was independently associated with increased systolic and diastolic blood pressure, higher fasting insulin and triglyceride concentrations, decreased HDL cholesterol, increased cholesterol:HDL ratio, and a trend towards higher HOMA values. Metabolic syndrome was 9.1 (95% confidence interval 2.6, 31.2: ) times more likely to be present in subjects with OSA. Conclusions OSA is independently associated with an increase in the cardiovascular risk factors that comprise the metabolic syndrome and its overall prevalence. This may help explain the increased cardiovascular morbidity and mortality associated with this condition.
Key Words: Obstructive sleep apnoea • Fasting glucose • Blood pressure • Lipids • Metabolic syndrome
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