ECE2013 Poster Presentations Obesity (65 abstracts)
Apnoeic episodes impair insulin resistance independently of oxygen desaturations: evidence from morbid obese patients with discordant apnoea/desaturation indexes
Patricia Andrada , Ana Chacon , Eider Pascual , Camilo Silva , Jorge Iriarte , Maria J Gil , Pedro Pujante , Cristina Abreu , Javier Escalada , Gema Frühbeck & Javier Salvador
University Clinic of Navarra, Pamplona, Spain.
Morbid obesity (MO) is often complicated by obstructive sleep apnoea (OSA), which in some cases is evaluated by pulsioximetry. This cross-sectional study was designed to investigate the prevalence of discordance between desaturation index (DI) and apnoea–hypopnoea index (AHI) and its effects on insulin resistance and secretion in MO patients candidate to bariatric surgery (n=496) in whom a full polysomnographic study was carried out. We identified 163 (33%) out of 496 patients with normal DI (<3/h), 42 (26%) of which showed significant nocturnal apnoeas (AHI >10). When comparing DI less than three patients with IAH>10 (n=42) with those showing IAH<10 (n=121), apnoeic subjects showed higher fasting insulin (17.4+1.1 vs 15+0.6 mU/l, P<0.05), post-OGTT insulin peak (151.2+11.5 vs 123.2+5.6 mU/l, P<0.05) and HOMAr values (4.4+0.3 vs 3.6+0.1, P<0.05) than those with AHI <10, despite exhibiting similar waist and neck circumference. On the other hand, there were 333 patients with DI >3, of which 60 (18%) showed AHI <10. In this subgroup of patients with significant oxygen desaturations there were no differences in fasting, post OGTT insulin levels or HOMAr between patients classified according with AHI values. No differences were seen in insulinogenic index between patients with AHI >10 and AHI <10 in any of DI subgroups. AHI values were correlated with peak insulin values after OGTT (r=0.15, P<0.01), QUICKI (r=−0.17, P<0.01), HOMAr (r=0.14, P<0.05) and Matsuda index (r=−0.10, P<0.01) only in patients with DI >3. These findings show that discordant results between AHI and DI can be observed in up to 26% of cases when the diagnosis is based only on pulsioximetry results, leading to patient misclassification. Presence of apnoeas in absence of DI abnormalities is associated with disturbances in insulin resistance parameters, suggesting that apnoeic episodes, independently of oxygen desaturations, participate in the impairment of carbohydrate metabolism seen in MO patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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