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Cardiometabolic correlates of sleep disordered breathing in Andean highlanders

Luu V. Pham, Catherine H. Miele, Noah G. Schwartz, Rafael S. Arias, Adi Rattner, Robert H. Gilman, J. Jaime Miranda, Vsevolod Y. Polotsky, William Checkley, Alan R. Schwartz
European Respiratory Journal 2017 49: 1601705; DOI: 10.1183/13993003.01705-2016
Luu V. Pham
Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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  • ORCID record for Luu V. Pham
  • For correspondence: lpham1@jhmi.edu
Catherine H. Miele
Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Noah G. Schwartz
University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Rafael S. Arias
School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Adi Rattner
School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Robert H. Gilman
Program in Global Disease, Epidemiology and Control, Dept of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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J. Jaime Miranda
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, PeruSchool of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Vsevolod Y. Polotsky
Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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William Checkley
Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USAProgram in Global Disease, Epidemiology and Control, Dept of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Alan R. Schwartz
Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Abstract

Associations between sleep disordered breathing (SDB) and cardiometabolic outcomes have not been examined in highlanders.

We performed nocturnal polygraphy in Peruvian highlanders (3825 m). Multivariable linear regression models examined associations between SDB metrics and haemoglobin, glucose tolerance (haemoglobin A1c (HbA1c)), fasting glucose, homeostatic model-based assessments of insulin resistance and β-cell function (HOMA-IR and HOMA-β, respectively), blood pressure, and lipids, while adjusting for age, sex, body mass index (BMI) and wake oxygenation.

Participants (n=187; 91 men) were (median (interquartile range)) 52 (45–62) years old, and had a BMI of 27.0 (24.3–29.5) kg·m−2 and 87% (85–88%) oxyhaemoglobin (arterial oxygen) saturation during wakefulness. In fully adjusted models, worsening nocturnal hypoxaemia was associated with haemoglobin elevations in men (p=0.03), independent of wake oxygenation and apnoea–hypopnoea index (AHI), whereas worsening wake oxygenation was associated with haemoglobin elevations in older women (p=0.02). In contrast, AHI was independently associated with HbA1c elevations (p<0.05). In single-variable models, nocturnal hypoxaemia was associated with higher HbA1c, HOMA-IR and HOMA-β (p<0.001, p=0.02 and p=0.04, respectively), whereas AHI was associated with HOMA-IR, systolic blood pressure and triglyceride elevations (p=0.02, p=0.01 and p<0.01, respectively). These associations were not significant in fully adjusted models.

In highlanders, nocturnal hypoxaemia and sleep apnoea were associated with distinct cardiometabolic outcomes, conferring differential risk for excessive erythrocytosis and glucose intolerance, respectively.

Abstract

In highlanders, nocturnal hypoxaemia and sleep apnoea were associated with differential outcomes http://ow.ly/1k6z309MyDR

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • Support statement: This project was funded with federal funds from the US National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Dept of Health and Human Services, under contract HHSN268200900033C. L. Pham was further supported by a NIH National Research Service Award (5T32HL1109523). J. Jaime Miranda is supported by the Fogarty International Centre (R21TW009982), Grand Challenges Canada (0335-04), International Development Research Center Canada (106887-001), Inter-American Institute for Global Change Research (IAI CRN3036), Medical Research Council UK (M007405), NHLBI (U01HL114180), and National Institutes of Mental Health (U19MH098780). V.Y. Polotsky was supported by NHLBI grants (R01s HL133100, HL128970 and HL080105) and by the National Institute of Environmental Health Sciences P50ES018176. A.R. Schwartz was supported by NHLBI grants (HL128970 and HL133100). ResMed Ltd provided ApneaLink recording devices. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com

  • Received August 26, 2016.
  • Accepted March 5, 2017.
  • Copyright ©ERS 2017
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Cardiometabolic correlates of sleep disordered breathing in Andean highlanders
Luu V. Pham, Catherine H. Miele, Noah G. Schwartz, Rafael S. Arias, Adi Rattner, Robert H. Gilman, J. Jaime Miranda, Vsevolod Y. Polotsky, William Checkley, Alan R. Schwartz
European Respiratory Journal Jun 2017, 49 (6) 1601705; DOI: 10.1183/13993003.01705-2016

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Cardiometabolic correlates of sleep disordered breathing in Andean highlanders
Luu V. Pham, Catherine H. Miele, Noah G. Schwartz, Rafael S. Arias, Adi Rattner, Robert H. Gilman, J. Jaime Miranda, Vsevolod Y. Polotsky, William Checkley, Alan R. Schwartz
European Respiratory Journal Jun 2017, 49 (6) 1601705; DOI: 10.1183/13993003.01705-2016
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