Effect of Interaction Between Slow Wave Sleep and Obstructive Sleep Apnea on Insulin Resistance: A Large-Scale Study

Slow-wave sleep (SWS) and obstructive sleep apnea (OSA) have attracted recent research attention. However, their joint effects on insulin resistance (IR) remain unclear. This study explored whether SWS influences the relationship between OSA and IR.

We enrolled potential participants in our sleep center from 2007 to 2019. We collected demographic and clinical characteristics and determined IR status. SWS was derived from polysomnography data. Logistic regression analysis was used to reveal the associations between SWS and IR.

In all, 6966 participants (5709 OSA and 1257 primary snoring [PS] subjects) were enrolled. Less SWS increased the risk of IR in OSA patients but not in PS patients. OSA patients with SWS <6.5% were more likely to have IR than were those with SWS >21.3%. OSA was an independent risk factor for IR after adjusting for potential confounding factors. In stratified analyses according to the percentage of SWS, OSA patients with SWS <6.5% had an odds ratio for IR of 2.461 (95% CI, 2.018-3.002) compared to the PS group after adjusting for potential confounders.

Less SWS is associated with higher odds for IR in OSA patients but not in PS patients. OSA is independently associated with IR. In addition, OSA combined with an extreme lack of SWS has a more harmful effect on the status of IR than OSA itself.