Table 3.
Associations between baseline hyperglycemia measured by hemoglobin A1c and risk of developing obstructive sleep apnea*
| Quintiles of hemoglobin A1c |
Per 1% increase | P-trend | |||||
|---|---|---|---|---|---|---|---|
| Q1 | Q2 | Q3 | Q4 | Q5 | |||
| NHS | |||||||
| Median (range)* | 5.1 (3.7–5.3) | 5.4 (5.3–5.5) | 5.6 (5.5–5.7) | 5.8 (5.7–6.0) | 6.3 (6.0–10.9) | — | — |
| Cases/N | 10/252 | 13/253 | 15/298 | 9/248 | 20/261 | — | — |
| Model 1† | 1.00 (ref) | 1.42 (0.60–3.33) | 1.38 (0.60–3.20) | 1.00 (0.39–2.53) | 2.21 (0.98–4.99) | 1.46 (1.03–2.07) | 0.04 |
| Model 2‡ | 1.00 (ref) | 1.53 (0.64–3.71) | 1.13 (0.48–2.69) | 0.58 (0.21–1.57) | 1.46 (0.63–3.38) | 1.20 (0.81–1.78) | 0.37 |
| NHSII | |||||||
| Median (range)* | 5.0 (0.3–5.2) | 5.2 (5.2–5.3) | 5.4 (5.3–5.5) | 5.6 (5.5–5.8) | 6.0 (5.8–10.3) | — | — |
| Cases/N | 18/426 | 32/428 | 46/425 | 59/429 | 93/427 | — | — |
| Model 1† | 1.00 (ref) | 1.80 (0.98–3.28) | 2.52 (1.42–4.47) | 2.89 (1.65–5.07) | 4.46 (2.57–7.74) | 1.88 (1.50–2.37) | <0.0001 |
| Model 2‡ | 1.00 (ref) | 1.69 (0.91–3.12) | 1.97 (1.09–3.55) | 1.77 (0.99–3.18) | 1.94 (1.08–3.50) | 1.20 (0.93–1.56) | 0.16 |
| HPFS | |||||||
| Median (range)* | 5.0 (4.2–5.1) | 5.3 (5.1–5.4) | 5.5 (5.4–5.6) | 5.8 (5.6–5.9) | 6.1 (5.9–12.1) | — | — |
| Cases/N | 29/196 | 34/196 | 22/196 | 19/195 | 31/197 | — | — |
| Model 1† | 1.00 (ref) | 1.32 (0.76–2.29) | 0.73 (0.40–1.35) | 0.62 (0.33–1.17) | 1.15 (0.65–2.04) | 1.05 (0.78–1.40) | 0.76 |
| Model 2‡ | 1.00 (ref) | 1.24 (0.71–2.17) | 0.72 (0.39–1.34) | 0.60 (0.32–1.13) | 0.96 (0.53–1.73) | 0.97 (0.72–1.31) | 0.84 |
| MESA | |||||||
| Median (range)* | 4.9 (3.9–5.1) | 5.3 (5.2–5.3) | 5.4 (5.4–5.5) | 5.7 (5.6–5.9) | 6.5 (6.0–15.9) | — | — |
| Cases/N | 41/397 | 39/346 | 36/342 | 68/455 | 81/375 | — | — |
| Model 1† | 1.00 (ref) | 1.13 (0.70–1.82) | 1.07 (0.66–1.74) | 1.52 (0.98–2.36) | 2.38 (1.52–3.74) | 1.22 (1.08–1.38) | 0.002 |
| Model 2‡ | 1.00 (ref) | 1.12 (0.69–1.83) | 0.99 (0.60–1.64) | 1.33 (0.85–2.09) | 1.73 (1.08–2.76) | 1.14 (1.01–1.30) | 0.04 |
| Pooled analysis§ | |||||||
| Median (range)* | 5.0 (0.3–5.2) | 5.3 (5.2–5.4) | 5.5 (5.4–5.6) | 5.7 (5.6–5.9) | 6.2 (5.9–15.9) | — | — |
| Cases/N | 105/1255 | 117/1185 | 116/1267 | 163/1365 | 214/1270 | — | — |
| Model 1† | 1.00 (ref) | 1.24 (0.94–1.64) | 1.18 (0.89–1.56) | 1.51 (1.16–1.98) | 2.21 (1.69–2.89) | 1.29 (1.18–1.42) | <0.0001 |
| Model 2‡ | 1.00 (ref) | 1.21 (0.91–1.61) | 0.99 (0.74–1.32) | 1.13 (0.86–1.49) | 1.31 (0.99–1.73) | 1.12 (1.01–1.24) | 0.03 |
| Model 3ǁ | 1.00 (ref) | 1.05 (0.74–1.50) | 1.07 (0.75–1.51) | 1.15 (0.82–1.62) | 1.26 (0.89–1.78) | 1.09 (0.97–1.23) | 0.14 |
Definition of abbreviations: HPFS = Health Professionals Follow-up Study; MESA = Multi-Ethnic Study of Atherosclerosis; NHS = Nurses’ Health Study; NHSII = Nurses’ Health Study II; ref = reference.
HbA1c values were reported as a percent.
Model 1: Adjusted for cohort (pooled analysis), age, race and ethnicity, sex (MESA and pooled analysis), menopausal status in women, smoking, sleep duration, diet quality, physical activity, hypertension, and family history of diabetes.
Model 2: Model 1 + continuous body mass index and waist circumference.
Based on the association estimates per 1% hemoglobin A1c increase, there was significant between-cohort heterogeneity in Model 1 (P = 0.004) and no significant between-cohort heterogeneity in Model 2 (P = 0.73).
Model 3: Model 2 + fasting insulin.