Original Research: Sleep Disorders |

Independent Association Between Nocturnal Intermittent Hypoxemia and Metabolic DyslipidemiaMetabolic Dyslipidemia in Obstructive Sleep Apnea

Wojciech Trzepizur, MD; Marc Le Vaillant, PhD; Nicole Meslier, MD; Thierry Pigeanne, MD; Philippe Masson, MD; Marie P. Humeau, MD; Acya Bizieux-Thaminy, MD; François Goupil, MD; Sylvaine Chollet, MD; Pierre H. Ducluzeau, MD, PhD; Frédéric Gagnadoux, MD, PhD; for the Institut de Recherche en Santé Respiratoire des Pays de la Loire (IRSR) Sleep Cohort Group
Author and Funding Information

From the LUNAM University (Drs Trzepizur, Meslier, Ducluzeau, and Gagnadoux), Angers, France; Department of Respiratory Diseases (Drs Trzepizur, Meslier, Ducluzeau, and Gagnadoux) and Department of Endocrinology-Diabetology-Nutrition (Dr Ducluzeau), Angers University Hospital, Angers, France; INSERM U1063 (Drs Trzepizur, Meslier, and Gagnadoux), Angers, France; CERMES (Dr Le Vaillant), CNRS UMR8211-INSERM U988-EHESS, Villejuif, France; Department of Respiratory Diseases (Dr Pigeanne), Pôle santé des Olonnes, Olonnes sur Mer, France; Department of Respiratory Diseases (Dr Masson), Cholet Hospital, Cholet, France; Department of Respiratory Diseases (Dr Humeau), Nouvelles Cliniques Nantaises, Nantes, France; Department of Respiratory Diseases (Dr Bizieux-Thaminy), La Roche sur Yon Hospital, La Roche sur Yon, France; Department of Respiratory Diseases (Dr Goupil), Le Mans Hospital, Le Mans, France; and Department of Respiratory Diseases (Dr Chollet), Nantes University Hospital, Nantes, France.

Correspondence to: Frédéric Gagnadoux, MD, PhD, Université d’Angers, CHU Angers, Département de Pneumologie, 4 rue Larrey, 49033 Angers Cedex, France; e-mail: frgagnadoux@chu-angers.fr

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;143(6):1584-1589. doi:10.1378/chest.12-1652
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Background:  There is growing evidence from animal models that intermittent hypoxemia (IH) may induce dyslipidemia. Altered lipid metabolism may contribute to the increased cardiovascular risk observed in obstructive sleep apnea (OSA). In this multisite, cross-sectional study, we tested the hypothesis that there is an independent association between nocturnal IH and dyslipidemia in OSA.

Methods:  Fasting serum lipid levels were measured in 2,081 patients (638 women) undergoing nocturnal recording for clinical suspicion of OSA. Multivariate regression analyses were performed to evaluate the independent associations between oxygen desaturation index (ODI) and lipid profile after adjustment for potential confounders, including components of the metabolic syndrome (MS) or the MS itself. Adjusted OR for metabolic dyslipidemia (triglycerides [TG] ≥ 150 mg/dL and high-density lipoprotein cholesterol [HDL-C] ≤ 50 mg/dL for women and ≤ 40 mg/dL for men) according to quartiles of ODI were determined by logistic regression.

Results:  Total cholesterol and low-density lipoprotein cholesterol were not associated with ODI. In contrast, nocturnal IH and OSA severity were associated with higher TG levels and lower HDL-C levels after adjustment for confounding factors. The association between ODI and TG and HDL-C levels was independent of the MS. Adjusted OR (95% CIs) for metabolic dyslipidemia were 1 (reference), 1.56 (1.24-1.96), 1.72 (1.29-2.29), and 1.93 (1.55-2.41) for ODI ≤ 7, > 7 to ≤ 18, > 18 to ≤ 38, and > 38, respectively (P < .0001 for linear trend).

Conclusions:  Nocturnal IH is independently associated with metabolic dyslipidemia, which may predispose patients with OSA to a higher risk of cardiovascular disease.

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