Triglyceride-glucose index as a predictor of obstructive sleep apnoea severity in the absence of traditional risk factors

Abstract

Objective We evaluated the association between the triglyceride–glucose (TG) index, a marker of insulin resistance, and obstructive sleep apnoea (OSA) severity in patients without diabetes mellitus, obesity, and metabolic syndrome.

Methods This retrospective cohort study included 1,527 patients. We used univariate and multivariate analyses to identify the independent predictors associated with OSA.

Results Most patients were males (81.5%) with a mean age of 43.9 ± 11.1 (15–90) years. Based on the apnoea–hypopnea index (AHI), 353 (23.1%) patients were included in the control group, whereas 32.4%, 23.5%, and 21% had mild, moderate, and severe OSA, respectively. The TG index values demonstrated significant associations with OSA patients compared with the control group (p = 0.001). In addition, the mean values of the oxygen desaturation index (ODI), AHI, minimum oxygen saturation, and total sleep time percentage with saturation below 90% demonstrated statistically significant differences among the TG index groups (p: 0.001; p:0.001; p:0.001; p:0.003). The optimal TG index cutoff value to predict OSA was 8.615 (AUC = 0.638, 95% CI = 0.606–0.671, p = 0.001). In multivariate logistic regression analysis, after adjusting for age, sex, and body mass index, the TG index was independently associated with OSA patients.

Conclusion The TG index is independently associated with increased risk for OSA. This indicates that this index, a marker for disease severity, can be used to identify severe OSA patients on waiting lists for PSG.

Resumo

Objetivo Avaliamos a associação entre o índice triglicerídeos-glicose (TG), um marcador de resistência à insulina, e a gravidade da apneia obstrutiva do sono (AOS) em pacientes sem diabetes mellitus, obesidade e síndrome metabólica.

Métodos Este estudo de coorte retrospectivo incluiu 1.527 pacientes. Utilizamos análises univariadas e multivariadas para identificar os preditores independentes associados à AOS.

Resultados A maioria dos pacientes era do sexo masculino (81,5%) com idade média de 43,9 ± 11,1 anos (15-90). Com base no índice apneia-hipopneia (IAH), 353 (23,1%) pacientes foram incluídos no grupo de controle, enquanto 32,4%, 23,5% e 21% tinham AOS leve, moderada e grave, respectivamente. Os valores do índice TG demonstraram associações significativas com pacientes com AOS em comparação com o grupo de controle (p = 0,001). Além disso, os valores médios do índice de dessaturação de oxigênio (IDO), IAH, saturação mínima de oxigênio e porcentagem de tempo total de sono com saturação abaixo de 90% demonstraram diferenças estatisticamente significativas entre os grupos de índice TG (p = 0,001; p = 0,001; p = 0,001; p = 0,003). O valor de corte ideal do índice TG para prever a AOS foi de 8,615 (AUC=0,638, IC de 95% = 0,606–0,671, p = 0,001). Na análise de regressão logística multivariada, após o ajuste para idade, sexo e índice de massa corporal, o índice TG foi independentemente associado a pacientes com AOS.

Conclusão O índice TG está independentemente associado a um maior risco de AOS. Isso indica que este índice, um marcador de gravidade da doença, pode ser usado para identificar pacientes com AOS grave em listas de espera para polissonografia.

Keywords

Sleep Apnea, Obstructive - Prognosis - Triglyceride Glucose Index

Palavras-chave

Apneia Obstrutiva do Sono - Prognóstico - Índice Triglicerídeos e Glicose

Authors' Contributions

SNS: investigation, methodology, writing – original draft, writing – review & editing; SA: investigation, methodology, software, writing – original draft, writing – review & editing; CS: methodology, software, writing – review & editing; STO: software, writing – review & editing; CO: investigation, writing – review & editing.

Publication History

Received: 22 November 2022

Accepted: 24 June 2023

Article published online:
08 November 2023

• References

• 1 Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008; 5 (02) 136-143
• 2 Heinzer R, Vat S, Marques-Vidal P. et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015; 3 (04) 310-318
• 3 Sanchez Garcia A, Rodriguez-Gutierrez R, Mancillas-Adame L. et al. Diagnostic Acuracy of the Triglyceride and Glucose Index for Insulin Resistance: A systemic review. Int J Endocrinology Volume 2020; x: 7
• 4 Vasques AC, Novaes FS, de Oliveira MdaS. et al. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract 2011; 93 (03) e98-e100
• 5 da Silva A, Caldas APS, Rocha DMUP, Bressan J. Triglyceride-glucose index predicts independently type 2 diabetes mellitus risk: A systematic review and meta-analysis of cohort studies. Prim Care Diabetes 2020; 14 (06) 584-593
• 6 Li M, Li X, Lu Y. Obstructive Sleep Apnea Syndrome and Metabolic Diseases. Endocrinology 2018; 159 (07) 2670-2675
• 7 Reutrakul S, Mokhlesi B. Obstructive Sleep Apnea and Diabetes: A State of the Art Review. Chest 2017; 152 (05) 1070-1086
• 8 Giampá SQC, Lorenzi-Filho G, Drager LF. Obstructive sleep apnea and metabolic syndrome. Obesity (Silver Spring) 2023; 31 (04) 900-911
• 9 Adedayo AM, Olafiranye O, Smith D. et al. Obstructive sleep apnea and dyslipidemia: evidence and underlying mechanism. Sleep Breath 2014; 18 (01) 13-18
• 10 Huang PL. A comprehensive definition for metabolic syndrome. Dis Model Mech 2009; 2 (5-6): 231-237
• 11 Zou J, Wang Y, Xu H. et al. The use of visceral adiposity variables in the prediction of obstructive sleep apnea: evidence from a large cross-sectional study. Sleep Breath 2020; 24 (04) 1373-1382
• 12 Kang HH, Kim SW, Lee SH. Association between triglyceride glucose index and obstructive sleep apnea risk in Korean adults: a cross-sectional cohort study. Lipids Health Dis 2020; 19 (01) 182
• 13 Bianchi VE, Herbert WG, Myers J, Ribisl PM, Miller LE, Dalman RL. Relationship of obstructive sleep apnea and cardiometabolic risk factors in elderly patients with abdominal aortic aneurysm. Sleep Breath 2015; 19 (02) 593-598
• 14 Bikov A, Frent SM, Meszaros M. et al. Triglyceride-Glucose Index in Non-Diabetic, Non-Obese Patients with Obstructive Sleep Apnoea. J Clin Med 2021; 10 (09) 1932
• 15 Lindberg E, Theorell-Haglöw J, Svensson M, Gislason T, Berne C, Janson C. Sleep apnea and glucose metabolism: a long-term follow-up in a community-based sample. Chest 2012; 142 (04) 935-942
• 16 Mesarwi O, Polak J, Jun J, Polotsky VY. Sleep disorders and the development of insulin resistance and obesity. Endocrinol Metab Clin North Am 2013; 42 (03) 617-634
• 17 Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013; 177 (09) 1006-1014
• 18 Wang Y, Liu X, Xiang Y, Chen B, Chen Y, Zhou C. The association between triglyceride-glycemic index and obstructive sleep apnea (OSA9: a meta-analysis.
• 19 Wang K, He G, Zhang Y. et al. Association of triglyceride-glucose index and its interaction with obesity on hypertension risk in Chinese: a population-based study. J Hum Hypertens 2021; 35 (03) 232-239
• 20 Zhu B, Wang J, Chen K. et al. A high triglyceride glucose index is more closely associated with hypertension than lipid or glycemic parameters in elderly individuals: a cross-sectional survey from the Reaction Study. Cardiovasc Diabetol 2020; 19 (01) 112
• 21 Xie Y, Guo R, Li Z. et al. Temporal relationship between body mass index and triglyceride-glucose index and its impact on the incident of hypertension. Nutr Metab Cardiovasc Dis 2019; 29 (11) 1220-1229
• 22 Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: implications for comorbidities. Chest 2015; 147 (01) 266-274
• 23 Joo S, Lee S, Choi HA. et al. Habitual snoring is associated with elevated hemoglobin A1c levels in non-obese middle-aged adults. J Sleep Res 2006; 15 (04) 437-444