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

Abstract Objectives: Slow wave sleep (SWS) and obstructive sleep apnea (OSA) have attracted more and more attention. Their joint effect on insulin resistance (IR) remains to be further studied. This study explored whether less SWS influences the relationship between OSA and IR.Methods: We enrolled potential participants in our sleep center from 2007 to 2019. We collected demographic and clinical characteristics and gauged the IR status. SWS was derived from polysomnography data. Logistic regression analyses were used to reveal the associations between SWS and IR.Results: In all, 6966 participants (5709 OSA and 1257 primary snoring [PS] subjects) were enrolled. Less SWS increases 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 those with SWS > 21.3%. OSA was an independent risk factor for IR after adjusting for all potential confounding factors. In stratified analyses according to the percentage of SWS, patients with OSA with SWS < 6.5% had 38.2% higher odds of IR than the PS group after adjusting for all potential confounders. Conclusions: Less SWS is associated with higher odds for IR in OSA patients but not in PS patients. OSA is independently correlated 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.