• Darko Stefanovski, Ray C Boston, and Naresh M Punjabi.
• Department of Clinical Studies, New Bolton Center, University of Pennsylvania, New Bolton, Philadelphia, PA.
• Chest. 2020 Nov 1; 158 (5): 2155-2164.

BackgroundSleep-disordered breathing (SDB) is independently associated with insulin resistance, glucose intolerance, and type 2 diabetes mellitus. However, data on whether SDB alters the metabolism of free fatty acids (FFAs) are lacking.Research QuestionThe primary objective of the current study was to characterize alterations in FFA metabolism across the spectrum of SDB severity.Study Design And MethodsThe study sample included 118 participants with and without SDB who underwent full-montage polysomnography, the frequently sampled IV glucose tolerance test (FSIGTT), and body composition measurements including determination of percent body fat. Parameters of lipolysis suppression, time to FFA nadir, and FFA rebound after an IV glucose challenge were derived using a mathematical model. Multivariable regression analyses were used to characterize the independent associations between SDB severity and parameters of FFA metabolism.ResultsSDB severity, as assessed by the apnea-hypopnea index, was associated with adipocyte insulin resistance, a decrease in the glucose- and insulin-mediated suppression of lipolysis, a longer duration to reach a nadir in FFA levels during the FSIGTT, and a sluggish rebound in FFA levels after suppression. Severity of SDB-related hypoxemia was independently associated with adipocyte insulin resistance and the time to reach the FFA nadir during the FSIGTT. Finally, a higher percentage of stage N3 sleep was positively associated with greater suppression of lipolysis and a faster rebound in the FFA levels during the FSIGTT.InterpretationIndependent of adiposity, SDB is associated with impairments in FFA metabolism, which may contribute to the development of glucose intolerance and type 2 diabetes in SDB.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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