Journal of Sleep Sciences 2017. 2(1-2):7-12.

Insulin Resistance and Leptin Levels in Patients with Obstructive Sleep Apnea
Khosro Sadeghniiat-Haghighi, Mohammad Reza Mohajeri-Tehrani, Ahmad Khajeh-Mehrizi, Zahra Banafsheh Alemohammad, Ania Rahimi-Golkhandan, Sina Hafizi, Bagher Larijani



 Background and Objective: Obstructive sleep apnea (OSA) has been associated with metabolic syndrome, diabe-tes mellitus, and cardiovascular diseases. Insulin resistance and increased leptin levels could explain the impaired meta-bolic conditions in patients with OSA. This study aimed to assess the association of OSA severity with insulin re-sistance and leptin levels in a group of patients referred to a sleep disorders’ clinic.

Materials and Methods: Seventeen patients without OSA and 28, 33, and 30 patients with mild, moderate, and se-vere OSA; respectively, were included in this study. All participants underwent full night polysomnography (PSG), and blood samples were collected in the morning after PSG. The insulin resistance index was estimated by homeostasis model assessment (HOMA).

Results: HOMA values were not significantly different among the study groups. Significant difference in leptin lev-el was found between patients with severe and mild OSA. Leptin level was significantly correlated with age (r = 33, P = 0.020), apnea–hypopnea index (AHI) (r = 0.41, P = 0.004), and oxygen desaturation index (r = 46, P = 0.030). HOMA was insignificant positive correlation only with triglyceride level (P = 0.010). Stepwise multiple regression analysis showed that AHI, body mass index, and gender were determinants of leptin levels, however, no variable was found for predicting HOMA.

Conclusions: Present findings suggest that leptin levels might be independently associated with severity of OSA. Other factors other than insulin resistance should be considered for increasing vascular diseases in patients with OSA.


Insulin; Leptin; Obstructive sleep apnea

Full Text:



Franklin KA, Lindberg E. Obstructive sleep ap-nea is a common disorder in the population-a review

on the epidemiology of sleep apnea. J Thorac Dis 2015; 7: 1311-22.

Qian Y, Xu H, Wang Y, et al. Obstructive sleep apnea predicts risk of metabolic syndrome inde-pendently of obesity: A meta-analysis. Arch Med Sci 2016; 12: 1077-87.

Rajan P, Greenberg H. Obstructive sleep apnea as a risk factor for type 2 diabetes mellitus. Nat Sci Sleep 2015; 7: 113-25.

Sadeghniiat-Haghighi K, Mohajeri-Tehrani MR, Khajeh-Mehrizi A, et al. Obstructive sleep apnea and excessive daytime sleepiness among patients with type 2 diabetes mellitus: A single-center study from Iran. Int J Diabetes Dev Ctries 2015; 35: 189-93.

Uyar M, Davutoglu V. An update on cardiovas-cular effects of obstructive sleep apnoea syndrome. Postgrad Med J 2016; 92: 540-4.

Khajeh-Mehrizi A, Rahimi-Golkhandan A, Sed-aghat M. Obstructive sleep apnea among individuals admitted for myocardial infarction. J Sleep Sci 2016; 1: 23-7.

Xu S, Wan Y, Xu M, et al. The association be-tween obstructive sleep apnea and metabolic syn-drome: A systematic review and meta-analysis. BMC Pulm Med 2015; 15: 105.

Reaven GM. Banting lecture 1988. Role of in-sulin resistance in human disease. Diabetes 1988; 37: 1595-607.

Haffner SM, Miettinen H. Insulin resistance im-plications for type II diabetes mellitus and coronary heart disease. Am J Med 1997; 103: 152-62.

Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: Relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 2000; 85: 1151-8.

Tassone F, Lanfranco F, Gianotti L, et al. Ob-structive sleep apnoea syndrome impairs insulin sensi-tivity independently of anthropometric variables. Clin Endocrinol (Oxf) 2003; 59: 374-9.

Zahin M, Bercik Ynal B, Ögeden S, et al. Meta-bolic profile and insulin resistance in patients with ob-structive sleep apnea syndrome. Turk J Med Sci 2011; 41: 443-54.

Ip MS, Lam B, Ng MM, et al. Obstructive sleep apnea is independently associated with insulin re-sistance. Am J Respir Crit Care Med 2002; 165: 670-6.

Gruber A, Horwood F, Sithole J, et al. Obstruc-tive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state. Cardiovasc Diabetol 2006; 5: 22.

Mark AL, Correia ML, Rahmouni K, et al. Se-lective leptin resistance: A new concept in leptin phys-iology with cardiovascular implications. J Hypertens 2002; 20: 1245-50.

Considine RV, Sinha MK, Heiman ML, et al. Serum immunoreactive-leptin concentrations in nor-mal-weight and obese humans. N Engl J Med 1996; 334: 292-5.

Tokuda F, Sando Y, Matsui H, et al. Serum lev-els of adipocytokines, adiponectin and leptin, in pa-tients with obstructive sleep apnea syndrome. Intern Med 2008; 47: 1843-9.

Kapsimalis F, Varouchakis G, Manousaki A, et al. Association of sleep apnea severity and obesity with insulin resistance, C-reactive protein, and leptin levels in male patients with obstructive sleep apnea. Lung 2008; 186: 209-17.

Ulukavak Ciftci T, Kokturk O, Bukan N, et al. Leptin and ghrelin levels in patients with obstructive sleep apnea syndrome. Respiration 2005; 72: 395-401.

Ozturk L, Unal M, Tamer L, et al. The associa-tion of the severity of obstructive sleep apnea with plasma leptin levels. Arch Otolaryngol Head Neck Surg 2003; 129: 538-40.

Ursavas A, Ilcol YO, Nalci N, et al. Ghrelin, lep-tin, adiponectin, and resistin levels in sleep apnea syn-drome: Role of obesity. Ann Thorac Med 2010; 5: 161-5.

Sadeghniiat Haghighi K, Montazeri A, Khajeh Mehrizi A, et al. The Epworth Sleepiness Scale: Trans-lation and validation study of the Iranian version. Sleep Breath 2013; 17: 419-26.

Sadeghniiat-Haghighi K, Montazeri A, Khajeh-

Mehrizi A, et al. The Insomnia Severity Index: Cross-cultural adaptation and psychometric evaluation of a Persian version. Qual Life Res 2014; 23: 533-7.

American Academy of Sleep Medicine. The in-ternational classification of sleep disorders: Diagnostic and coding manual. 3rd ed. Darien, IL: American Acad-emy of Sleep Medicine, 2014.

Spiegel K, Knutson K, Leproult R, et al. Sleep loss: A novel risk factor for insulin resistance and Type 2 diabetes. J Appl Physiol (1985) 2005; 99: 2008-19.

Barcelo A, Barbe F, Llompart E, et al. Neuro-peptide Y and leptin in patients with obstructive sleep apnea syndrome: Role of obesity. Am J Respir Crit Care Med 2005; 171: 183-7.

Sharma SK, Kumpawat S, Goel A, et al. Obesi-ty, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleep-disordered breathing. Sleep Med 2007; 8: 12-7.

Harsch IA, Konturek PC, Koebnick C, et al. Leptin and ghrelin levels in patients with obstructive sleep apnoea: Effect of CPAP treatment. Eur Respir J 2003; 22: 251-7.

Schafer H, Pauleit D, Sudhop T, et al. Body fat distribution, serum leptin, and cardiovascular risk fac-tors in men with obstructive sleep apnea. Chest 2002; 122: 829-39.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.