Metabolic and endocrine status associate with obstructive sleep apnea risk among patients with polycystic ovary syndrome

Jacob P Christ; Kanade Shinkai; Jamie Corley; Lauri Pasch; Marcelle I Cedars; Heather G Huddleston

doi:10.5664/jcsm.11012

Metabolic and endocrine status associate with obstructive sleep apnea risk among patients with polycystic ovary syndrome

J Clin Sleep Med. 2024 Jan 13. doi: 10.5664/jcsm.11012. Online ahead of print.

Authors

Jacob P Christ¹, Kanade Shinkai², Jamie Corley¹, Lauri Pasch¹, Marcelle I Cedars¹, Heather G Huddleston¹

Affiliations

¹ Center for Reproductive Health, University of California San Francisco, San Francisco, CA.
² Department of dermatology, University of California San Francisco, San Francisco, CA.

PMID: 38217476
DOI: 10.5664/jcsm.11012

Abstract

Study objectives: Risk of obstructive sleep apnea appears to be increased among patients with polycystic ovary syndrome (PCOS), but the underlying physiology is unclear. We sought to identify predictors of OSA risk among patients with PCOS.

Methods: A cross-sectional analysis of patients evaluated for PCOS at a single tertiary center from 2017 to 2022 was completed. Inclusion criteria included: age 18-44, Rotterdam criteria for PCOS, and had completed a Berlin Questionnaire (BQ) for OSA risk assessment. All patients underwent standardized anthropometric, ultrasound, endocrine, and metabolic phenotyping.

Results: Of the 572 patients screened during the study period, 309 patients with PCOS met inclusion criteria, and 104 (33.7%) had a high risk BQ. Those with high-risk BQ, compared to those without, had significantly (p<0.05) higher waist:hip ratio, LDL-C, triglycerides, fasting insulin, 2-hour insulin, fasting glucose, 2-hour glucose, HOMA-IR, HbA1_c, CRP, free testosterone, free androgen index, and lower HDL-C and SHBG. In multivariable modeling controlling for all significantly differing variables in univariate analyses, HbA1_c (β (S.E.) 1.05 (0.45), p=0.02), CRP (0.09 (0.04), p=0.01), and SHBG (-0.02 (0.01), p=0.02)) associated with high risk BQ.

Conclusions: Dysglycemia, inflammation, and androgen status independently associate with predicted OSA risk by BQ. Future studies are needed to comprehensively assess the impact of treatment of OSA on these outcomes among patients with PCOS to better clarify the directionality and clinical implications of these associations.

Keywords: PCOS; hyperandrogenism; hyperinsulinemia, inflammation; metabolic syndrome; sleep apnea.