Intramyocellular Lipids, Insulin Resistance, and Functional Performance in Patients with Severe Obstructive Sleep Apnea

Overview

Journal Nat Sci Sleep

Publisher Dove Medical Press

Date 2020 Feb 26

PMID 32095087

Citations 3

Authors

Meng-Yueh Chien

Pei-Lin Lee

Chih-Wei Yu

Shwu Yuan Wei

Tiffany Ting-Fang Shih

Affiliations

Soon will be listed here.

Abstract

Purpose: An increasing number of studies have linked the severity of obstructive sleep apnea (OSA) with metabolic dysfunction. However, little is known about the lipid compartments (intramyocellular [IMCL] and extramyocellular [EMCL] lipids) inside the musculature in these patients. The present study was designed to investigate the IMCL and EMCL, biochemical data, and functional performance in patients with severe OSA, and to examine the correlations between intramuscular lipid contents and test variables.

Participants And Methods: Twenty patients with severe OSA (apnea-hypopnea index [AHI]: ≥30/h; body mass index [BMI]: 26.05±2.92) and 20 age- and BMI-matched controls (AHI <5/h) were enrolled. Proton magnetic resonance spectroscopy was used to measure the IMCL and EMCL of the right vastus lateralis muscle. Biochemical data, including levels of fasting plasma glucose, insulin, lipid profiles, and high-sensitivity C-reactive protein (hsCRP), were measured. Insulin resistance index (IR) was calculated using the homeostasis model assessment method. Performance tests included a cardiopulmonary exercise test and knee extension strength and endurance measurements.

Results: Patients with severe OSA had significantly (<0.05) lower values of IMCL (14.1±5.4 AU) and EMCL (10.3±5.8 AU) compared to the control group (25.2±17.6 AU and 14.3±11.1 AU, respectively). Patients with severe OSA had significantly higher hsCRP, IR, and dyslipidemia compared with controls (all <0.05). Furthermore, IMCL was negatively correlated with AHI, cumulative time with nocturnal pulse oximetric saturation lower than 90% (TSpO<90%) (=-0.35, <0.05), IR (=-0.40, <0.05), glucose (=-0.33, <0.05), and insulin (=-0.36, <0.05), and positively correlated with lowest oximetric saturation (=0.33, <0.01).

Conclusion: Skeletal muscle dysfunction and metabolic abnormalities were observed in patients with OSA that did not have obesity. IMCL was positively correlated with aerobic capacity and muscular performance, but negatively correlated with AHI and IR. Large-scale clinical trials are required to explore the complicated mechanism among OSA, intramuscular metabolism, and insulin action.

Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT00813852.

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References

Misra A, Sinha S, Kumar M, Jagannathan N, Pandey R . Proton magnetic resonance spectroscopy study of soleus muscle in non-obese healthy and Type 2 diabetic Asian Northern Indian males: high intramyocellular lipid content correlates with excess body fat and abdominal obesity. Diabet Med. 2003; 20(5):361-7. DOI: 10.1046/j.1464-5491.2003.00932.x. View

Chien M, Wu Y, Lee P, Chang Y, Yang P . Inspiratory muscle dysfunction in patients with severe obstructive sleep apnoea. Eur Respir J. 2009; 35(2):373-80. DOI: 10.1183/09031936.00190208. View

Jackson A, Pollock M, Graves J, Mahar M . Reliability and validity of bioelectrical impedance in determining body composition. J Appl Physiol (1985). 1988; 64(2):529-34. DOI: 10.1152/jappl.1988.64.2.529. View

Punjabi N, Shahar E, Redline S, Gottlieb D, Givelber R, Resnick H . Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004; 160(6):521-30. DOI: 10.1093/aje/kwh261. View

Ip M, Lam B, Ng M, Lam W, Tsang K, Lam K . Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002; 165(5):670-6. DOI: 10.1164/ajrccm.165.5.2103001. View

Bonanni E, Pasquali L, Manca M, Maestri M, Prontera C, Fabbrini M . Lactate production and catecholamine profile during aerobic exercise in normotensive OSAS patients. Sleep Med. 2004; 5(2):137-45. DOI: 10.1016/j.sleep.2003.08.009. View

Kelley D . Skeletal muscle fat oxidation: timing and flexibility are everything. J Clin Invest. 2005; 115(7):1699-702. PMC: 1159159. DOI: 10.1172/JCI25758. View

Wilcock A, Maddocks M, Lewis M, Howard P, Frisby J, Bell S . Use of a Cybex NORM dynamometer to assess muscle function in patients with thoracic cancer. BMC Palliat Care. 2008; 7:3. PMC: 2324074. DOI: 10.1186/1472-684X-7-3. View

Machann J, Haring H, Schick F, Stumvoll M . Intramyocellular lipids and insulin resistance. Diabetes Obes Metab. 2004; 6(4):239-48. DOI: 10.1111/j.1462-8902.2004.00339.x. View

10.

Boesch C, Machann J, Vermathen P, Schick F . Role of proton MR for the study of muscle lipid metabolism. NMR Biomed. 2006; 19(7):968-88. DOI: 10.1002/nbm.1096. View

11.

Dube J, Goodpaster B . Assessment of intramuscular triglycerides: contribution to metabolic abnormalities. Curr Opin Clin Nutr Metab Care. 2006; 9(5):553-9. DOI: 10.1097/01.mco.0000241664.38385.12. View

12.

Virkamaki A, Korsheninnikova E, Seppala-Lindroos A, Vehkavaara S, Goto T, Halavaara J . Intramyocellular lipid is associated with resistance to in vivo insulin actions on glucose uptake, antilipolysis, and early insulin signaling pathways in human skeletal muscle. Diabetes. 2001; 50(10):2337-43. DOI: 10.2337/diabetes.50.10.2337. View

13.

Machann J, Stefan N, Schick F . (1)H MR spectroscopy of skeletal muscle, liver and bone marrow. Eur J Radiol. 2008; 67(2):275-284. DOI: 10.1016/j.ejrad.2008.02.032. View

14.

Perseghin G, Scifo P, De Cobelli F, Pagliato E, Battezzati A, Arcelloni C . Intramyocellular triglyceride content is a determinant of in vivo insulin resistance in humans: a 1H-13C nuclear magnetic resonance spectroscopy assessment in offspring of type 2 diabetic parents. Diabetes. 1999; 48(8):1600-6. DOI: 10.2337/diabetes.48.8.1600. View

15.

Shifflett D, Walker E, Gregg J, Zedalis D, Herbert W . Effects of short-term PAP treatment on endurance exercise performance in obstructive sleep apnea patients. Sleep Med. 2001; 2(2):145-151. DOI: 10.1016/s1389-9457(00)00070-8. View

16.

Petersen K, Shulman G . Pathogenesis of skeletal muscle insulin resistance in type 2 diabetes mellitus. Am J Cardiol. 2002; 90(5A):11G-18G. DOI: 10.1016/s0002-9149(02)02554-7. View

17.

Hwang J, Pan J, Heydari S, Hetherington H, Stein D . Regional differences in intramyocellular lipids in humans observed by in vivo 1H-MR spectroscopic imaging. J Appl Physiol (1985). 2001; 90(4):1267-74. DOI: 10.1152/jappl.2001.90.4.1267. View

18.

Pastoris O, Dossena M, Foppa P, Arnaboldi R, Gorini A, Villa R . Modifications by chronic intermittent hypoxia and drug treatment on skeletal muscle metabolism. Neurochem Res. 1995; 20(2):143-50. DOI: 10.1007/BF00970538. View

19.

Thomson R, Brinkworth G, Buckley J, Noakes M, Clifton P . Good agreement between bioelectrical impedance and dual-energy X-ray absorptiometry for estimating changes in body composition during weight loss in overweight young women. Clin Nutr. 2007; 26(6):771-7. DOI: 10.1016/j.clnu.2007.08.003. View

20.

Sinha S, Rathi M, Misra A, Kumar V, Kumar M, Jagannathan N . Subclinical inflammation and soleus muscle intramyocellular lipids in healthy Asian Indian males. Clin Endocrinol (Oxf). 2005; 63(3):350-5. DOI: 10.1111/j.1365-2265.2005.02353.x. View