Diabetes is associated with increased nocturnal respiratory rate

Background and Objective

Diabetes mellitus (DM) causes autonomic neuropathy, which may alter nocturnal respiratory rate (NRR). To test the association between DM and NRR, we analyzed elective polysomnograms of four large observational cohorts.

Research Design and Methods

We performed cross-sectional analysis of over 25,000 individuals with polysomnograms (PSGs) from the Sleep Heart Health Study (SHHS), Hispanic Community Health Study/Study of Latinos (HCHS/SOL), Osteoporotic Fractures in Men Study (MrOS), and Wisconsin Sleep Cohort (WSC). Patient-level NRRs were derived from inductance plethysmography waveforms. DM status was determined by self-report, physician diagnosis, medication use, or laboratory values, depending on the cohort. We related DM and NRR (continuous and dichotomized) using logistic regression models and adjusted for potential confounders. Cohort-specific results were combined using random-effects meta-analysis.

Results

Meta-analysis of unadjusted models showed a pooled odds ratio (OR) of 1.10 (95% CI:1.04–1.17) for each breath-per-minute (brpm) increase in NRR. This association remained significant after multivariable adjustment (OR:1.06, 95% CI:1.02–1.11). Dichotomized analyses similarly showed higher odds of DM across dichotomization thresholds ranging from 15 to 21 brpm. At a threshold of 18 brpm, the unadjusted pooled OR was 1.77 (95% CI:1.23–2.55, P=0.0022), and the adjusted OR was 1.49 (95% CI:1.10–2.02, P=0.0098).

Conclusions

Clinically stable outpatients with elevated NRR have an increased prevalence of DM. Additional studies are needed to investigate whether the mechanism is autonomic neuropathy and whether monitoring NRR can detect early complications of DM.

ARTICLE HIGHLIGHTS

• Why did we undertake this study?

  Diabetes mellitus (DM) is linked to autonomic neuropathy, and nocturnal respiratory rate (NRR) is regulated by the autonomic nervous system; yet the relationship between NRR and DM is unknown.

• What specific question did we want to answer?

  Is NRR associated with DM? To answer this, we derived NRR and DM status from 25,000+ PSGs.

• What did we find?

  Individuals with elevated NRR have higher DM prevalence even after adjusting for confounding variables. Additionally, groups with DM had a significantly higher median NRR compared to those without DM.

• What are the implications of our findings?

  If the mechanism of association between NRR and DM involves autonomic neuropathy, then NRR may represent an easy-to-longitudinally-monitor biomarker for development of DM complications.