The Circulatory Risk in Communities Study investigated the association between nocturnal intermittent hypoxia as a surrogate  marker of OSA and risk of type 2 diabetes in community residents aged 40–69 years (n = 4,398).

After a median (interquartile  range) follow-up period of 3.0 years (2.9–4.0 years), 210 participants developed diabetes, and the multivariableadjusted  HR (95% CI) for developing type 2 diabetes was 1.26 (0.91–1.76) among those with mild nocturnal intermittent hypoxia, and 1.69 (1.04–2.76) among those with moderate-tosevere  nocturnal intermittent hypoxia (P = 0.03 for trend) .

In a study carried out in Toon, Japan, the adjusted ORs (95% CI) for impaired fasting glucose, glucose intolerance and diabetes for participants with ODI ≥15.0 events/h were 1.27 (0.72–2.23), 1.69 (1.03–2.76) and 1.28 (0.59–2.79), respectively, compared with participants with ODI <5 events/h.

The HOMA index and Matsuda index, both of which reflect insulin tolerance, were significantly associated with the severity of sleep-related intermittent hypoxemia, as assessed using ODI (P = 0.03 and P = 0.007, respectively) .

To evaluate the contributing effect of OSA on type 2 diabetes in the Japanese population, we calculated the PAF of 3% ODI levels in relation to incident type 2 diabetes (Figure 2) 41 . In total, the PAF of OSA for diabetes development is 11.5% (3% ODI ≥5 events/h), suggesting that if OSA were successfully treated in the population, 11.5% of diabetes cases could be prevented.

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