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Hagerstown study looks at link between sleep disruption, glucose metabolism

February 04, 2013|By CRYSTAL SCHELLE | crystal.schelle@herald-mail.com
  • Dr. Naresh Punjabi is working on the SOMNOS Study for sleep apnea and glucose metabolism at the John Hopkins University here in Hagerstown.
Photo by Yvette May/Staff Photographer


Snoring is often the butt of jokes between couples. The wife complains that her husband's snoring keeps her awake. He's sick of the elbow to the ribs to wake him up.

But the truth is that sometimes snoring can be a sign for something that isn't a laughing matter — sleep apnea.

"Sleep apnea is a very common condition and undiagnosed primarily because there is a lack of awareness in the medical community and also in the lay community," said Dr. Naresh Punjabi, professor of medicine and epidemiology for Johns Hopkins' Division of Pulmonary and Critical Care Medicine. "(Sleep apnea) is a common condition that is characterized by breathing pauses during sleep."

Doctors and researchers at George W. Comstock Center for Public Health Research and Prevention in Hagerstown as well as Johns Hopkins Bayview Medical Center in Baltimore are seeing if glucose metabolism might be affected by the disruption of sleep that sleep apnea causes. Their work is part of the SOMNOS Study of sleep apnea and metabolism.

"There's a lot of bad things that happen in your body when you have sleep apnea and that affects your metabolism," said Melissa Minotti, research program coordinator. "And if left alone, they believe that could turn into insulin resistance, sort of the next step to diabetes."

Punjabi is the principal investigator for both the Hagerstown and Baltimore studies, which have been conducted for the last year. He said the goal of the study "is to determine whether treatment of sleep apnea in individuals who have not previously been treated improves how patients handle glucose."

Specifically, he said, researchers are looking at the metabolism of glucose in the body.

"As we now know, that if you have sleep apnea and it's untreated, there is a propensity for developing insulin resistance, developing glucose intolerance and maybe type 2 diabetes," he said.

Punjabi noted that there have been numerous studies over the last decade that sleep apnea, may, in fact, be related to these conditions.

"And the question we are asking now is if you treat sleep apnea, can we potentially decrease the risk of type 2 diabetes," he said.

The study is seeking participants who meet certain criteria to participate in the study.

"We're targeting anyone with sleep apnea and so we're looking for people who have at least mild to moderate sleep apnea, if not more," Minotti said. "We're actually taking those people and bringing them in for a more intensive study, looking at glucose metabolism."

According to Punjabi, who is also a certified sleep doctor, sleep apnea is a serious disorder because, most notably, someone with sleep apnea stops breathing periodically during sleep.

"When all of us sleep there is a decrease in muscle tone particularly in the throat region. When that muscle tone decreases there is a propensity for the throat to close up, and in some patients, it completely collapses," he explained. "So the fundamental characteristics of sleep apnea is a disorder with breathing pauses during sleep. Now when breathing stops during sleep or decreases during sleep, there is a tendency to develop hypoxemia or decrease of oxygen levels in the blood."

This decrease of oxygen can lean to serious health concerns, he said.

"It is potentially related to an increase risk of heart disease, high blood pressure and stroke," Punjabi said. "Sleep apnea also leads to destruction of sleep .... So this is a common condition that often goes unnoticed and it's often spouses or bed partners who complain (about) the loud snoring or breathe pauses, the snorting or gasping during sleep that really bring these effected patients to our clinical setting."

It was participant George Jacob's wife who encouraged him to participate in the study.

Jacob, 44, of Hagerstown, said his wife thought he would be a good candidate.

"She heard about it. She thought I had sleep apnea and I stopped breathing at night, so she pushed me to come and find out," he said.

Jacob said he's interested in seeing whether he has sleep apnea, and if he does, at what level he has it.

Those who snore might not have sleep apnea, but, Punjabi said, those with sleep apnea usually snore. However, it is the times that the person with sleep apnea stops breathing — sometimes 70 to 80 — times per hour that are of the most concern, he said.

Although men are often labeled as the snoring culprits, Punjabi said literature published 20 years ago said that's not 100-percent true. He said one out of four men have sleep apnea, and estimates one out of eight or nine women have it.

"The risk factors in women include being post-menopausal, being overweight and age," he said. "Similar risk factors exist in men, men that are overweight and obese, that are older, that have the typical symptoms of snoring, stopping breathing episodes, are the most at risk for having sleep apnea."

Minotti said the study designers estimate that at the end of the study, they would have seen between 200 and 250 participants. She said the study hopes to have recruited all of its participants by next fall.

The study is seeking people ages 21 and those younger than 75.

"To participate in the study, they can't be being treated for sleep apnea," Punjabi said. "We are looking for individuals who are "treatment naive." One of the first things they do, they actually get a simple home sleep monitor they take with them."

Minotti said participants will undergo an oral glucose intolerance test, as well as an IV glucose intolerance test. Other tests include an EKG, blood pressure tests, a Dexa scan, which measures muscle mass and bone density and body fat. But most importantly, sleep apnea must be established.

Participants who qualify for the study will first undergo a home sleep study.

"After we do those tests, we're asking those people to be treated with the treatment for sleep apnea, or not be treated for two months," Minotti said.

 She said participants will return after that to repeat the tests. At that time there will be a group that had to wear the CPAP (continous positive airway pressure) machine and those who did not. 

The commitment is between three and four months, Minotti said. And participants will be compensated for their time. She said there is the possibility of earning up to $860, depending on how far participants get in the study.

In addition to the money, participants will also be given their medical information so they can share it with a family doctor or find a sleep doctor in the area, Minotti said.

For Punjabi, he would just hope that those jokes about snoring would stop.

"We hope to raise the awareness of sleep apnea and that it's no longer a condition for party jokes of 'My spouse snores,'" he said. "... This study would hopefully add to that sort of knowledge base to determine whether treatment of sleep apnea may be related to risk factors of diabetes.



Want to participate?

To participate in Johns Hopkins study call SOMNOS Study recruiter at 410-550-4891.

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