We tested the hypothesis of an independent cross-sectional association between obstructive sleep apnea (OSA) severity and glycated hemoglobin (HbA^sub 1c^) in adults without known diabetes. HbA^sub 1c^ was measured in whole-blood samples from 2,139 patients undergoing nocturnal recording for suspected OSA. Participants with self-reported diabetes, use of diabetes medication, or HbA^sub 1c^ value ?6.5% were excluded from this study. Our final sample size comprised 1,599 patients. A dose-response relationship was observed between apnea-hypopnea index (AHI) and the percentage of patients with HbA^sub 1c^ >6.0%, ranging from 10.8% for AHI <5 to 34.2% for AHI ?50. After adjustment for age, sex, smoking habits, BMI, waist circumference, cardiovascular morbidity, daytime sleepiness, depression, insomnia, sleep duration, and study site, odds ratios (95% CIs) for HbA^sub 1c^ >6.0% were 1 (reference), 1.40 (0.84-2.32), 1.80 (1.19-2.72), 2.02 (1.31-3.14), and 2.96 (1.58-5.54) for AHI values <5, 5 to <15, 15 to <30, 30 to <50, and ?50, respectively. Increasing hypoxemia during sleep was also independently associated with the odds of HbA^sub 1c^ >6.0%. Among adults without known diabetes, increasing OSA severity is independently associated with impaired glucose metabolism, as assessed by higher HbA^sub 1c^ values, which may expose them to higher risks of diabetes and cardiovascular disease.
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