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The role of obesity, different fat compartments and sleep apnea severity in circulating leptin levels: the Icelandic Sleep Apnea Cohort study

Abstract

Objectives:

To assess whether sleep apnea severity has an independent relationship with leptin levels in blood after adjusting for different measures of obesity and whether the relationship between obstructive sleep apnea (OSA) severity and leptin levels differs depending on obesity level.

Methods:

Cross-sectional study of 452 untreated OSA patients (377 males and 75 females), in the Icelandic Sleep Apnea Cohort (ISAC), age 54.3±10.6 (mean±s.d.), body mass index (BMI) 32.7±5.3 kg m−2 and apnea-hypopnea index 40.2±16.1 events per h. A sleep study and magnetic resonance imaging of abdominal visceral and subcutaneous fat volume were performed, as well as fasting serum morning leptin levels were measured.

Results:

Leptin levels were more highly correlated with BMI, total abdominal and subcutaneous fat volume than visceral fat volume per se. No relationship was found between sleep apnea severity and leptin levels, assessed within three BMI groups (BMI <30, BMI 30–35 and BMI 35 kg m−2). In a multiple linear regression model, adjusted for gender, BMI explained 38.7% of the variance in leptin levels, gender explained 21.2% but OSA severity did not have a significant role and no interaction was found between OSA severity and BMI on leptin levels. However, hypertension had a significant effect on the interaction between OSA severity and obesity (P=0.04). In post-hoc analysis for nonhypertensive OSA subjects (n=249), the association between leptin levels and OSA severity explained a minor but significant variance (3.2%) in leptin levels. This relationship was greatest for nonobese nonhypertensive subjects (significant interaction with obesity level). No relationship of OSA severity and leptin levels was found for hypertensive subjects (n=199).

Conclusion:

Obesity and gender are the dominant determinants of leptin levels. OSA severity is not related to leptin levels except to a minor degree in nonhypertensive nonobese OSA subjects.

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Acknowledgements

We are grateful to Sigrun Gudmundsdottir, Lovisa Gudmundsdottir, Magdalena Osk Sigurgunnarsdottir, Kristjan Andri Kristjansson, Bethany Staley, Matthew Thorne-Fitzgerald, Robert Hachadoorian and the other staff at the Sleep Centers of Landspitali—The National University Hospital of Iceland, and the University of Pennsylvania who helped assemble and analyze the data, as well as Heather Collins and the other staff at the Radioimmunoassay and Biomarker Core, Diabetes and Endocrinology Research Center, University of Pennsylvania (NIH DK 19525), who performed the leptin measurements. We would also like to thank Ms Karen McLaughlin and Mr Daniel Barrett for their help in the preparation of the manuscript. This work was supported by NIH Grant HL72067 for ‘A Family Linkage Study of Obstructive Sleep Apnea’ and HL94307 for ‘Endophenotypes of Sleep Apnea and Role of Obesity’, the Eimskip Fund of the University of Iceland and the Landspitali University Hospital Research Fund.

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Correspondence to E S Arnardottir.

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AI Pack is the John Miclot Professor of Medicine. Other authors declare no conflict of interest. Funds for this endowment were provided by the Phillips Respironics Foundation.

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Arnardottir, E., Maislin, G., Jackson, N. et al. The role of obesity, different fat compartments and sleep apnea severity in circulating leptin levels: the Icelandic Sleep Apnea Cohort study. Int J Obes 37, 835–842 (2013). https://doi.org/10.1038/ijo.2012.138

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