Issue Navigator

Volume 09 No. 12
Earn CME
Accepted Papers

Scientific Investigations

Sleep and Insulin-Like Growth Factors in the Cardiovascular Health Study

Neomi Shah, M.D., M.P.H.1,4; Tom Rice, M.D.2; Daniel Tracy, M.P.H.1; Thomas Rohan, M.D., Ph.D.1; Petra Bůžková, Ph.D.3; Anne Newman, M.D., M.P.H.2; Robert C. Kaplan, Ph.D.1
1Albert Einstein College of Medicine, Bronx, NY; 2University of Pittsburgh School of Medicine, Pittsburgh, PA; 3University of Washington, Seattle, WA; 4Montefiore Medical Center, Bronx, NY

Study Objectives:

Sleep and sleep disordered breathing (obstructive sleep apnea [OSA]) are known to affect the growth hormone/insulin-like growth factor (GH/IGF) axis. There are few relevant population studies in this area, particularly in the elderly. We conducted this study to investigate the relationship between sleep (architecture and OSA) and circulating IGF-I (insulin-like growth factor-1), IGFBP-1 (insulin-like growth factor binding protein-1), and IGFBP-3 (insulin-like growth factor binding protein-3) levels in an elderly population.

Design Setting:

Cross-sectional analysis of participants from the year 9 visit of the Cardiovascular Health Study (CHS) who were enrolled in the Sleep Heart Health Study (SHHS).

Patients or Participants:

1,233 elderly participants from the CHS and SHHS.

Measurements and Results:

The mean age of males (n = 526) and females (n = 697) was 77 years. The mean value of IGF-I (ng/mL) in males was 112.4 vs. 97.1 in females (p < 0.01). Mean IGFBP-1 and IGFBP-3 levels were higher in females than males (p < 0.01). As expected, slow wave sleep was better preserved in females compared to males (22% total sleep time vs. 9% total sleep time, p < 0.01). Furthermore, as expected, OSA (apneahypopnea index [AHI] ≥ 5/h) was more prevalent in males compared to females (60% vs. 46%, p < 0.01). Multivariable linear regression was used to determine the relationship between objective sleep parameters and circulating IGF-I, IGFBP-1, and IGFBP-3 levels, with adjustment for age, sex, race, BMI, diabetes, estrogen use, progestin use, and physical activity. We did not detect a significant association between slow wave sleep (SWS) (per 5 min) and IGF-I, IGFBP-1, and IGFBP-3 levels (ng/mL). We found no significant linear association between OSA (AHI ≥ 5/h) and IGF-I, IGFBP-1, and IGFBP-3 levels. Gender-stratification of the entire cohort did not alter these findings. Sensitivity analyses excluding diabetics revealed that moderate OSA (AHI ≥ 5 and < 15) is inversely associated with IGFBP-3 levels in women.

Conclusions The relationship between SWS and GH/IGF system is not significant in the elderly. Furthermore, OSA does not appear to adversely influence the GH/IGF axis, as reported in younger individuals. Whether our study findings are due to diminished GH/IGF-I axis activity in elderly needs further investigation by replication in other large population based elderly cohorts.


Shah N; Rice T; Tracy D; Rohan T; Bůžková P; Newman A; Kaplan RC. Sleep and insulin-like growth factors in the cardiovascular health study. J Clin Sleep Med 2013;9(12):1245-1251.

Please login to continue reading the full article

Subscribers to JCSM get full access to current and past issues of the JCSM.

Login to JCSM

Not a subscriber?

Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership