Comparative Study of Clinical and Polysomnographic Characteristics of Obstructive Sleep Apnea Among Obese and Non-Obese Patients at Chiang Mai University Hospital
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 14, Issue 5
Abstract
Background: Recent studies have shown that obstructive sleep apnea (OSA) is common in both obese and nonobese patients with different clinical and polysomnographic features in each group. However, such studies were scarce and diverse, with small sample sizes, and were rarely conducted in Asian populations. Only one trial to date has employed the classification of BMI in adult Asians by WHO criteria which is currently used as a reference based on morbidity risk. Objectives: To compare the clinical, anthropometric and polysomnographic characteristics of non-obese and obese patients with OSA. Methods: Data from OSA patients at Chiang Mai University Hospital Sleep Clinic from January 2013 to December 2015 were reviewed, including clinical characteristics, anthropometric measurements, and polysomnographic parameters. Patients were stratified into obese and non-obese groups, using BMI ≥ 25 kg/m2 as the cutoff for obesity. Results: Of the total 418 patients analyzed, 295 (70.6%) were obese. Mean age was higher in the non-obese group (59.14 ± 13.48 yr vs 55.16 ± 13.33yr, p 0.020). Diabetes mellitus and hypertension were more common in the obese group, and obese patients had larger neck circumference (15.71 ± 1.54 in vs 13.94 ± 1.10 in, p < 0.001) and waist circumference (41.26 ± 5.37 in vs 34.66 ± 3.43 in, p < 0.001). There were no differences in any other comorbidities, ESS, EDS or other clinical parameters. Regarding anthropometric measurements, obese patients had higher Friedmann tongue position scores (p < 0.001), while micrognathia and retrognathia were more prevalent in non-obese patients (27.3% vs 7.6%, p < 0.001, and 3.3% vs 0.3%, p 0.028, respectively). Regarding polysomnographic recordings, obese patients had significantly worse parameters demonstrated by higher NREM AHI (87.31 ± 31.08 vs 67.71 ± 27.70), desaturation index (5.93 ± 6.07 vs 2.50 ± 3.55), more total sleep time with oxygen saturation < 90% (10.83% vs 3.08%), more CPAP use (94.8% vs 85.1%) with higher CPAP pressure (11.17 ± 4.02 vs 8.65 ± 4.62 cmH2O), but lower minimal oxygen saturation (83.00% vs 88.08%). Multivariate logistic regression analysis showed that only age, neck and waist circumferences, micrognathia, desaturation index, and CPAP use were significantly and independently associated with OSA in the nonobese population. Obstructive sleep apnea (OSA) is a disease characterized by repetitive sleep disruptions due to episodes of upper airway obstruction (UAO), resulting in nocturnal hypoxemia, sleep termination with frequent arousals, and excessive daytime sleepiness [1- 3]. OSA is more common than generally believed. It can also be a serious and life-threatening disorder, which may lead to adverse cardiovascular consequences and increased mortality. Obesity has been recognized as one of the classical risk factors of OSA, with up to 60% of OSA patient being obese, and up to 40% of the obese population carrying a diagnosis of OSA [4]. This may be due to anatomical alterations in obesity predisposing to UAO or collapse during sleep. Recent studies have shown that OSA is not uncommon in the non-obese population, and many have proposed some different characteristics of OSA in this population in regard to clinical, cephalometric and polysomnographic features, suggesting two different disease entities among the OSA population. For non-obese OSA patients, medical comorbidities (e.g. diabetes mellitus, hypertension, and coronary artery disease (CAD), smoking, alcohol use and sedative drug use) were less prevalent. As for cepholometric parameters, thyromental distance was significantly shorter in this population. However, differences in other factors, including adenotonsillar hypertrophy, neck circumference, and symptoms of excessive day time sleepiness (EDS) evaluated by the Epworth Sleepiness Scales (ESS) did not reach statistical significance. On the other hand, OSA was more severe in obese patients as demonstrated by most polysomnographic parameters including the apnea-hypopnea index (AHI) [4-10]. However, related studies were scarce and diverse, with small samples, were rarely conducted in Asian populations. Only one study to date [5] has employed the proposed classification of weight by BMI in adult Asians by WHO (WPRO, 2000), using BMI ≥ 25kg/m2 as the cutoff point for obesity, which is currently used as a reference based on the risk of morbidities [11,12]. This study was designed to evaluate the differences in clinical, anthropometric and polysomnographic characteristics between non-obese and obese patients with OSA in a Thai population.
Authors and Affiliations
Theerakorn Theerakittikul, Nattinee Laksananun, Juthamas Inchai, Chaicharn Pothirat, Chalerm Liwsrisakun, Chaiwat Bumroongkit, Athavudh Deesomchok, Atikun Limsukon, Pattraporn Tajaroenmuang
Keywords
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- EP ID EP594763
- DOI 10.26717/BJSTR.2019.14.002608
- Views 168
- Downloads 0
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