Timo Leppänen1,2,3, Antti Kulkas2,3, Esa Mervaala4,5, Juha Töyräs4,3. 1. Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland. leppanen_timo@outlook.com. 2. Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland. 3. Department of Applied Physics, University of Eastern Finland, Kuopio, Finland. 4. Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland. 5. Department of Clinical Neurophysiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Abstract
BACKGROUND: Obesity is one of the most prominent risk factors for obstructive sleep apnea (OSA). Weight loss decreases the number of shorter respiratory events (<40 s), whereas the number of longer events remains almost unchanged. However, it is unknown how body mass index (BMI) affects individual obstruction event severity within OSA severity categories when age, sex, smoking, daytime sleepiness, snoring, hypertension, heart failure, and sleeping posture are considered. Therefore, we investigated whether individual obstruction event severity varies with BMI within the OSA severity categories when considering the most important confounding factors. METHODS: Polygraphic recordings of 723 subjects without CPAP treatment and with an apnea-hypopnea index (AHI) of ≥5 events/hour were reanalyzed retrospectively. The effect of BMI on the severities of OSA and individual obstruction events was evaluated in general, within OSA severity categories, and between different BMI groups (ie, BMI < 25; 25 ≤ BMI < 30; 30 ≤ BMI < 35; 35 ≤ BMI < 40; and BMI ≥ 40 kg/m2). RESULTS: AHI increased in mild and severe (β ≥ 0.10, P < .001) OSA categories, with increasing BMI. However, the proportion of apneas from all respiratory events decreased (β = -0.55, P = .068) with increasing BMI in all the OSA categories. An increase in BMI led to a decrease in the median duration of individual apneas, hypopneas, and desaturations in all OSA categories, whereas desaturation depth increased statistically significantly in the severe category (β = 0.20, P < .001). CONCLUSIONS: Because BMI is related to the duration of individual obstruction events, its effect on OSA severity is more complex than its effect on AHI would implicate. Therefore, overall severity of OSA may not be the same for non-obese patient and obese patient who have similar AHI. Thus, these patient-specific characteristics of individual breathing cessations should be considered when estimating the severity of disease and risk of related adverse health effects.
BACKGROUND: Obesity is one of the most prominent risk factors for obstructive sleep apnea (OSA). Weight loss decreases the number of shorter respiratory events (<40 s), whereas the number of longer events remains almost unchanged. However, it is unknown how body mass index (BMI) affects individual obstruction event severity within OSA severity categories when age, sex, smoking, daytime sleepiness, snoring, hypertension, heart failure, and sleeping posture are considered. Therefore, we investigated whether individual obstruction event severity varies with BMI within the OSA severity categories when considering the most important confounding factors. METHODS: Polygraphic recordings of 723 subjects without CPAP treatment and with an apnea-hypopnea index (AHI) of ≥5 events/hour were reanalyzed retrospectively. The effect of BMI on the severities of OSA and individual obstruction events was evaluated in general, within OSA severity categories, and between different BMI groups (ie, BMI < 25; 25 ≤ BMI < 30; 30 ≤ BMI < 35; 35 ≤ BMI < 40; and BMI ≥ 40 kg/m2). RESULTS: AHI increased in mild and severe (β ≥ 0.10, P < .001) OSA categories, with increasing BMI. However, the proportion of apneas from all respiratory events decreased (β = -0.55, P = .068) with increasing BMI in all the OSA categories. An increase in BMI led to a decrease in the median duration of individual apneas, hypopneas, and desaturations in all OSA categories, whereas desaturation depth increased statistically significantly in the severe category (β = 0.20, P < .001). CONCLUSIONS: Because BMI is related to the duration of individual obstruction events, its effect on OSA severity is more complex than its effect on AHI would implicate. Therefore, overall severity of OSA may not be the same for non-obesepatient and obesepatient who have similar AHI. Thus, these patient-specific characteristics of individual breathing cessations should be considered when estimating the severity of disease and risk of related adverse health effects.
Authors: Noah C Schammel; Trevor VandeWater; Stella Self; Christopher Wilson; Christine M G Schammel; Ronald Cowley; Dominic B Gault; Lee A Madeline Journal: Brain Imaging Behav Date: 2022-02-26 Impact factor: 3.224
Authors: Priya V Borker; Michelle Reid; Tamar Sofer; Matthew P Butler; Ali Azarbarzin; Heming Wang; Andrew Wellman; Scott A Sands; Susan Redline Journal: Am J Respir Crit Care Med Date: 2021-05-01 Impact factor: 21.405
Authors: Viktória Molnár; András Molnár; Zoltán Lakner; Dávid László Tárnoki; Ádám Domonkos Tárnoki; Zsófia Jokkel; Helga Szabó; András Dienes; Emese Angyal; Fruzsina Németh; László Kunos; László Tamás Journal: Sleep Breath Date: 2021-09-03 Impact factor: 2.655