Gender‐specific anthropometric markers of adiposity, metabolic syndrome and visceral adiposity index (VAI) in patients with obstructive sleep apnea

Abstract

SUMMARYObstructive sleep apnea often coexists with visceral adiposity and metabolic syndrome. In this study, we analysed gender-related differences in anthropometrics according to sleep apnea severity and metabolic abnormalities. In addition, the visceral adiposity index, a recently introduced marker of cardiometabolic risk, was analysed. Consecutive subjects with suspected obstructive sleep apnea (n = 528, 423 males, mean age AE standard deviation: 51.3 AE 12.8 years, body mass index: 31.0 AE 6.2 kg m À2 ) were studied by full polysomnography (apneahypopnea index 43.4 AE 27.6 h À1 ). Variables of general and visceral adiposity were measured (body mass index, neck, waist and hip circumferences, waist-to-hip ratio). The visceral adiposity index was calculated, and metabolic syndrome was assessed (NCEP-ATP III criteria). The sample included controls (apnea-hypopnea index <10 h À1 , n = 55), and patients with mild-moderate (apnea-hypopnea index 10-30 h À1, n = 144) and severe sleep apnea (apnea-hypopnea index >30 h À1 , n = 329). When anthropometric variables were entered in stepwise multiple regression, body mass index, waist circumference and diagnosis of metabolic syndrome were associated with the apneahypopnea index in men (adjusted R 2 = 0.308); by contrast, only hip circumference and height-normalized neck circumference were associated with sleep apnea severity in women (adjusted R 2 = 0.339). These results changed little in patients without metabolic syndrome; conversely, waist circumference was the only correlate of apnea-hypopnea index in men and women with metabolic syndrome. The visceral adiposity index increased with insulin resistance, but did not predict sleep apnea severity. These data suggest gender-related interactions between obstructive sleep apnea, obesity and metabolic abnormalities. The visceral adiposity index was a good marker of metabolic syndrome, but not of obstructive sleep apnea. IN TROD UCTI ONObesity is a major risk factor for obstructive sleep apnea (OSA), and OSA is more prevalent among obese than nonobese patients. The first studies, mostly conducted in men, identified body mass index (BMI), and neck and waist circumference as major predictors of OSA. Women with OSA were usually older and more obese than men, but had smaller neck circumference and less centrally distributed fat (Kapsimalis and Kryger, 2002a,b). Adiposity and sleepMore recent literature re-examined anthropometrics in patients with OSA by assessing gender-related differences in adipose tissue distribution, suggesting the need to take into account the new information in order to develop new models possibly indicative of gender-specific OSA phenotypes. Some studies highlighted the close relationship of OSA severity with neck circumference normalized by height (NC/h) and visceral fat in both genders (Kawaguchi et al., 2011;Simpson et al., 2010). Conversely, a recent study found that visceral abdominal fat was increased in men but not in women with OSA; women with OSA showed increased total and subcutaneous fat with a n...

Meta-analyses of the Association of Sleep Apnea with Insulin Resistance, and the Effects of CPAP on HOMA-IR, Adiponectin, and Visceral Adipose Fat

“…[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Baseline characteristics of the study participants are detailed in Table 3. …”

Anthropometrical phenotypes are important when explaining obstructive sleep apnea in female bariatric cohorts

“…Regarding whether anthropometrics could help to explain AHI variability in morbidly obesity women awaiting bariatric surgery, the present work is the first to analyse this issue in this specific setting, showing that anthropometrics may be responsible for nearly one‐fifth of AHI variability. Based on previous clinical studies that investigated OSA and anthropometrics with individual data according to gender, anthropometrics in women may explain nearly 25%–30% of total AHI variance (Cizza et al., ; Mazzuca et al., ; Simpson et al., ; Subramanian, Jayaraman, Majid, Aguilar, & Surani, ). It should be noted that, compared to women included in previous works, our cohort included 115 women with extreme obesity, mostly in a premenopausal state and suffering from moderate‐severe OSA.…”

Visceral Adiposity Index: An Indicator of Adipose Tissue Dysfunction

“…The same can also be said about subjects with morbid obesity, in which even WC has no great diagnostic value. An example of incorrect application of the VAI is a recent study in a population with obstructive sleep apnoea, where the authors wanted to test the association with the severity of sleep apnoea [47]. In actual fact, in many patients with this problem morbid obesity and a metabolic syndrome occurred.…”