Obesity Without Sleep Apnea Is Associated With Daytime Sleepiness

Vgontzas, AN; Bixler, Edward O.; Tan, Tjiauw Ling; Kantner, Deborah; Martin, Louis F.; Kales, Anthony

doi:10.1001/archinte.158.12.1333

Cited by 295 publications

(209 citation statements)

References 17 publications

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“…The limited number and possible selection of participants make it difficult to draw general conclusions. However, the similar results of our large, epidemiological data and of the smaller studies with more precise diagnostic methodology 24,45 make it possible to conclude that even without OSA, obesity is associated with sleep disturbances and daytime tiredness.…”

Section: Discussionsupporting

confidence: 73%

“…12,16,44 Only a couple of studies have shown a relationship between objectively measured indicators of self-reported sleep quality (for example increased sleep latency, lower proportion of Rapid Eye Movement (REM) sleep and frequent awakenings and increased nocturnal motor activity) and daytime tiredness in individuals with obesity and without OSA. 24,26,45 Compared to our study, the above studies used laboratory-based diagnosis of OSA or nocturnal breathing patterns. The limited number and possible selection of participants make it difficult to draw general conclusions.…”

Section: Discussionmentioning

confidence: 98%

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Sleep-related disturbances and physical inactivity are independently associated with obesity in adults

Kronholm²,

et al. 2007

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Objective: To study relationships between obesity, physical inactivity and sleep-related disturbances (obstructive sleep apnea (OSA), sleep duration, sleep disturbances concomitant with daytime tiredness) in adults (X30 years). Design: Cross-sectional study with a random population sample. Participants: A total of 3377 men (mean age 52.3, s.d. 14.8, years) and 4264 women (56.4, s.d. 17.2, years). Main outcome measures: Dependent variables, measured: Waist circumference (WC) and body mass index (BMI). Independent variables, from a detailed interview/questionnaire: probable OSA, other sleep-related disturbances, sleep duration, type and frequency of leisure physical activity. Age, mental health, smoking and education were included in analyses as potential confounders. Results: In men, OSA and physical inactivity increased likelihood for abdominal obesity (WC X102 cm). Physical inactivity also increased, but long (X9 h/day) sleep decreased likelihood for abdominal overweight (WC: 94-101 cm) in men. In women, abdominal obesity (WC X88 cm) was associated positively with OSA, moderate sleep-related disturbances, and physical inactivity. Education modulated the influence of age on abdominal obesity in both genders. Using BMI as the dependent variable did not change the general information obtained by the model. In addition, abdominal obesity was found to be an independent risk factor also in multivariable models predicting categories of a combined sleep duration and sleep disturbances. Conclusions: Sleep duration and sleep-related disturbances are associated with obesity, even after controlling for OSA and physical inactivity. The results support the hypothesis of vicious circle between sleep and obesity.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 98%

Sleep-related disturbances and physical inactivity are independently associated with obesity in adults

Kronholm²,

et al. 2007

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“…After resection of craniopharyngiomas, children will lose their ability to downregulate appetite, demonstrate abnormal food-seeking behavior, and rapidly gain weight. 2,3,6,7,51,52 This can result in daytime somnolence either directly 20 or secondary to OSA. 14,15,19 Our observation that in the 2 morbidly obese patients MSLT scores did not change significantly on documented optimal CPAP treatment suggests that their sleepiness was not caused by sleep-disordered breathing.…”

Section: Figmentioning

confidence: 99%

“…20 When OSA exists, therapy with continuous positive airway pressure (CPAP) is effective and usually results in a substantial improvement of daytime vigilance. [21][22][23] Therefore, a patient who has OSA and is regularly treated with CPAP at an optimal pressure is not expected to be severely sleepy, although some residual sleepiness may remain.…”

mentioning

confidence: 99%

Severe Hypersomnolence After Pituitary/Hypothalamic Surgery in Adolescents: Clinical Characteristics and Potential Mechanisms

Snow¹,

Gozal

Malhotra

et al. 2002

Pediatrics

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ABSTRACT. Objectives. After resection of hypothalamic/pituitary tumors, children are at risk for development of hormonal deficiencies, obesity, and hypersomnolence. However, the prevalence and pathophysiology of these complications are unclear. The purpose of this study was to assess the prevalence and severity of hypersomnolence in children after resection of pituitary tumors and to study the potential factors that contribute to this sleepiness if present. We further hypothesized that decrements in orexin levels may contribute to the sleepiness.Methods. Six children who underwent hypothalamic/ pituitary surgery were identified. Five of these patients and 5 matched control subjects underwent overnight polysomnography followed by a multiple sleep latency test. Children who had a primary sleep disorder (eg, obstructive sleep apnea) underwent treatment and were restudied subsequently (n ‫؍‬ 2). Blood levels of pituitary hormones were measured. Blood and cerebrospinal fluid (CSF) were drawn from 4 patients and 3 control subjects to measure orexin levels.Results. Endocrine control was appropriate in all children. Although patients had longer sleep duration but similar sleep efficiency than control subjects, relatively severe daytime somnolence was present (mean sleep latency: 10.3 ؎ 5.3 minutes vs 26.2 ؎ 1.1 minute in control subjects). Sleepiness did not correlate with body mass index or age. Furthermore, serum and CSF orexin levels did not differ between patients and control subjects.Conclusions. Severe daytime sleepiness is frequent among children who undergo pituitary/hypothalamic surgery and does not seem to result from inappropriate cortisol or thyroxine replacement, disturbed nocturnal sleep, or low levels of orexin in the serum or CSF. We therefore speculate that other, unidentified neurohormonal mechanisms may mediate the excessive sleepiness of these patients. Pediatrics 2002;110(6). URL: http:// www.pediatrics.org/cgi/content/full/110/6/e74; sleep, excessive daytime sleepiness, adolescents, orexin (hypocretin), brain tumors, craniopharyngioma.

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“…In this regard, Vgontzas et al recently reported that obese patients can be sleepier than normal-weight controls during the daytime even if they do not demonstrate any degree of sleep disorder breathing. 16 This study, performed by full-night polysomnography, aimed to investigate the prevalence and severity of sleep breathing disorder and loud snoring in obese patients, and the possible independent in¯uence of body mass index (BMI) and body fat distribution on these alterations. The possibility of a difference in daytime sleepiness between nonapnoeic obese and normal-weight subjects was also examined.…”

Section: Introductionmentioning

confidence: 99%

Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects

et al. 2001

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OBJECTIVE:To investigate the prevalence of sleep breathing disorders, loud snoring and excessive daytime sleepiness in a group of obese subjects, and to identify the predictors of obstructive sleep apnea (OSA) severity in these patients. SUBJECTS: A total of 161 consecutive obese patients (body mass index (BMI) ! 30.0 kgam 2 ), ranging between 30.0 and 67.3, represented by 57 men and 104 women, aged 16 ± 75 y. Forty (15 men and 25 women) age-matched (20 ± 70 y) nonobese (BMI`27 kgam 2 ) volunteers were also recruited for the study. MEASUREMENTS: Respiratory function parameters, nocturnal sleep quality (evaluated by a speci®c questionnaire), nocturnal hypoventilation and OSA (evaluated by night polysomnography) were examined in all subjects. Anthropometric parameters (neck circumference, waist circumference, waist-to-hip ratio) were also investigated. RESULTS: Eighty-three obese patients (51.5% of the obese group) had a respiratory disturbance index (RDI) ! 10, corresponding to a moderate or severe sleep apnea. In particular, 24.8% (40a161), ie a quarter of all obese patients, were affected by severe OSA and this alteration was present in 42.1% of obese men (24a57) and in 15.4% (16a104) of obese women. When a stepwise multiple regression analysis was performed, neck circumference in men and BMI in women were shown to be the strongest predictors of sleep apnea. Twenty-nine percent of all obese subjects (40.3% of men and 23.1% of women) showed nocturnal hypoventilation; however, it was present as a unique breathing alteration in only 5% of the obese population. The percentage of patients having excessive daytime sleepiness was signi®cantly higher than in nonobese subjects, even when only nonapneic obese patients were considered (P`0.001). CONCLUSION: This study shows that OSA is present in more than 50% of a population of obese patients with a mean BMI higher than 40.0, this percentage being much higher than that commonly reported in previous studies, particularly in women. Neck circumference in men and BMI in women seem to be the strongest predictors of the severity of OSA in obese patients. Nocturnal hypoventilation seems to be present in more than 29% of a severe obese population. Moreover, this study indicates that morbid obesity can be associated with excessive daytime sleepiness even in the absence of sleep apnea.

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Obesity Without Sleep Apnea Is Associated With Daytime Sleepiness

Abstract: Background: Daytime sleepiness and fatigue is a frequent complaint of obese patients even among those who do not demonstrate sleep apnea.

Cited by 295 publications

References 17 publications

Sleep-related disturbances and physical inactivity are independently associated with obesity in adults

Sleep-related disturbances and physical inactivity are independently associated with obesity in adults

Severe Hypersomnolence After Pituitary/Hypothalamic Surgery in Adolescents: Clinical Characteristics and Potential Mechanisms

Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects

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