Predictors of sleep-disordered breathing in obese adults who are chronic short sleepers

Abstract

Background Sleep disordered breathing (SDB) is more common in obese adults, but not all obese adults have SDB. The aim of these analyses was to determine what predicted SDB in a sample of obese adults. Methods We conducted cross-sectional analysis of 139 obese men and women aged 18–50 years who are chronic short sleepers. Habitual sleep duration and sleep efficiency were estimated using 2 weeks of wrist actigraphy. Respiratory Disturbance Index (RDI) was assessed by a portable screening device. SDB was defined as RDI≥15 events/hour. Subjective sleep quality, sleepiness, and sociodemographic characteristics were evaluated by questionnaires. Results Increased sleep duration from actigraphy was associated with reduced odds of SDB (OR 0.44 per hour, p=.043). Neither subjective sleep quality nor sleepiness was associated with SDB. Male sex, older age, and increased waist circumference were associated with increased odds of SDB. Conclusions In this sample of obese adults, subjective measures of sleep quality and sleepiness were not indicators of SDB. These results suggest that in obese patients, physicians should not rely on subjective measures to determine who should be referred for a clinical sleep study. A wider use of portable apnea screening devices should be considered in non symptomatic, Non-Hispanic white males.

Interacting epidemics? Sleep curtailment, insulin resistance, and obesity

“…Depression and obesity may occur together as well: obesity may negatively affect mood and both pharmacologic antidepressant therapy and major depression itself are associated with weight gain 147 . We recently reported that obese subjects often suffer from sleep‐disordered breathing, which induces frequent microawakenings and loss of SWS 148 . Similar effects of BMI on sleep have also been observed in youth.…”

Neck Circumference Is a Predictor of Metabolic Syndrome and Obstructive Sleep Apnea in Short-Sleeping Obese Men and Women

“…25 Previously, we reported in this patient cohort that short sleep duration by actigraphy is associated with increased odds of OSAS. 26 C-reactive protein (CRP), an accepted marker of inflammation and an independent predictor of cardiovascular risk, is elevated both in metabolic syndrome and in OSAS. 27 Finally, several endocrine systems, including the glucorticoid axis and the sympatho-adrenal system, are disrupted in obesity and metabolic syndrome.…”

Liver Enlargement Predicts Obstructive Sleep Apnea–Hypopnea Syndrome in Morbidly Obese Women

“…In severe obesity, it was also found a weak association between AHI and excessive daytime sleepiness or other symptoms and signs of OSAHS especially in females. Obesity itself is a cause of poor subjective assessment of sleep quality and sleepiness ( 15 , 42 , 43 ).…”

“…On the basis of animal models ( 10 ), it has been postulated that leptin resistance developed by obese patients may impair the neuroanatomic interaction necessary for stable breathing, thereby contributing to the genesis of OSAHS ( 11 ). The disruption of normal sleep and chronic intermittent hypoxia starts a vicious circle by worsening obesity and may explain the close association between OSAHS and some of the features of the metabolic syndrome (MS), including hypertension, insulin resistance, and type 2 diabetes, ultimately leading to cardiovascular and cerebro-vascular illness ( 12 – 15 ). The name “syndrome Z” has been proposed for the association between MS and OSAHS ( 16 ) and the inclusion of this sleep and breathing disorder among the manifestations of MS has been also suggested ( 17 ).…”