Relationships between Body Fat Distribution, Epicardial Fat and Obstructive Sleep Apnea in Obese Patients with and without Metabolic Syndrome

Abstract

BackgroundObstructive sleep apnea (OSA) and metabolic syndrome, both closely related to obesity, often coexist in affected individuals; however, body mass index is not an accurate indicator of body fat and thus is not a good predictor of OSA and other comorbidities. The aim of this study was to investigate whether the occurrence of OSA could be associated with an altered body fat distribution and a more evident cardio metabolic risk independently from obesity and metabolic syndrome.Methods and Results171 consecutive patients (58 men and 113 women) were included in the study and underwent overnight polysomnography. Anthropometric data, blood pressure, lipid profile, glycaemic parameters were recorded. Body composition by DXA, two-dimensional echocardiography and carotid intima/media thickness measurement were performed. 67 patients (39.2%) had no OSA and 104 (60.8%) had OSA. The percentage of patients with metabolic syndrome was significantly higher among OSA patients (65.4%) that were older, heavier and showed a bigger and fatter heart compared to the control group. Upper body fat deposition index , the ratio between upper body fat (head, arms and trunk fat in kilograms) and lower body fat (legs fat in kilograms), was significantly increased in the OSA patients and significantly related to epicardial fat thickness. In patients with metabolic syndrome, multivariate regression analyses showed that upper body fat deposition index and epicardial fat showed the best association with OSA.ConclusionThe occurrence of OSA in obese people is more closely related to cardiac adiposity and to abnormal fat distribution rather than to the absolute amount of adipose tissue. In patients with metabolic syndrome the severity of OSA is associated with increase in left ventricular mass and carotid intima/media thickness.

CPAP therapy induces favorable short-term changes in epicardial fat thickness and vascular and metabolic markers in apparently healthy subjects with obstructive sleep apnea-hypopnea syndrome (OSAHS)

“…There are limited data on the association between EAT and OSAHS. Two previous studies demonstrated a possible association between EAT thickness and OSAHS severity in obese patients [18] and in OSAHS patients with and without metabolic syndrome [19]. Another study was found thicker EAT only in women with severe OSAHS [20].…”

Perfis metabólico e nutricional como preditores da síndrome da apneia obstrutiva do sono

“…A obesidade geral e, principalmente, a abdominal contribuem como principais fatores determinantes de hipoventilação e, além disso, colaboram para o aparecimento da apneia obstrutiva que aumenta o colapso das vias aéreas superiores [4][5][6] . Portanto, devido à grande importância da avaliação da gordura abdominal, torna-se necessário realizar a antropometria para a sua detecção.…”

“…Lubrano et al 6 também encontraram um percentual de SM maior entre os pacientes com a síndrome (65,4%), porém, diferente desta pesquisa, a prevalência da SM estava aumentada em função da gravidade da SAOS: 52,4% dos pacientes com SAOS leve, 69,2% dos com SAOS moderada e 77,8% dos com SAOS grave. Embora a relação da SAOS com a SM tenha sido amplamente atribuída à obesidade, os mecanismos exatos da associação entre a síndrome e suas características individuais ainda permanecem não elucidados 14 .…”

“…Logo, permite a mensuração do risco metabólico e, assim, da SAOS. Outros autores 5,6,13 confirmaram esses resultados, os quais sugerem que as medidas Revista de Nutrição http://dx.doi.org/10.1590/1678-98652016000500005 antropométricas utilizadas no presente estudo e o perfil metabólico podem ser fatores preditores na determinação da gravidade da SAOS.…”

Regulation of MicroRNA-378 expression in mature human adipose tissue cells by adiponectin, free fatty acids and dexamethasone

“…Childhood and adult obesity are two of the most critical threats to health in recent decades [2,3]. Obesity is caused by several factors, and its pathogenesis involves interplay of social, genetic and environmental considerations [4].…”