Sleep disordered breathing and metabolic comorbidities across sex and menopausal status in East Asians: the Nagahama Study

Abstract

It is well known that the prevalence of sleep disordered breathing (SDB) is increased in patients with obesity or metabolic comorbidities. However, the way in which the prevalence of SDB increases in relation to comorbidities according to the severity of obesity remains unclear.This cross-sectional study evaluated 7713 community participants with nocturnal oximetry ≥2 nights. SDB was assessed by the 3% oxygen desaturation index corrected for sleep duration obtained by wrist actigraphy (Acti-ODI3%). SDB severity was defined by Acti-ODI3%. Obesity was defined as body mass index ≥25 kg·/m−2.The prevalence of SDB was 41.0% (95% CI 39.9–42.1), 46.9% (45.8–48.0), 10.1% (9.5–10.8), and 2.0% (1.7–2.3) in normal, mild, moderate, and severe SDB, respectively, with notable sex differences evident (men >post-menopausal women >pre-menopausal women). Comorbidities such as hypertension, diabetes, and metabolic syndrome were independently associated with the prevalence of moderate-to-severe SDB, and coincidence of any one of these with obesity was associated with a higher probability of moderate-to-severe SDB (OR 8.2, 95% CI 6.6–10.2; 7.8, 5.6–10.9; 6.7, 5.2–8.6, respectively). Dyslipidemia in addition to obesity was not additively associated with the prevalence of moderate to-severe SDB. The number of antihypertensive drugs was associated with SDB (p for trend <0.001). Proportion of a high cumulative percentage of sleep time with SpO2 <90% increased even among moderate-to-severe SDB with increases in obesity.Metabolic comorbidities contribute to SDB regardless of the degree of obesity. We should recognise the extremely high prevalence of moderate-to-severe SDB in patients with obesity and metabolic comorbidities.

Validation of Oximetry for Diagnosing Obstructive Sleep Apnea in a Clinical Setting

“…The differences in the correlation coefficients between our data ( r = 0.561, p < 0.001) ( Figure 2 a) and Matsumoto et al ( r = 0.99, p < 0.001) [ 25 ] may be due to differences in settings. Our data compared previously performed oximetry with PSG or OCST that was performed later in a clinical setting.…”

“…First, the oximetry ODI was not measured simultaneously with PSG/OCST. Comparisons of ODI and AHI/REI from the same recordings showed the best correlation [ 14 , 15 , 16 , 17 , 18 , 19 ] ( Figure 5 ), followed by simultaneous recording by different devices [ 20 , 21 , 25 ]. The correlation was worst when comparing ODI and AHI/REI from different devices on different nights [ 23 , 24 ] ( Figure 2 a and Figure 6 ).…”

“…Among the participants of the Nagahama Study, 12.1% ( n = 933) had an ODI of ≥ 15 and were advised to undertake clinical sleep tests [ 25 ]. From October 24, 2013 to March 19, 2020, 129 participants visited our outpatient unit located at a tertiary care center in the Nagahama City Hospital for evaluation of OSA.…”

“…Matsumoto et al [ 25 ] published a large epidemiological study (the Nagahama Study) in Nagahama, Japan, in which 7713 participants underwent pulse oximetry in their homes to screen for sleep apnea. In this study, home fingertip oximetry worn on the nondominant wrist was performed with wrist actigraphy.…”

“…This study also found that comorbidities like hypertension, diabetes, and metabolic syndrome were independently associated with moderate-to-severe OSA. As a preliminary study, Matsumoto et al [ 25 ] compared simultaneous in-lab PSG with oximetry and actigraphy among 32 participants. Actigraphy-modified 3%ODI ( r = 0.99, p < 0.001) was more comparable to the AHI recorded from PSG than the non-modified 3%ODI ( r = 0.92, p < 0.001).…”