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

Abstract

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.

Diurnal PaCO2 tension in obese women: relationship with sleep disordered breathing

“…We would like to suggest that the discrepancy between men and women (confirmed by our unpublished data) may be due to differences in fat distribution (mainly subcutaneous in women and visceral in men) and hormonal milieu, and to a higher prevalence and severity of sleep-respiratory disturbances in obese males. 8 Indeed, visceral fat, rather than overall adiposity, has been demonstrated to predispose to the development of sleep apnoea in obese individuals. 19 In particular, it has been shown that sleep apneics obese patients have significantly higher amount of visceral fat, compared to nonsleep apneics obese controls, even though there was no difference between the two groups in terms of Diurnal PaCO 2 tension in obese women O Resta et al BMI, as well as the amount of both total and subcutaneous body fat.…”

“…3 Several studies on diurnal hypoventilation in patients affected by obesity hypoventilation syndrome (OHS) have been performed, [4][5][6] whereas few data exist on diurnal PaCO 2 tension in apparently healthy nonsmoking obese patients. 7 It is noteworthy that several studies demonstrated a wide array of respiratory disturbances during sleep (hypoventilation, obstructive apnoea-hypopnoea events, and 'flow limitation') in obese individuals, 8,9 but no information is available about the possible relationship between diurnal PaCO 2 tension and sleep-respiratory disturbances.…”

The Association Between Snoring, Daytime Sleepiness and Obesity in Professional Wrestlers

“…Resta et al (16) investigated 161 obese subject and 40 age-matched control subjects. They found that neck circumference in men, and BMI in women were strongest predictors of sleep apnea.…”

Long term evaluation of mental fatigue by Maastricht Questionnaire in patients with OSAS treated with CPAP

“…The second group (group two) of 16 patients was treated with CPAP for at least two years. The polysomnography was performed according to the protocol of our sleep laboratory [3]. The diagnosis of OSAS was made according to ASDA criteria [4].…”