Association of adiposity with risk of obstructive sleep apnea: a population-based study

BACKGROUND

Obesity is a crucial risk factor for obstructive sleep apnea (OSA), but the association between adiposity deposition and OSA risk has not reached a consistent conclusion. This study sought to reveal the association of multiple adiposity indicators with OSA risk.

METHODS

This cross-sectional study included 9,733 participants aged 35-74 years, recruited from an ongoing population-based cohort. OSA was assessed by the Berlin Questionnaire. Six adiposity indicators, including neck circumference (NC), body fat percentage (BF%), waist-to-hip ratio (WHR), visceral adiposity index (VAI), lipid accumulation product (LAP), and resting metabolic rate (RMR), were selected. Multivariate logistic regression models were used to examine the association of adiposity indicators with OSA risk.

RESULTS

One thousand six hundred twenty-six participants (16.71%) were classified into the OSA group. NC, BF%, WHR, VAI, LAP, and RMR were all positively associated with the risk of OSA after adjusting for confounders, regardless of age, sex, and history of dyslipidemia. Every 1-unit increment of NC, BF%, and VAI was associated with a 13%, 9%, and 14% increased risk of OSA, respectively; every 0.01-unit increment of WHR was associated with a 3% increased risk of OSA; every 10-unit increment of LAP and RMR was associated with 2% and 4% increased risk of OSA, respectively.

CONCLUSIONS

NC, BF%, WHR, VAI, LAP, and RMR were all independently and positively associated with OSA risk, regardless of age, sex, history of dyslipidemia, and menopausal status. Application of these new indicators could help to more comprehensively reflect and predict the risk of OSA in the general population.

A risk-predictive model for obstructive sleep apnea in patients with chronic obstructive pulmonary disease

Background

Obstructive sleep apnea syndrome (OSA) is increasingly reported in patients with chronic obstructive pulmonary disease (COPD). Our research aimed to analyze the clinical characteristics of patients with overlap syndrome (OS) and develop a nomogram for predicting OSA in patients with COPD.

Methods

We retroactively collected data on 330 patients with COPD treated at Wuhan Union Hospital (Wuhan, China) from March 2017 to March 2022. Multivariate logistic regression was used to select predictors applied to develop a simple nomogram. The area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA) were used to assess the value of the model.

Results

A total of 330 consecutive patients with COPD were enrolled in this study, with 96 patients (29.1%) confirmed with OSA. Patients were randomly divided into the training group (70%, n = 230) and the validation group (30%, n = 100). Age [odds ratio (OR): 1.062, 1.003–1.124], type 2 diabetes (OR: 3.166, 1.263–7.939), neck circumference (NC) (OR: 1.370, 1.098–1,709), modified Medical Research Council (mMRC) dyspnea scale (OR: 0.503, 0.325–0.777), Sleep Apnea Clinical Score (SACS) (OR: 1.083, 1.004–1.168), and C-reactive protein (CRP) (OR: 0.977, 0.962–0.993) were identified as valuable predictors used for developing a nomogram. The prediction model performed good discrimination [AUC: 0.928, 95% confidence interval (CI): 0.873–0.984] and calibration in the validation group. The DCA showed excellent clinical practicability.

Conclusion

We established a concise and practical nomogram that will benefit the advanced diagnosis of OSA in patients with COPD.

Incorporating neck circumference or neck-to-height ratio into the GOAL questionnaire to better detect and describe obstructive sleep apnea with application to clinical decisions

Objective

Although neck circumference (NC) and neck-to-height ratio (NHR) have been recognized as effective predictors of the clinical diagnosis of adult obstructive sleep apnea (OSA), they have not been included in the widely used GOAL questionnaire. Not coincidentally, the NHR has not been adequately considered in the development and validation of the STOP-Bang questionnaire, No-Apnea score and the NoSAS score. The motivation for the study was (1) to combine the GOAL questionnaire with the NC and NHR, respectively, to evaluate its predictive performance and (2) to compare it with the STOP-Bang questionnaire, the No-Apnea score, the NOSAS score, and the GOAL questionnaire.

Materials and methods

This retrospectively allocated cross-sectional study was conducted from November 2017 to March 2022 in adults who underwent nocturnal polysomnography (PSG) or home sleep apnea testing (HSAT). In this paper, the GOAL questionnaire was combined with the NC and NHR, respectively, using logistic regression. The performance of the six screening tools was assessed by discriminatory ability [area under the curve (AUC) obtained from receiver operating characteristic (ROC) curves] and a 2 × 2 league table [including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR−)] and compared under AHI ≥5/h, AHI ≥15/h, and AHI ≥30/h conditions.

Results

A total of 288 patients were enrolled in the study. For all severity OSA levels, the sensitivity of GOAL+NC ranged from 70.12 to 70.80%, and specificity ranged from 86.49 to 76.16%. The sensitivity of GOAL+NHR ranged from 73.31 to 81.75%, while specificity ranged from 83.78 to 70.86%. As for area under the curve (AUC) value under ROC curve, when AHI ≥5/h, compared with GOAL (0.806), No-Apnea (0.823), NoSAS (0.817), and GOAL+NC (0.815), GOAL+NHR (0.831) obtained the highest AUC value, but lower than STOP-Bang (0.837).

Conclusion

The predictive power of incorporating NC or NHR into the GOAL questionnaire was significantly better than that of the GOAL itself. Furthermore, GOAL+NHR was superior to GOAL+NC in predicting OSA severity and better than the No-Apnea score and the NoSAS score.

The influence of sex on anthropometric methods and four scales for screening obstructive sleep apnea

OBJECTIVES

Obstructive Sleep Apnea (OSA) is a kind of respiratory disease that occurs apnea repeatedly during sleep. The purpose of this study was to investigate the influence of sex on anthropometric methods and four scales for screening OSA.

METHODS

The basic data and PSG data of 2108 patients who underwent PSG examination at the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University from July 2017 to December 2020 were continuously included. Then the sensitivity, specificity, positive predictive value, negative predictive value, AUC and DOR of the anthropometric method and the four scales were calculated.

RESULTS

2108 OSA patients were enrolled from the Sleep Medicine Center, including 1644 males (78.0%). The average neck circumference and waist circumference of male and female patients were respectively (39.4±3.4) cm and (96.7±13.8) cm,(34.6±3.5) cm and (90.1±11.6) cm. In female patients. the AUC of NoSAS was the largest. When AHI was 5, 15, and 30 evens/h as the cut-off point, in male patients, the sensitivity of NHR was the highest,in female patients, the sensitivity of WHR was the highest.

CONCLUSIONS

NHR and WHR are good tools for screening OSA in male and female patients respectively. They are worthy of promotion.

Neck Circumference Is Associated With Poor Outcome in Patients With Spontaneous Intracerebral Hemorrhage

Objective: This study aimed to assess the association between neck circumference (NC) and functional outcome in intracerebral hemorrhage (ICH) patients.

Methods: We prospectively analyzed data from ICH patients who received treatment at our institution from January 2018 to November 2019. Patients were categorized into two groups according to 180-day modified Rankin scale (MRS) scores. Univariate and multivariate analyses were performed to assess whether NC was associated with poor outcome in ICH patients. Receiver operating characteristic (ROC) curve analysis was performed to determine the significance of NC in predicting the functional outcome of ICH patients.

Results: A total of 312 patients were enrolled in our study. Multivariate logistic regression analysis indicated that NC was an independent predictor of poor 180-day functional outcome [odds ratio (OR) = 1.205, 95% confidence interval (CI): 1.075–1.350, p = 0.001]. ROC analysis revealed that NC could predict poor functional outcome at 6 months.

Conclusions: NC is an independent predictor of unfavorable functional outcome at 6 months in ICH patients.

Does neck circumference predict obstructive sleep apnea in children with obesity?

OBJECTIVES

Obstructive sleep apnea (OSA) affects 10-50% of children with obesity, but its identification is challenging and wait times for testing are long. Previous studies suggest that neck circumference (NC) and neck-to-height ratio (NHR) may predict OSA. Our objectives were to 1) evaluate associations of NC and NHR with OSA; 2) model NHR as a predictor of OSA, adjusting for age, sex, and Tanner stage; and 3) identify thresholds of NHR associated with OSA, in children with obesity.

METHODS

Participants were aged 8-17 years, with obesity (BMI >95%ile), undergoing polysomnography. Associations between NC and NHR with OSA were evaluated. NHR, age, sex and self-reported Tanner stage (early/late) were included in a negative binomial multiple regression model to predict obstructive apnea hypopnea index (OAHI).

RESULTS

71 children participated, with median age 14.8 years (IQR 12.6, 16.0), 54% male, median BMI z-score 2.5 (IQR 2.3, 2.7), and 77% late Tanner stage. OSA was severe in 18 children (25.4%), moderate in 12 (16.9%), and mild in 18 (25.4%). In the model, each 0.01 increase in NHR was associated with a 55% increase in OAHI (95% CI: 36%, 80%); boys had a 119% higher OAHI than girls (95% CI: 10%, 337%). Threshold NHR associated with moderate-severe OSA was 0.25 in females and 0.23 in males.

CONCLUSIONS

NHR and male sex independently predict OSA severity in children with obesity, adjusting for age and Tanner stage. Children with obesity and NHR above identified thresholds are more likely to have moderate-severe OSA, and may benefit from earlier polysomnography.

Association of snoring and body composition in (peri-post) menopausal women

BACKGROUND

Little attention has been paid to whether snoring frequency is associated with body composition in menopausal women, particularly in China. This study objected to investigate the association between self-reported snoring and body composition in (peri-post) menopausal Chinese women as well as metabolic indicators.

METHODS

This cross-sectional study enrolled 715 participants aged 40-67 years from the Menopause Clinic in the Shanghai Sixth People's Hospital. Participants were categorized into four subgroups stratified by self-reported snoring frequency: never, rarely (< 1 night per week), occasionally (1-2 nights per week), regularly (≥3 nights per week), while body composition was measured using bioelectrical impedance analysis (BIA). Besides, blood sample were collected to test the glycolipid indicators.

RESULTS

In our sample of investigation, regular snoring (≥3 nights per week) was found to be an independent risk factor for higher fat mass (total, upper limbs, trunk), with the highest risk of 2.4 times for fat mass of trunk after adjusting for metabolic confounders(p = 0.003). Meanwhile, regular snoring was independently associated with higher fat mass (total and each segment) only in menopausal transition (p = 0.023).

CONCLUSIONS

We suggested that self-reported regular snoring may be taken as a simple alternative to predict higher fat mass (≥17.11 kg, upper quartile) in menopausal women. Similarly, body composition should be attached to the great importance to those who in menopausal transition in order to help to prevent obstructive sleep apnea (OSA).

Effects of Whole-Body Vibration Exercises on Parameters Related to the Sleep Quality in Metabolic Syndrome Individuals: A Clinical Trial Study

Metabolic syndrome (MetS) is an undesirable clinical condition with physiological, biochemical, clinical, and metabolic factors that contribute to increased cardiovascular risks (CR). A poor sleep quality might be found in obese and MetS individuals. Whole-body vibration (WBV) exercise has been used on the management of MetS individuals. This clinical trial investigated the effect of WBV exercise on parameters related to the sleep quality in MetS individuals. After randomization, nine individuals (seven women and two men) were exposed to a fixed frequency (FF) and ten individuals (eight women and two men) were exposed to a variable frequency (VF). Both groups performed the protocol twice a week, for 6 weeks. All of the evaluations were performed before the first and after the last sessions. Anthropometric and cardiovascular parameters were measured before and after the 6-week intervention. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Berlin Questionnaire were also used to evaluate the quality of the sleep. A significant (p ≤ 0.05) reduction of the waist circumference in the VFG and an increase of the heart rate were found in the FFG and VFG group. The score of the PSQI of the both groups decreased significantly (p = 0.01). The score of the ESS decreased (p = 0.04) only in the VF group. The scores of the Berlin Questionnaire were not altered in both groups. In conclusion, WBV intervention was capable in interfering with physiological mechanisms with effects on the WC and HR, leading to the improvement of the quality of sleep in MetS individuals. WBV exercise might be an important clinical intervention to the management of some factors associated with poor quality of sleep (FFG and VFG) and in the daytime sleepiness in MetS individuals with variable frequencies (5–16 Hz) (VFG).