Abstract
Background: Persons with obesity are at high risk of obstructive sleep apnea (OSA); however, the relationship between obesity in young adulthood and future OSA risk is unknown. Methods: We prospectively examined the association between changes in measures of adiposity in young adulthood and subsequent risk of OSA in 857 middle-aged adults free of cardiovascular disease at baseline. Data included at least 2 measures of adiposity (BMI, waist circumference, waist/hip ratio, and waist/height ratio) after 18 years of age. High-risk of OSA was defined as 2 of the following: hypertension, persistent snoring, and persistent daytime sleepiness, based on modified Berlin Questionnaire score, excluding BMI. Persistent snoring was defined as snoring on ≥3 nights/week, snoring louder than talking or very loud, and breathing pauses on ≥3 nights/week. Persistent daytime sleepiness was defined as feeling tired ≥3 days/week after sleeping, feeling tired during time awake ≥3 days/week, and falling asleep while driving. Results: The sample was 42% male and 32% African-American. Mean age was 43 years and mean BMI was 31 kg/m 2 when sleep outcomes were measured. BMI increased by 6.1 kg/m 2 over 25 years, waist circumference increased by 16.4 cm over 22 years, waist/hip ratio increased by 0.05 over 15 years, and waist/height ratio increased by 0.09 over 22 years. There were 235 (27%) participants with high-risk of OSA. In multivariate log linear regression models, participants with a one standard deviation increase in BMI had 1.30 (95% CI: 1.14, 1.49) times the risk of OSA, after adjustment for age, gender, race, educational level, leisure-time physical activity, regular drinking, current smoking, and years of follow-up. Participants with a one standard deviation increase in BMI, waist circumference, and waist/height ratio had 1.35 (95% CI: 1.22, 1.50), 1.17 (95% CI: 1.08, 1.27), and 1.22 (95% CI: 1.11, 1.34) times the risk of persistent snoring. The association was not significant for persistent daytime sleepiness. Waist/hip ratio was not significantly associated with any sleep-related outcome. Conclusions: Our findings suggest that an increase in BMI in young adulthood is an independent predictor of high-risk of OSA in middle age. Increases in BMI, waist circumference, and waist/height ratio are independently associated with persistent snoring in middle age.
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