Clinical Factors Associated With Extreme Sleep Apnea in Patients Living at High Altitude (Bogotá D.C., Colombia): A Case–Control Study

Abstract

ObjectiveTo assess risk factors associated with extreme obstructive sleep apnea (OSA) in patients living at high altitudes. MethodsA case–control study was conducted using data collected between 2016 and 2017 in patients who lived in Bogotá D.C. (2640m above sea level) and were treated at FUNDASUVICOL. Participants: Six hundred twenty patients met the inclusion criteria: 110 had moderate OSA, 144 had severe OSA, 203 had very severe OSA and 163 had extreme OSA (cases). The controls–cases ratio was 3:1. Measurements: Participants’ data were obtained from their medical records. Logistic regression models were used to calculate adjusted odds ratios and 95% confidence intervals. ResultsThe bivariate analysis showed that the following variables were associated with extreme OSA: morbid obesity (ORcrude=32.22; 95% CI=9.10–114.1), high blood pressure (HBP) (ORcrude=2.40; 95% CI=1.66–3.46), snoring (ORcrude=4.69; 95% CI=1.42–15.45), body mass index (BMI) (ORcrude=1.14; 95% CI=1.10–1.18), neck circumference (ORcrude=1.13; 95% CI=1.08–1.18) and age (ORcrude=1.02; 95% CI=1.01–1.04). Somehow, after performing a multivariate regression analysis adjusted by age, gender, morbid obesity, snoring, HBP and neck circumference, it was determined that only morbid obesity (OR=8.34; 95% CI=2.04–34.05) and neck circumference (OR=1.09; 95% CI=1.01–1.16) are risk factors for extreme OSA. DiscussionMorbid obesity and neck circumference were significantly associated with extreme OSA. Therefore, losing weight and improving anthropometric measurements should be considered in OSA treatment to reduce the severity of symptoms and to improve polysomnographic parameters in these patients.