Abstract
PurposeExcessive daytime sleepiness is a common symptom in obstructive sleep apnea (OSA). Previous studies have showed that excessive daytime sleepiness is associated with some individual components of metabolic syndrome. We performed a large cross-sectional study to explore the relationship between excessive daytime sleepiness and metabolic syndrome in male OSA patients.MethodsA total of 2241 suspected male OSA patients were consecutively recruited from 2007 to 2013. Subjective daytime sleepiness was assessed using the Epworth sleepiness scale. Anthropometric, metabolic, and polysomnographic parameters were measured. Metabolic score was used to evaluate the severity of metabolic syndrome.ResultsAmong the male OSA patients, most metabolic parameters varied by excessive daytime sleepiness. In the severe group, male OSA patients with excessive daytime sleepiness were more obese, with higher blood pressure, more severe insulin resistance and dyslipidemia than non-sleepy patients. Patients with metabolic syndrome also had a higher prevalence of excessive daytime sleepiness and scored higher on the Epworth sleepiness scale. Excessive daytime sleepiness was independently associated with an increased risk of metabolic syndrome (odds ratio =1.242, 95% confidence interval: 1.019-1.512). No substantial interaction was observed between excessive daytime sleepiness and OSA/ obesity.ConclusionsExcessive daytime sleepiness was related to metabolic disorders and independently associated with an increased risk of metabolic syndrome in men with OSA. Excessive daytime sleepiness should be taken into consideration for OSA patients, as it may be a simple and useful clinical indicator for evaluating the risk of metabolic syndrome.
Highlights
Obstructive sleep apnea (OSA) is estimated to occur in 9-24% of adults, with a two- to three-fold greater risk for men than women [1, 2]
In the OSA group, patients with Excessive daytime sleepiness (EDS) presented with more severe obesity indices (i.e., body mass index (BMI), neck circumference [Neck circumference (NC)], waist circumference [WC] and waistto-hip ratio [waist-to-hip ratio (WHR)], p < 0.001); higher blood pressure
OSA patients with EDS had a higher prevalence of metabolic syndrome (MetS) (62.6% vs. 48.0%, p < 0.001) and higher metabolic score (2.84 ± 1.21 vs. 2.43 ± 1.27; p < 0.001) than non-EDS patients
Summary
Obstructive sleep apnea (OSA) is estimated to occur in 9-24% of adults, with a two- to three-fold greater risk for men than women [1, 2]. Excessive daytime sleepiness (EDS) is an important feature of OSA [2], and its prevalence is in the range 2.5-26.1% according to several studies in many different countries [3,4,5,6,7,8,9,10]. OSA is independently associated with metabolic syndrome (MetS), a combination of excess abdominal obesity, dyslipidemia, hypertension, hyperglycemia, and insulin resistance [16]. The pathogenesis of OSA (i.e., intermittent hypoxia and sleep fragmentation) may directly contribute to increases in risk factors that comprise MetS via pathological changes including sympathetic activation, oxidative stress, and systemic inflammation [17, 18]. Some studies have reported that EDS is associated with some individual components of MetS, i.e., obesity, insulin resistance and hypertension [19,20,21]. It has been argued that EDS and MetS may share a common pathogenic mechanism (i.e., hypoxia), or that EDS may contribute to MetS by itself [19, 22, 23]
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