Mental Health and Sleep Disorders in Obese Patients, Their Relationship with Clinical and Pathogenetic Changes in the Organism and Impact on Quality of Life

Abstract

In the world the problem of obesity is an important aspect in the non-infectious diseases progression. It is known, that 95% of the pathogenic factor for the obesity development depends on the changes caused by neurochemical, hormonal and metabolic mechanisms that occur by depression, anxiety, eating disorders, circadian rhythms and sleepiness. The objective: to determine the psychosocial features and their relationship with clinical and pathogenetic changes in obese patients of working age. Materials and methods. 75 patients with obesity of the 1st and 2d degrees (39.03±0.93 years old) and 75 practically healthy persons of the corresponding age (36.84±0.96 years old) were examined. Waist circumference (WC), hip circumference (HC), body surface area (BSA), waist/hip ratio (WHR), conicity index (ConI), a body shape index (ABSI), abdominal volume index (AVI), blood pressure, blood levels of glucose, insulin, index HOMA, cholesterol, lipidogram indicators, serotonin, and leptin were determined in the patients. The psychological status was assessed by Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Scale (HAM-A), the Dutch Eating Behavior Questionnaire (DEBQ), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), the patient’s quality of life – by 36-Item Short Form Survey (SF-36). The statistical analysis was conducted by IBM SPSS Statistics, Statistica 12, descriptive statistics Excel 2010. Results. The patients of the studied group, unlike the control group, had significantly higher indices of WC, HC, BMI, WHR, ConI, ABSI, AVI, HOMA index, blood pressure, glucose, insulin, total cholesterol, lipidogram, leptin and the lower level of serotonin. This was accompanied with clinically expressed anxiety of depression which led to eating disorders (a tendency “to eat emotions”, to overeat when food is available, a habit to eat without restrictions), sleep disorders (excessive day time sleepiness, low quality of sleep) and reduced quality of life. The results of correlation analysis indicate a strong or moderate positive correlation between obesity indices, glucose level, lipidogram, atherogenicity index, HOMA index, scores of depression and anxiety scales, as well as strong negative correlation with ABSI index, high density lipoproteins, serotonin. In addition, a positive correlation was found between leptin level and scores of depression and anxiety scales, scores of eating behavior, sleepiness, and a negative correlation was determined between these indices and serotonin level. Conclusions. The patients of the studied group (100.0 %) had abdominal obesity. Among the anthropometric indices ABSI and AVI ones were the most significant and informative for determination of abdominal obesity in gender aspect, this can be an alternative for MRI diagnosis of visceral obesity at the level of primary medical care. A close relationship between abdominal obesity with psycho-emotional disorders, disorders of sleep and eat behavior, metabolic disorders, leptin and serotonin levels was determined. Taking into account these interrelationships in a patient-centered management in persons with obesity will improve the quality of medical care.