Abstract
BackgroundObstructive sleep apnea (OSA) and metabolic syndrome, both closely related to obesity, often coexist in affected individuals; however, body mass index is not an accurate indicator of body fat and thus is not a good predictor of OSA and other comorbidities. The aim of this study was to investigate whether the occurrence of OSA could be associated with an altered body fat distribution and a more evident cardio metabolic risk independently from obesity and metabolic syndrome.Methods and Results171 consecutive patients (58 men and 113 women) were included in the study and underwent overnight polysomnography. Anthropometric data, blood pressure, lipid profile, glycaemic parameters were recorded. Body composition by DXA, two-dimensional echocardiography and carotid intima/media thickness measurement were performed. 67 patients (39.2%) had no OSA and 104 (60.8%) had OSA. The percentage of patients with metabolic syndrome was significantly higher among OSA patients (65.4%) that were older, heavier and showed a bigger and fatter heart compared to the control group. Upper body fat deposition index , the ratio between upper body fat (head, arms and trunk fat in kilograms) and lower body fat (legs fat in kilograms), was significantly increased in the OSA patients and significantly related to epicardial fat thickness. In patients with metabolic syndrome, multivariate regression analyses showed that upper body fat deposition index and epicardial fat showed the best association with OSA.ConclusionThe occurrence of OSA in obese people is more closely related to cardiac adiposity and to abnormal fat distribution rather than to the absolute amount of adipose tissue. In patients with metabolic syndrome the severity of OSA is associated with increase in left ventricular mass and carotid intima/media thickness.
Highlights
Obesity is a common finding and a major pathogenetic factor in obstructive sleep apnea (OSA) [1]
Obstructive sleep apnea (OSA) is characterized by recurrent episodes of absent or decreased airflow in the upper airway during sleep and most often arises in obese individuals who have a narrowing of the upper airway because of fatty deposits in the tongue and para-pharyngeal areas
The roles of sex, age, Body mass index (BMI), body fat distribution, Carotid intima/media thickness (cIMT), epicardial fat thickness (EFT), glucose and serum lipids as associated variables with apnea/hypopnea index (AHI) were tested by linear regression with the use of multivariate models
Summary
Obesity is a common finding and a major pathogenetic factor in obstructive sleep apnea (OSA) [1]. In recent years a number of studies have suggested a strong bidirectional association between OSA and metabolic syndrome (MetS), the commonly used term for the clustering of cardio metabolic risk factors including visceral obesity, hypertension, dyslipidaemia and type 2 diabetes mellitus [14]. Obstructive sleep apnea (OSA) and metabolic syndrome, both closely related to obesity, often coexist in affected individuals; body mass index is not an accurate indicator of body fat and is not a good predictor of OSA and other comorbidities. The aim of this study was to investigate whether the occurrence of OSA could be associated with an altered body fat distribution and a more evident cardio metabolic risk independently from obesity and metabolic syndrome
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