Study to evaluate obstructive sleep apnea in metabolic syndrome at a tertiary hospital in India

Abhinandan S Kumbar,Bm Rashmi,Rahul M Lokhande,Rakesh D Waghmare

doi:10.18231/j.ijirm.2021.002

Abstract

Background: Obstructive sleep apnea (OSA) is a prevalent sleep disorder known to be associated with cardiovascular risk factors and metabolic syndrome (MetS). The studies on OSA burden in MetS patients in India is scarce. Aim: To study prevalence of OSA in MetS and to study factors associated with OSA among MetS. Settings and design: Hospital based cross-sectional study was conducted for 2 years (year 2015-2016) at a Tertiary Care Teaching Hospital in Pune. Materials and Methods: MetS patients aged 18 years, of either sex were included in this study. Polysomnography was performed in all patients and grading of OSA severity was based on the apneahypopnea index (AHI). Statistical analysis: Data was analyzed in SPSS V:20. To find association of OSA with MetS and its components, statistical tests like chi-square, independent student t–test and One-way ANOVA test were applied. Results: Study prevalence of OSA among MetS patients was 73.3%. Relatively older age group (50.6814.15years), male sex (81.0%), obesity (84.4%). Among OSA group, Mild OSA was present in 40.91%, moderate grade OSA in 31.8% and severe grade OSA in 27.27%. Severe grade OSA was significantly associated with older age (45.67 14.3 years), obesity (35.758.3 Kg/m2), higher serum triglyceride and lower HDL-C levels, larger waist (110.7511.9cm) and neck circumference (40.585.2cm). Conclusions: Central obesity, larger waist circumference, dyslipidemia were striking features of OSA patients that were significantly associated with severe grades of OSA. A trend of increased fasting blood sugar levels, systolic and diastolic blood pressure levels were noted in severe OSA groups. Thus, OSA is associated with higher levels of metabolic dysfunction. Keywords: Cardiovascular risk, Dyslipidemia, Obstructive sleep apnea, Metabolic Syndrome, Obesity, Body mass index.

Highlights

Obstructive sleep apnea (OSA) is a sleep disorder characterized by recurrent upper airway obstruction during sleep, leading to intermittent breathing pauses alveolar hypoventilation and intermittent arousal from sleep
Body Mass Index was found to be significantly associated with OSA, wherein majority of 84.4% obese patients (BMI: ≥ 30) suffered from Obstructive Sleep Apnea when compared to those with normal or low BMI levels (45.5% OSA among Low BMI group patients and 70.6% OSA among normal BMI group patients)
OSA is independently associated with dyslipidemia and serum triglycerides, LDL cholesterol are found to be directly related with higher apneahypopnea index (AHI) levels, whereas high density lipoprotein (HDL) cholesterol are inversely related to AHI levels. 2,10,26 The present study found similar trend of significantly higher serum triglyceride levels (186.67±42.5mg/dL) and significantly lesser serum HDL cholesterol levels (38±2.6 mg/dL)in severe OSA cases. (Tables 3 and 4)

Summary

Introduction

Obstructive sleep apnea (OSA) is a sleep disorder characterized by recurrent upper airway obstruction during sleep, leading to intermittent breathing pauses alveolar hypoventilation and intermittent arousal from sleep These in turn result in imbalances in arterial blood gas levels and acid base levels.[1] OSA is associated with insulin resistance, hypertension and cardiovascular morbidities. Metabolic syndrome (MetS) is a group of several cardiovascular risk factors like central obesity, dyslipidemia, higher blood pressure levels and blood glucose levels, with raises the prothrombotic and inflammatory states. Severe grade OSA was significantly associated with older age (45.67 ± 14.3 years), obesity (35.75±8.3 Kg/m2), higher serum triglyceride and lower HDL-C levels, larger waist (110.75±11.9cm) and neck circumference (40.58±5.2cm). Conclusions: Central obesity, larger waist circumference, dyslipidemia were striking features of OSA patients that were significantly associated with severe grades of OSA. OSA is associated with higher levels of metabolic dysfunction

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