Obese Sleep Apnea Patients Research Articles

Analysis of Possible Predictors of Moderate and Severe Obstructive Sleep Apnea in Obese Patients.

The online version contains supplementary material available at 10.1007/s12070-024-04908-0.

502 Does obstructive sleep apnea in obese patients affect neonatal outcomes?

502 Does obstructive sleep apnea in obese patients affect neonatal outcomes?

Bariatric surgery reduces sleep apnea in obese patients with obstructive sleep apnea by increasing pharyngeal cross-sectional area during the early postoperative period

ObjectiveBariatric surgery (BS) is considered one of the most effective treatments for obese individuals with Obstructive Sleep Apnea (OSA). However, otolaryngologists have raised concerns about the structural alterations caused by BS on the upper respiratory tract, especially, on the pharyngeal cavity.MethodsIn this study, we recruited 42 individuals who underwent BS at our hospital. They were divided into two groups based on apnea–hypopnea index (AHI): mild group (5 ≤ AHI < 15) and moderate-severe group (AHI ≥ 15). The participants were followed up for 12 months and several indicators, including body mass index (BMI), polysomnography (PSG), and acoustic pharyngometry (APh), were assessed repeatedly before surgery and at 3, 6, and 12 months (m) after surgery.ResultsParticipants exhibited significant decreases in BMI (F = 128.1, P = 0.001) and total weight loss (F = 176.7, P < 0.001) after BS. The AHI value among obese patients with mild OSA decreased significantly within three months after surgery (0 day vs. 3 months, P < 0.01), and decreased significantly more than 12 months with moderate-to-severe patients (0 day vs. 3 months, 3 months vs. 6 months, 6 months vs. 12 months, P < 0.01). The therapeutic effect of OSA of the mild group was significantly better compared with that of the moderate-severe group at 6 months (mean rank = 28.13 vs. 14.21, P < 0.001) and 12 m (mean rank = 26.75 vs. 15.52, P = 0.001). The APh results revealed that the pharyngeal volume of the two groups increased significantly between 0 day and 6 months after surgery (P < 0.01). The oropharyngeal junction (OPJ) area and the glottal area were increased significantly between 0 day and 6 m after surgery (P < 0.01).ConclusionBS can relieve apnea and OSA symptoms among obese patients with OSA, especially in the early postoperative period. Moreover, OSA severity was closely associated with OPJ and glottal areas, rather than pharyngeal cavity volume.

Evaluation the Possible Role of Interleukin-6 and Tumor Necrosis Factor- Alpha in Pathogenesis of Obstructive Sleep Apnea in Obese Patients: A Case-Control Study:.

According to a mounting body of evidence, recent observations have highlighted considerable association between obstructive sleep apnea (OSA) syndrome and patients' obesity and inflammation, however the exact underlying mechanisms remain to be fully understood. In this study, the relationship between OSA and Interleukin-6 and Tumor necrosis factor- alpha was assessed in obese patients and their serum concentrations were compared to non-OSA obese subjects. This case-control study was conducted on forty-six obese OSA patients (body mass indices, BMI30) and 42 obese but otherwise healthy individuals who were admitted to the pulmonary or obesity clinics of the Hazrat-e Rasool General Hospital (Tehran, Iran) between November 2019 and May 2020 were included. The participants completed the NOSAS, EPWORTH and STOPBANG questionnaires. Tumor Necrosis Factor-Alpha (TNF-α) and Interleukin-6 (IL-6) serum concentrations were determined using the enzyme-linked immunosorbent assay (ELISA) method. Compared to the non-OSA group, OSA patients had higher systolic and diastolic blood pressure, pCO2, bicarbonate (HCO3) and hemoglobin and lower high-density lipoprotein (HDL) values. IL-6 and TNF-α serum levels were not significantly different between both groups. Univariate and multivariate linear regression models showed that BMI, systolic blood pressure, pCO2 and HCO3 can positively affect the serum TNF-α and systolic blood pressure and HCO3 can also positively affect the serum IL-6 values in patients with the OSA. This investigation suggests that among the OSA patients, the heightened inflammatory profile may be influenced by the high BMI. Furthermore, the exclusive relationship between different disease biomarkers and inflammatory agents in OSA patients is intriguing and needs further research.

Simple predictors of obstructive sleep apnea in obese patients

Simple predictors of obstructive sleep apnea in obese patients

Study on the structural changes of pharyngeal cavity after bariatric surgery in obese patients with obstructive sleep apnea

Objective:To study whether and how bariatric surgery changes the structure of the pharyngeal cavity in obese patients with obstructive sleep apnea（OSA）. Methods:Forty-two patients who underwent laparoscopic sleeve gastrectomy were recruited. Morphological indicators（BMI, neck and waist circumference）, PSG and acoustic pharyngometry indicators were evaluated pre-operatively and 3, 6, and 12 months post-operatively. Results:All indicators including morphology, pharyngeal cavity structure and OSA severity changed significantly after surgery. Among them, BMI, neck circumference, waist circumference and AHI value were significantly reduced（P<0.001）, while pharyngeal cavity volume, pharynx volume, oropharyngeal junction area, glottis area and LSaO2 increased significantly（P<0.001）. The results of multiple comparisons showed that BMI, neck and waist circumference decreased significantly in the first 6 months, and no further decline occurred during 6 to 12 months postoperatively. The decrease in AHI and LSaO2 mainly occurred within the first 3 months postoperatively, while there was no statistically significant difference in these two indicatiors between 3 months vs. 6 months, 6 months vs. 12 months postoperatively. The area of the oropharyngeal junction increased significantly within 0 to 3 months after surgery, while the volume of the pharyngeal cavity and the area of the glottis increased at 6 months and 12 months after surgery. Conclusion:Bariatric surgery can significantly reduce body weight and reduce fat accumulation in the neck. It can also enlarge the volume and cross-sectional area of the pharyngeal cavity, and improve upper airway obstruction, therefore reduce the symptoms of sleep apnea in obese patients with OSA to a certain extent.

Does every obese sleep apnea patients need CPAP treatment before bariatric surgery: Results of a validation study

RATIONALE/OBJECTIVES: Due to a higher risk of postoperative complications in obstructive sleep apnea (OSA) patients, a systematic screening for OSA is recommended for patients undergoing bariatric surgery. We developed an algorithm based on the results of nocturnal oximetry and pCO2 to identify patients who should or should not be treated with continuous positive airway pressure (CPAP) before surgery. The objective of this study was to get validation data to determine if our algorithm safely selects subjects who need CPAP before surgery. METHODS/MEASUREMENTS: This is a retrospective cohort study. We looked for the occurrence of postoperative complications in 39 patients with moderate OSA not requiring CPAP treatment according to our algorithm, in 41 patients requiring CPAP, and in an historic group of 198 treated OSA patients. Untreated OSA patients were matched for oxygen desaturation index and body mass index to the treated patients in the historic group (1 untreated/2 treated matching). MAIN RESULTS: No statistical difference was found between treated and untreated OSA groups regarding cardiopulmonary complications (n = 0), length of hospital stay, 10 days reoperation and 30 days rehospitalization. Matching analysis showed similar results. CONCLUSIONS: The results of this validation study suggest that our preoperative screening algorithm may safely select patients who do not need CPAP before surgery. In the context of bariatric surgery, there is no increase in the occurrence of postoperative complications in patients with moderate OSA and no criteria for hypoventilation not receiving CPAP in the perioperative period. These results need to be confirmed in a large sample size study.

Study of Obstructive Sleep Apnea in Obese Patients with Type 2 Diabetes Mellitus

Study of Obstructive Sleep Apnea in Obese Patients with Type 2 Diabetes Mellitus

Quantifying Long QT Syndrome in Obese Sleep Apnea Patients Undergoing Roux-en-Y Gastric Bypass Surgery.

Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS) is sleep-disordered breathing distinguished by repetitive cessation or reduction of airflow due to the collapse or narrowing of the upper airway during sleep with continued respiratory effort. A high level of incidence of OSAHS is correlated with obesity. Both severely obese patients and OSAHS patients manifest Long QT Syndrome (LQTS). It is reported that most obese patients undergoing weight reduction surgery positively reverse symptoms of LQST. Also, severely obese OSAHS undergoing the same surgery report alleviation of OSAHS symptoms. In this study, we presented preliminary results of the changes in QT and QTc intervals for obese OSAHS patients undergoing Roux-en-Y Gastric Bypass (RYGB) surgery and had their weight reduced, and were treated from OSAHS post-RYGB surgery. We developed an algorithm to detect the different waveforms in the ECG signal and calculated QT and QTc intervals. Results comparing the changes in the QT and QTc pre- and post-RYGB surgery for four apneic subjects (Aged 37.0 ± 8.9 years, Pre-RYGB BMI 51.7 ± 10.1 kg/m2, Post-RYGB BMI 35.6 ± 7.9 kg/m2) were contrasted with a control group of 3 non-apneic subjects (Aged 32.7 ± 7.0 years, Pre-RYGB BMI 50.8 ± 11.8 kg/m2, Post-RYGB BMI 31.6 ± 2.9 kg/m2) who underwent the same surgery. The results suggest that although the RYGB surgery is successful in weight loss and OSAHS symptoms reduction, apneic patients may continue to have non-reversible LQTS despite long-term weight reduction.

A3440 rs1275988 and rs2586886 in TASK-1 gene may be a protective genetic markers of Obstructive Sleep Apnea in obese patients

Objectives: Acid-sensitive K+ channels (TASK-1) are sensitive to changes in extracellular pH in the physiological range, which have been implicated in peripheral and central respiratory chemosensitivity. We sought to assess the association between the human TASK-1 genetic polymophisms and obstructive sleep apnea (OSA). Methods: 154 severe OSA patients and 156 non-OSA individuals were collected baseline characteristics and genotyped for rs1275988 and rs2586886 single nucleotide polymorphisms (SNPs) of the human TASK-1 gene by a Kompetitive Allele Specific PCR genotyping system. The association between genotypes and OSA status was assessed. Results: No significant differences in the genotype distribution and allele frequencies of SNPs (rs1275988 and rs2586886) were found between severe OSA patients and non-OSA groups. Stratified by BMI, the distribution of SNPs (rs1275988 and rs2586886) genotype distribution, allele frequencies, recessive model (GG+GA vs AA) and dominant model (GG vs AA + GA) showed a significant difference between severe OSA groups and non-OSA groups in patients with BMI≥28 kg/m2 (for genotype: P = 0.034 and P = 0.025, respectively; for allele: P = 0.007 and P = 0.002, respectively; for Recessive model: P = 0.027 and P = 0.013, respectively; for dominant model: P = 0.038 and P = 0.046, respectively). The multivariate logistic regression analysis showed that the AA genotype was a protective factor for OSA[for rs1275988:OR = 0.340 (95% CI: 0.120–0.966; for rs2586886: OR = 0.283 (95%CI:0.097–0.832) respectively]. Conclusion: The rs1275988 and rs2586886 SNPs in TASK-1 may be a protective genetic markers to OSA in obese patients.

The relation between type 2 diabetes and obstructive sleep apnea in obese patients

The relation between type 2 diabetes and obstructive sleep apnea in obese patients

Intermittent hypoxemia and sleep fragmentation: associations with daytime alertness in obese sleep apnea patients living at moderate altitude

BackgroundAlthough obstructive sleep apnea (OSA) has long been associated with daytime sleepiness, far less is known about its association with the ability to remain awake. The aim of this study was to examine the relative importance of inter-correlated measures of OSA severity (eg, various indices of oxygen saturation and sleep fragmentation) in the ability to stay alert as measured objectively by the Maintenance of Wakefulness Test (MWT), defined by a mean sleep latency of ≥12 min. MethodsSeventy-eight obese women and men of similar age and body mass index living at altitude (Mexico City) underwent standard polysomnography, MWT, and completed validated sleep-related questionnaires. ResultsMen had more severe sleep apnea than women (p = 0.002) and were also less alert on MWT (p = 0.022). Logistic regression models indicated that measures of desaturation consistently predicted MWT-defined alertness, whereas varied measures of sleep fragmentation did not. Nearly a third of the variance (r2 = 0.304) in MWT-defined alertness was accounted for by the number of desaturations per hour of sleep (p = 0.003), which is considerably higher than other studies have reported in different populations. ConclusionThe ability to remain awake in obese patients is best accounted for by hypoxemia rather than sleep fragmentation. Whether the size of this effect reflects differences in the population under study (eg, extent of obesity, racial background, residence at moderate altitude) and/or is a function of the measurement of alertness with the MWT remains uncertain.

Effects of obesity on the association between long-term sleep apnea treatment and changes in interleukin-6 levels: the Icelandic Sleep Apnea Cohort.

The aim of this study was to evaluate changes in interleukin (IL)-6 and soluble IL-6 receptor levels in obstructive sleep apnea patients and assess the role of positive airway pressure treatment and obesity on these changes. A total of 309 newly diagnosed subjects with sleep apnea from the Icelandic Sleep Apnea Cohort were referred for treatment and reassessed at a 2-year follow-up. Full treatment was defined objectively as use ≥ 4 h day(-1) and ≥ 20 days month(-1). At the 2-year follow-up, there were 177 full users, 44 partial users and 88 non-users. The mean change in biomarker levels from baseline to the 2-year follow-up was assessed in a primary model that included adjustment for baseline biomarker levels, baseline body mass index and change in body mass index, as well as after adjustment for numerous relevant covariates. No significant overall difference in IL-6 level change was found among full, partial and non-users. However, in severely obese patients (body mass index ≥ 35), a significant increase in IL-6 levels during the 2-year period was found in partial and non-users, compared to no change in full users. Results were attenuated in a smaller propensity score matched subsample, although similar trends were observed. No differences were found in soluble IL-6 receptor levels between full users and non-users, after adjustment for confounders. In conclusion, among untreated obese sleep apnea patients, IL-6 levels increase substantially during 2 years, while adherence to positive airway pressure treatment may prevent further increases in this inflammatory biomarker.

When Obesity and Chronic Obstructive Pulmonary Disease Collide. Physiological and Clinical Consequences

In many parts of the world, the prevalence of both chronic obstructive pulmonary disease (COPD) and obesity is increasing at an alarming rate. Such patients tend to have greater respiratory symptoms, more severe restriction of daily activities, poorer health-related quality of life, and greater health care use than their nonobese counterparts. Physiologically, increasing weight gain is associated with lung volume reduction effects in both health and disease, and this should be considered when interpreting common pulmonary function tests where lung volume is the denominator, such as FEV1/FVC and the ratio of diffusing capacity of carbon monoxide to alveolar volume, or indeed when evaluating the physiological consequences of emphysema in obese individuals. Contrary to expectation, the presence of mild to moderate obesity in COPD appears to have little deleterious effect on respiratory mechanics and muscle function, exertional dyspnea, and peak symptom-limited oxygen uptake during cardiopulmonary exercise testing. Thus, in evaluating obese patients with COPD reporting activity restriction, additional nonpulmonary factors, such as increased metabolic loading, cardiocirculatory impairment, and musculoskeletal abnormalities, should be considered. Care should be taken to recognize the presence of obstructive sleep apnea in obese patients with COPD, as effective treatment of the former condition likely conveys an important survival advantage. Finally, morbid obesity in COPD presents significant challenges to effective management, given the combined effects of erosion of the ventilatory reserve and serious metabolic and cardiovascular comorbidities that collectively predispose to an increased risk of death from respiratory failure.

Predictive Performance of the STOP-Bang Score for Identifying Obstructive Sleep Apnea in Obese Patients

The loud Snoring, Tiredness, Observed apnea, high blood Pressure (STOP)-Body mass index (BMI), Age, Neck circumference, and gender (Bang) questionnaire is a validated screening tool for identifying obstructive sleep apnea in surgical patients. However, the predictive performance of the STOP-Bang score in obese and morbidly obese patients remains unknown. Preoperative patients were approached for consent and were screened for obstructive sleep apnea (OSA) by the STOP questionnaire. Information concerning Bang was collected. Laboratory or portable polysomnography were performed in 667 patients. Patients with BMI of ≥ 30 kg/m(2) were defined as obese patients and ≥ 35 kg/m(2) as morbidly obese. The predictive parameters (sensitivity, specificity, and positive and negative predictive values) for the STOP-Bang score in obese and morbidly obese patients were analyzed. In 310 obese patients, a STOP-Bang score of 3 has high sensitivity of 90 % and high positive predictive value of 85 % for identifying obese patient with OSA. A STOP-Bang score of 4 had high sensitivity (87.5 %) and high negative predictive value (90.5 %) for identifying severe OSA, whereas a STOP-Bang score of 6 had high specificity (85.2 %) to identify severe OSA. The diagnostic odds ratio of a STOP-Bang score of 4 was 4.9 for identifying severe OSA. In 140 morbidly obese patients, a STOP-Bang score of 4 had high sensitivity (89.5 %) for identifying severe OSA. The STOP-Bang score was validated in the obese and morbidly obese surgical patients. For identifying severe OSA, a STOP-Bang score of 4 has high sensitivity of 88 %. For confirming severe OSA, a score of 6 is more specific.

Relationships between Body Fat Distribution, Epicardial Fat and Obstructive Sleep Apnea in Obese Patients with and without Metabolic Syndrome

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.

Association of epicardial fat thickness with the severity of obstructive sleep apnea in obese patients

BackgroundThe correlation between obesity and severity of obstructive sleep apnea (OSA) is controversial. Although fat excess is a predisposing factor for the development of OSA, it has not been determined whether fat distribution rather than obesity per se is associated with OSA severity. Epicardial fat thickness (EFT) is an independent index of visceral adiposity and cardiometabolic risk. We investigated the relation between fat distribution and cardiometabolic risk factors, including EFT and common carotid intima-media thickness (cIMT), with the severity of OSA in obese patients. MethodsOne hundred and fifteen obese patients (56 males, 59 females) with polysomnographic evidence of OSA (≥5 apnea/hypopnea events per hour) of various degrees, without significant differences in grade of obesity as defined by body mass index (BMI), were evaluated. The following parameters were measured: BMI, body composition by dual energy X-ray absorptiometry, EFT, right ventricular end-diastolic diameter (RVEDD) and cIMT by ultrasound, and parameters of metabolic syndrome (waist circumference, arterial blood pressure, fasting glucose, HDL-cholesterol and triglycerides). ResultsEFT, RVEDD, cIMT and trunk/leg fat mass ratio showed a positive correlation with OSA severity in univariate analysis (r=0.536, p<0.001; r=0.480, p<0.001; r=0.345, p<0.001; r=0.330, p<0.001, respectively). However, multiple linear regression analysis showed that EFT was the most significant independent correlate of the severity of OSA (R2=0.376, p=0.022). ConclusionsThe present study suggests that, in obese patients, EFT may be included among the clinical parameters associating with OSA severity. The association of EFT with OSA, both cardiovascular risk factors, is independent of obesity as defined by classical measures.

Prevalence of obstructive sleep apnea in obese patients with psoriasis

Prevalence of obstructive sleep apnea in obese patients with psoriasis

Weight Reduction Programs in Obese Sleep Apnea Patients: The Role of the Mediterranean Diet

Obstructive Sleep Apnoea Syndrome (OSAS) is considered to be one of the most prevalent sleep-related breathing disorders, with an enormous effect on public health. Approximately 2-4% of the general adult population experiences some degree of this syndrome [1]. This percentage increases even more with obesity, up to 20-40%, especially in individuals with an excessive Body Mass Index (BMI) > 30 kg/m2 [2]. OSAS is associated with significant systemic consequences, including cardiovascular morbidity and mortality, and the risk increases with the severity of the syndrome [3]. The pathophysiology underlying the link between OSAS and the cardiovascular system is attributed largely to systemic inflammation and oxidative stress, which are both contributors to endothelial dysfunction [4]. The treatment modalities of OSAS include Continuous Positive Airway Pressure (CPAP), weight loss, upper airway surgery, and oral devices [5]. CPAP is the first line therapy, as a means of maintaining upper airway patency [6], and it is well known that this intervention reduces morbidity and mortality [7]. In severe cases of OSAS the weight loss strategy is essential and must accompany CPAP treatment [8]. A growing body of evidence in OSAS supports the beneficial role of weight reduction, induced by diet alone [9-12] or in combination with exercise [13], leading to a reduction in apnoeas and hypopnoeas. A recent study conducted at the University of Crete examined the effect of the Mediterranean diet (MD) compared with that of a prudent diet on obese adults with moderate-to-severe OSAS who were treated with CPAP while receiving counselling to increase their physical activity [14]. The results showed that people following the MD had a reduced number of disturbances, known as apnoeas, during the rapid eye movement (REM) stage of sleep, which usually accounts for approximately 25% of total sleep during the night. Recent reports have related an increase in disturbances during REM sleep with the risk of developing significant systemic consequences like diabetes type II. However, its clinical significance remains unclear.

Pre and postoperative management of morbidly obese sleep apnea patients scheduled for bariatric surgery

Pre and postoperative management of morbidly obese sleep apnea patients scheduled for bariatric surgery