Chest
Volume 103, Issue 5, May 1993, Pages 1336-1342
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Clinical Investigations
Adiposity and Cardiovascular Risk Factors in Men With Obstructive Sleep Apnea

https://doi.org/10.1378/chest.103.5.1336Get rights and content

Study objective

To assess anthropometric characteristics of patients with obstructive sleep apnea (OSA) and their relationship to cardiovascular risk factors (dyslipidemia, hypertension, glucose intolerance) and severity of breathing abnormalities during sleep.

Design

Case series.

Setting

Referral-based sleep disorder center serving Rhode Island and Southeastern Massachusetts.

Patients

Forty-five men, 26 to 65 years old, with OSA diagnosed by clinical and polysomnographic criteria.

Results

By national health survey criteria, 51 percent of patients were in the upper fifth percentile for weight, whereas 91 to 98 percent were in the upper fifth percentile for skinfold thicknesses (triceps, subscapular, triceps plus subscapular). Severe upper body obesity, as defined by a waist-hip ratio (WHR) greater than or equal to 1.00, was present in 51 percent of the patients. The WHR, however, did not correlate significantly with the severity of respiratory disturbances during sleep. The patients had higher prevalences of hypertension and impaired glucose tolerance than expected, but normal prevalences of hypercholesterolemia, low high-density lipoprotein cholesterol, and overt diabetes mellitus. Skinfold thicknesses correlated more closely with the severity of OSA than did body mass index (BMI) or neck circumference.

Conclusion

Men with OSA have a marked excess of body fat that is not always reflected in measurements of body weight or BMI. Also, upper body obesity, hypertension, and impaired glucose tolerance occur more frequently than expected in this population. Severe adiposity may not only promote development of the respiratory abnormalities of OSA, but also may contribute directly to the increased cardiovascular risk associated with OSA.

Section snippets

Subjects

Men, 18 to 65 years old, were candidates for the study if they had been assigned the diagnosis of OSA on the basis of clinical evaluation and overnight polysomnography at the Rhode Island Hospital Sleep Disorders Center. All subjects had been referred for evaluation of daytime somnolence, loud snoring, or apneic spells during sleep. Patients were excluded from the study if they had COPD, autoimmune disorders, liver disease, malignancy, renal insufficiency, drug or alcohol abuse, chronic

Subject Characteristics

Clinical characteristics of the study sample are shown in Table 1. In terms of age, BMI, severity of sleep apnea, and reported history of hypertension or diabetes, the study participants did not differ significantly from the men with OSA who did not participate in the study. Figure 1 shows the distributions of various measures of body mass (weight, BMI) and adiposity (skinfold thickness). More than 65 percent of the patients were obese, as defined by BMI or weight greater than the 85th

DISCUSSION

In this study the men with OSA were remarkably obese according to standard skinfold thickness criteria, but the extent of their adiposity was not always evident from weight and BMI measurements. In addition, a majority of the men were characterized as having severe upper-body obesity, a condition associated with high cardiovascular risk. The patients' excessive adiposity and the strong correlation between skinfold thickness and breathing abnormalities are also consistent with a role for obesity

ACKNOWLEDGEMENTS

The authors thank Anna Iosiphidis for providing technical support and Joan Paiva for her expert secretarial assistance.

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    This study was supported in part by Biomedical Research Support grant 507RR05862-08.

    Manuscript received April 28; revision accepted Sentember 15.

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