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Polysomnographic and Cephalometric Evaluation of Patients with Obstructive Sleep Apnea According to Obesity Level

  • Jo, Jung Hwan (Department of Oral Medicine, Seoul National University Dental Hospital) ;
  • Park, Ji Woon (Department of Oral Medicine, Seoul National University Dental Hospital) ;
  • Jang, Ji Hee (Department of Oral Medicine, Seoul National University Dental Hospital) ;
  • Chung, Jin Woo (Department of Oral Medicine, Seoul National University Dental Hospital)
  • Received : 2022.09.23
  • Accepted : 2022.09.25
  • Published : 2022.09.30

Abstract

Purpose: This study aimed to evaluate polysomnographic and cephalometric characteristics of patients with OSA according to obesity level based on the World Health Organization (WHO) Asian-Pacific BMI criteria. Methods: One hundred and thirty-one consecutive patients with obstructive sleep apnea (OSA) were evaluated using standard level 1 polysomnography and cephalometric analyses. The subjects were categorized into normal, overweight and obese groups according to the WHO Asian-Pacific BMI criteria. Respiratory indices and cephalometric parameters were compared among groups. Results: The 131 patients consisted of 111 males and 20 females, with a mean age of 44.1±12.4 years. The mean value of BMI was 25.3±3.4 kg/m2 for all subjects, 20.6±2.2 kg/m2 for normal (n=27), 24.0±0.5 kg/m2 for overweight (n=33) and 27.6±2.2 kg/m2 for obese (n=71). The obese group had a significantly higher apnea-hypopnea index (AHI) and respiratory arousal index and lower oxygen saturation level than the normal group (p<0.05). Total AHI, mean oxygen saturation level and respiratory arousal index were significantly correlated with BMI (p<0.001). A longer soft palate and anterior position of the hyoid bone were significantly correlated with BMI level (p ≤0.05). Conclusions: Obese patients have a higher risk of compromised craniofacial skeletal features and soft tissue structures, and severe OSA than non-obese patients.

Keywords

Acknowledgement

This study was partially supported by the National Evidence-based Healthcare Collaborating Agency (grant number: NA20-012).

References

  1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006-1014. https://doi.org/10.1093/aje/kws342
  2. Kapur V, Strohl KP, Redline S, Iber C, O'Connor G, Nieto J. Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath 2002;6:49-54. https://doi.org/10.1055/s-2002-32318
  3. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA 2004;291:2013-2016. https://doi.org/10.1001/jama.291.16.2013
  4. Budhiraja R, Budhiraja P, Quan SF. Sleep-disordered breathing and cardiovascular disorders. Respir Care 2010;55:1322-1332; discussion 1330-1332.
  5. Thomasouli MA, Brady EM, Davies MJ, et al. The impact of diet and lifestyle management strategies for obstructive sleep apnoea in adults: a systematic review and meta-analysis of randomised controlled trials. Sleep Breath 2013;17:925-935. https://doi.org/10.1007/s11325-013-0806-7
  6. Gami AS, Caples SM, Somers VK. Obesity and obstructive sleep apnea. Endocrinol Metab Clin North Am 2003;32:869-894. https://doi.org/10.1016/S0889-8529(03)00069-0
  7. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015-3021. https://doi.org/10.1001/jama.284.23.3015
  8. Schwab RJ. Genetic determinants of upper airway structures that predispose to obstructive sleep apnea. Respir Physiol Neurobiol 2005;147:289-298. https://doi.org/10.1016/j.resp.2005.06.006
  9. Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A. Sleep apnea and sleep disruption in obese patients. Arch Intern Med 1994;154:1705-1711. https://doi.org/10.1001/archinte.1994.00420150073007
  10. Leong WB, Arora T, Jenkinson D, et al. The prevalence and severity of obstructive sleep apnea in severe obesity: the impact of ethnicity. J Clin Sleep Med 2013;9:853-858. https://doi.org/10.5664/jcsm.2978
  11. Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C. Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope 2000;110(10 Pt 1):1689-1693. https://doi.org/10.1097/00005537-200010000-00022
  12. World Health Organization. Obesity: preventing and managing the global epidemic: report of a WHO consultation. Geneva: World Health Organization; 2000. pp. 1-253.
  13. Liu Y, Park YC, Lowe AA, Fleetham JA. Supine cephalometric analyses of an adjustable oral appliance used in the treatment of obstructive sleep apnea. Sleep Breath 2000;4:59-66. https://doi.org/10.1007/BF03045025
  14. Aboudara C, Nielsen I, Huang JC, Maki K, Miller AJ, Hatcher D. Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2009;135:468-479. https://doi.org/10.1016/j.ajodo.2007.04.043
  15. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8:597-619. https://doi.org/10.5664/jcsm.2172
  16. Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 1992;15:376-381. https://doi.org/10.1093/sleep/15.4.376
  17. Lowe AA, Ono T, Ferguson KA, Pae EK, Ryan CF, Fleetham JA. Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 1996;110:653-664. https://doi.org/10.1016/S0889-5406(96)80043-6
  18. Kirjavainen M, Kirjavainen T. Upper airway dimensions in Class II malocclusion. Effects of headgear treatment. Angle Orthod 2007;77:1046-1053. https://doi.org/10.2319/081406-332
  19. Horner RL, Mohiaddin RH, Lowell DG, et al. Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls. Eur Respir J 1989;2:613-622. https://doi.org/10.1183/09031936.93.02070613
  20. Weaver JM. Increased anesthetic risk for patients with obesity and obstructive sleep apnea. Anesth Prog 2004;51:75.
  21. Kuvat N, Tanriverdi H, Armutcu F. The relationship between obstructive sleep apnea syndrome and obesity: a new perspective on the pathogenesis in terms of organ crosstalk. Clin Respir J 2020;14:595-604. https://doi.org/10.1111/crj.13175
  22. Javaheri S, Barbe F, Campos-Rodriguez F, et al. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol 2017;69:841-858.
  23. Barcelo A, Barbe F, Llompart E, et al. Neuropeptide Y and leptin in patients with obstructive sleep apnea syndrome: role of obesity. Am J Respir Crit Care Med 2005;171:183-187. https://doi.org/10.1164/rccm.200405-579OC
  24. Hora F, Napolis LM, Daltro C, et al. Clinical, anthropometric and upper airway anatomic characteristics of obese patients with obstructive sleep apnea syndrome. Respiration 2007;74:517-524. https://doi.org/10.1159/000097790
  25. Itasaka Y, Miyazaki S, Ishikawa K, Togawa K. The influence of sleep position and obesity on sleep apnea. Psychiatry Clin Neurosci 2000;54:340-341. https://doi.org/10.1046/j.1440-1819.2000.00705.x
  26. Lee RWW, Sutherland K, Sands SA, et al. Differences in respiratory arousal threshold in Caucasian and Chinese patients with obstructive sleep apnoea. Respirology 2017;22:1015-1021. https://doi.org/10.1111/resp.13022
  27. Chaves Junior CM, Adriano Araujo VM, Estanislau IMG, et al. A retrospective study of the influence of obesity on polysomnography and cephalometric parameters in males with obstructive sleep apnea. Cranio 2021. doi: 10.1080/08869634.2021.1977055. [Epub ahead of print]
  28. Sakakibara H, Tong M, Matsushita K, Hirata M, Konishi Y, Suetsugu S. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J 1999;13:403-410. https://doi.org/10.1183/09031936.99.13240399
  29. Yu X, Fujimoto K, Urushibata K, Matsuzawa Y, Kubo K. Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome. Chest 2003;124:212-218. https://doi.org/10.1378/chest.124.1.212
  30. Sforza E, Bacon W, Weiss T, Thibault A, Petiau C, Krieger J. Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2000;161(2 Pt 1):347-352. https://doi.org/10.1164/ajrccm.161.2.9810091
  31. Ferguson KA, Ono T, Lowe AA, Ryan CF, Fleetham JA. The relationship between obesity and craniofacial structure in obstructive sleep apnea. Chest 1995;108:375-381. https://doi.org/10.1378/chest.108.2.375
  32. Nelson S, Hans M. Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. Chest 1997;111:154-162. https://doi.org/10.1378/chest.111.1.154
  33. Verma M, Rajput M, Kishore K, Kathirvel S. Asian BMI criteria are better than WHO criteria in predicting hypertension: a cross-sectional study from rural India. J Family Med Prim Care 2019;8:2095-2100. https://doi.org/10.4103/jfmpc.jfmpc_257_19
  34. Lim JU, Lee JH, Kim JS, et al. Comparison of World Health Organization and Asia-Pacific body mass index classifications in COPD patients. Int J Chron Obstruct Pulmon Dis 2017;12:2465- 2475. https://doi.org/10.2147/COPD.S141295
  35. Woo HJ, Lim JH, Ahn JC, et al. Characteristics of obstructive sleep apnea patients with a low body mass index: emphasis on the obstruction site determined by drug-induced sleep endoscopy. Clin Exp Otorhinolaryngol 2020;13:415-421. https://doi.org/10.21053/ceo.2019.00794
  36. Dixon JB, Schachter LM, O'Brien PE. Polysomnography before and after weight loss in obese patients with severe sleep apnea. Int J Obes (Lond) 2005;29:1048-1054. https://doi.org/10.1038/sj.ijo.0802960
  37. Foster GD, Borradaile KE, Sanders MH, et al.; Sleep AHEAD Research Group of Look AHEAD Research Group. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med 2009;169:1619-1626. https://doi.org/10.1001/archinternmed.2009.266
  38. Tuomilehto H, Seppa J, Uusitupa M, Tuomilehto J, Gylling H; Kuopio Sleep Apnea Group. Weight reduction and increased physical activity to prevent the progression of obstructive sleep apnea: a 4-year observational postintervention follow-up of a randomized clinical trial. JAMA Intern Med 2013;173:929-930. Erratum in: JAMA Intern Med 2013;173:996. https://doi.org/10.1001/jamainternmed.2013.7688
  39. Kuna ST, Reboussin DM, Borradaile KE, et al.; Sleep AHEAD Research Group of the Look AHEAD Research Group. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep 2013;36:641-649A. https://doi.org/10.5665/sleep.2618