The association of body mass index values with severity and phenotype of sleep-disordered breathing

OBJECTIVE: The purpose of this study was to identify prognostic indicators that would lead to stratification of patients likely to have successful surgery for sleep-disordered breathing (SDB) versus those destined to fail. STUDY DESIGN: We retrospectively reviewed 134 patients to correlate palate position and tonsil size to the success of the UPPP as based on postoperative polysomnography results. Similar to our previously published data on the Friedman Score as a predictor of the presence and severity of SDB, the palate position was determined on physical examination of the oral cavity and was graded for each patient. This grade combined with tonsil size was used to stage the patients. Stage I was defined as having palate position 1 or 2 combined with tonsil size 3 or 4. Stage II was defined as having palate position 3 or 4 and tonsil size 3 or 4. Stage III patients had palate position 3 or 4 and tonsil size 0, 1, or 2. Any patient with body mass index of greater than 40 was placed in the stage III group. The results of uvulopalatopharyngoplasty (UPPP) were then graded as success or failure and success rates were compared by stage. SETTING: Academically affiliated tertiary care referral center. RESULTS: Stage I patients who underwent UPPP had a success rate of 80.6%, stage II patients had a success rate of 37.9%, and stage III patients had a success rate of 8.1%. CONCLUSION: A clinical staging system for SDB based on palate position, tonsil size, and body mass index is presented. It appears to be a valuable predictor of the success of UPPP. Additional studies and wider use of the staging system will ultimately define its role in the treatment of SDB.

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Excess weight and sleep-disordered breathing

Journal of Applied Physiology ◽

10.1152/japplphysiol.00587.2005 ◽

2005 ◽

Vol 99 (4) ◽

pp. 1592-1599 ◽

Cited By ~ 393

Author(s):

Terry Young ◽

Paul E. Peppard ◽

Shahrad Taheri

Keyword(s):

United States ◽

Body Mass Index ◽

Body Mass ◽

Sleep Disordered Breathing ◽

Population Studies ◽

Strong Support ◽

The United States ◽

Excess Weight ◽

Apnea Hypopnea Index ◽

Disordered Breathing

Excess weight is a well-established predictor of sleep-disordered breathing (SDB). Clinical observations and population studies throughout the United States, Europe, Asia, and Australia have consistently shown a graded increase in the prevalence of SDB as body mass index, neck girth, or other measures of body habitus increases. Clinical studies of weight loss and longitudinal population studies provide strong support for a causal association. The role of excess body weight, a modifiable risk factor, with SDB raises many questions relevant to clinical practice and public health. The topic takes on added importance with the alarming rate of weight gain in children as well as adults in industrialized nations. Among adults ages 30–69 yr, averaging over the estimated United States 2003 age, sex, and BMI distributions, we estimate that ∼17% of adults have mild or worse SDB (apnea-hypopnea index ≥ 5) and that 41% of those adults have SDB “attributable” to having a body mass index of ≥25 kg/m2. Similarly, we estimate that ∼5.7% of adults have moderate or worse SDB (apnea-hypopnea index ≥ 15) and that 58% of those adults have SDB attributable to excess weight. Clearly, if the expanding epidemic of obesity seen in the United States continues, the prevalence of SDB will almost certainly increase, along with the proportion of SDB attributable to obesity.

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Association of childhood high body mass index and sleep disordered breathing with perioperative laryngospasm

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2013.10.004 ◽

2013 ◽

Vol 77 (12) ◽

pp. 2044-2048 ◽

Cited By ~ 9

Author(s):

Olubukola O. Nafiu ◽

Yosha Prasad ◽

Wilson T. Chimbira

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Sleep Disordered Breathing ◽

High Body Mass Index ◽

High Body ◽

Disordered Breathing

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Relationships of Craniofacial Morphology and Body Mass Index with Sleep-Disordered Breathing in Japanese Men

The Laryngoscope ◽

10.1097/00005537-200410000-00030 ◽

2004 ◽

Vol 114 (10) ◽

pp. 1838-1842 ◽

Cited By ~ 10

Author(s):

Masayuki Yao ◽

Naoko Tachibana ◽

Mutsumi Okura ◽

Takeshi Tanigawa ◽

Kazumasa Yamagishi ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Sleep Disordered Breathing ◽

Craniofacial Morphology ◽

Japanese Men ◽

Disordered Breathing

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0849 Association Of Sleep Disturbance With Neck Circumference, Body Mass Index & Blood Pressure In Pregnant Japanese Women

SLEEP ◽

10.1093/sleep/zsaa056.845 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A323-A323

Author(s):

A Morioka ◽

y Asaka

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Sleep Disturbance ◽

Pregnant Women ◽

Body Mass ◽

Sleep Disordered Breathing ◽

Japanese Women ◽

Neck Circumference ◽

Physical Factors ◽

Disordered Breathing

Abstract Introduction Snoring is one of the symptoms of sleep-disordered breathing. Sleep-disordered breathing is associated with blood pressure in pregnant women. However, studies reporting this association have been conducted overseas, and there is a lack of research in the Japanese context, where women have different lifestyles and physical attributes. The aim of this study is to clarify the association of sleep disturbance with physical factors in pregnant Japanese women. Methods A cross-sectional study was conducted with 80 pregnant Japanese women. The assessments for statistical analysis included the Japanese versions of the Pittsburgh Sleep Quality Index (J-PSQI) and Epworth Sleepiness Scale (JESS), as well as snoring frequency, blood pressure, and body mass index (BMI) before and during pregnancy. Results Participants’ average gestational age was 26.23±7.56 weeks, and the J-PSQI and JESS scores were 5.5±2.6 and 9.7±4.2, respectively. The average neck circumference was 33.4±2.6cm, and BMI before and during pregnancy was 21.0±2.9cm and 23.1±3.1cm, respectively. Among the participants, 42.5% displayed habitual snoring. These women had significantly higher BMI and weight before and during pregnancy than those who did not snore habitually. Participants with lower diastolic blood pressure and pre-pregnancy weight had significantly higher JESS scores. Participants with thick necks (neck circumference≥33.4cm) had significantly higher BMI and weight before and during pregnancy, as well as lower J-PSQI scores, than those with thin necks. Conclusion In pregnant Japanese women, neck circumference and BMI before and during pregnancy were lower than among pregnant women from other countries. However, Japanese women displayed a greater tendency toward snoring during pregnancy compared to women from other countries. Snoring was associated with obesity before and during pregnancy. However, the results suggest that thinness of physique prior to pregnancy is a risk factor for sleep disturbance during pregnancy. Support

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Relationship between body mass index, preeclampsia, and sleep disordered breathing

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2004.10.020 ◽

2004 ◽

Vol 191 (6) ◽

pp. S42

Author(s):

Jamison Morgan ◽

Sig-Linda Jacobson ◽

Robert Sack ◽

George Saade

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Sleep Disordered Breathing ◽

Disordered Breathing

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Cardiovascular and somatic comorbidities and sleep measures using three hypopnea criteria in mild obstructive sleep-disordered breathing: sex, age, and body mass index differences in a retrospective sleep clinic cohort

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.8644 ◽

2020 ◽

Vol 16 (10) ◽

pp. 1683-1691

Author(s):

Karin Gardner Johnson ◽

Douglas Clark Johnson ◽

Robert Joseph Thomas ◽

Vida Rastegar ◽

Paul Visintainer

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Sleep Disordered Breathing ◽

Obstructive Sleep ◽

Somatic Comorbidities ◽

Obstructive Sleep Disordered Breathing ◽

Disordered Breathing

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The Association of Testosterone Levels with Overall Sleep Quality, Sleep Architecture, and Sleep-Disordered Breathing

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-2622 ◽

2008 ◽

Vol 93 (7) ◽

pp. 2602-2609 ◽

Cited By ~ 78

Author(s):

Elizabeth Barrett-Connor ◽

Thuy-Tien Dam ◽

Katie Stone ◽

Stephanie Litwack Harrison ◽

Susan Redline ◽

...

Keyword(s):

Body Mass Index ◽

Sleep Apnea ◽

Body Mass ◽

Sleep Disordered Breathing ◽

Older Men ◽

Sleep Efficiency ◽

Total Testosterone ◽

Testosterone Levels ◽

Low Testosterone ◽

Disordered Breathing

Abstract Context: Little is known about the association of low endogenous testosterone levels and abnormal sleep patterns in older men, although pharmacological doses of testosterone are associated with increased severity of sleep apnea and other sleep disturbances. Objective: The objective of the study was to examine the association between serum testosterone levels with objectively measured sleep characteristics. Design: This was a cohort study. Setting: Community-dwelling men aged 65 yr or older from six clinical centers in the United States participated in the study. Participants and Main Outcome Measures: A total of 1312 men had baseline total testosterone levels measured in 2000–2002, followed 3.4 yr later by 72-h (minimum) actigraphy and one-night in-home polysomnography to assess sleep duration, sleep fragmentation, and sleep apnea. Analyses were performed by quartile of total testosterone and categorically defined low vs. higher total testosterone (<250 ng/dl vs. ≥250 ng/dl). Lifestyle and body size were covariates. Results: Total testosterone levels were unrelated to age or duration of sleep. Men with lower testosterone levels had lower sleep efficiency, with increased nocturnal awakenings and less time in slow-wave sleep as well as a higher apnea-hypopnea index and more sleep time with O2 saturation levels below 90%. Low testosterone levels were associated with overweight, and all significant associations were attenuated or absent after adjusting for body mass index or waist circumference. In a post hoc analysis in men with higher body mass index (>27 kg/m2), testosterone was significantly associated with more periods awake after sleep onset and lower sleep efficiency. Conclusion: Low total testosterone levels are associated with less healthy sleep in older men. This association is largely explained by adiposity. Clinical trials are necessary to determine whether body weight acts directly or indirectly (via low testosterone) in the causal pathway for sleep-disordered breathing in older men.

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Nocturnal hypoxia in patients with idiopathic pulmonary arterial hypertension

Pulmonary Circulation ◽

10.1177/2045894019885364 ◽

2020 ◽

Vol 10 (3) ◽

pp. 204589401988536

Author(s):

Lu Yan ◽

Qin Luo ◽

Zhihui Zhao ◽

Qing Zhao ◽

Qi Jin ◽

...

Keyword(s):

Body Mass Index ◽

Logistic Regression ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Oxygen Saturation ◽

Body Mass ◽

Sleep Disordered Breathing ◽

Idiopathic Pulmonary Arterial Hypertension ◽

Pulmonary Arterial ◽

Disordered Breathing

Background Sleep-disordered breathing causes a variety of cardiovascular complications and increases the risk of a poor prognosis in patients. There is still some controversy regarding the clinical diagnosis and treatment of sleep-disordered breathing in patients with pulmonary hypertension. The aim of this study was to determine the incidence of desaturation in idiopathic pulmonary arterial hypertension (IPAH) patients, evaluate the effect of desaturation on the clinical status of patients with IPAH, and identify possible influencing factors. Methods Patients with IPAH diagnosed by right heart catheterization who underwent overnight cardiorespiratory monitoring from January 2018 to July 2019 were enrolled. Nocturnal hypoxic time was defined as the time that oxygen saturation remained below 90%. Desaturation was defined as a nocturnal oxygen saturation level less than 90% for more than 10% of the total recording time. Baseline clinical characteristics and parameters were collected to compare IPAH patients with and without desaturation. In addition, logistic regression was performed to identify possible factors associated with desaturation in IPAH patients. Results Fifty patients with IPAH were included. Among them, 17 patients presented desaturation. Patients with desaturation were older, had a shorter six-min walking distance (6MWD), had a higher mean right atrial pressure, and had a lower daytime arterial oxygen partial pressure than patients without desaturation, and there were significant differences in the VE/VCO2 and VE/VCO2 slope ( P < 0.05). The multivariate logistic regression analysis indicated that the 6 MWD (OR = 0.971, 95% CI: 0.948–0.994, P = 0.013) and; VE/VCO2 slope (OR = 1.095, 95% CI: 1.010–1.307, P = 0.032) were independently associated with desaturation after adjusting for age, sex, and body mass index. Conclusion Nocturnal hypoxia is common in IPAH patients. Desaturation may aggravate the clinical situation of patients with IPAH. In IPAH patients, a poor exercise capacity (6 MWD) and the VE/VCO2 slope can predict desaturation after adjusting for age, sex, and body mass index.

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