nach oben

Erschienen in:

20.07.2021 | Sleep Breathing Physiology and Disorders • Original Article

Metabolic syndrome in non-obese patients with OSA: learning points of a cross-sectional study from a tertiary care hospital in Central India

verfasst von: Poonam Chaudhary, Abhishek Goyal, Abhijit Pakhare, S. K. Goel, Ashok Kumar, Mallu Abhinav Reddy, Vangala Anoohya

Erschienen in: Sleep and Breathing | Ausgabe 2/2022

Einloggen, um Zugang zu erhalten

Abstract

Study objectives

Obesity is often considered mandatory for the diagnosis of Metabolic Syndrome (MS). Data on the prevalence of MS in non-obese patients with Obstructive Sleep Apnea (OSA) is scarce. This study was aimed to determine the prevalence of MS in non-obese patients with OSA.

Methodology

All consecutively diagnosed patients with OSA between October 2018 and November 2019 were screened for metabolic syndrome. Patients with OSA and BMI < 25 kg/m² (NOOSA) vs BMI > 25 kg/m² (obese OSA) were compared. Lean waist NOOSA was defined as BMI < 25 kg/m² and WC < 80 cm (32 in.) for women or < 90 cm (36 in.) for men.

Results

During the study period, 502 patients were diagnosed with OSA. MS was observed in 35% of patients with NOOSA compared to obese patients with OSA (79%). In the NOOSA group, hypertension, impaired fasting glucose, diabetes mellitus and dyslipidemia were observed in 65, 48, 14 and 61% respectively and all of these parameters were significantly more common in the obese group (p < 0.001). Parameters of OSA severity (apnea-hypopnea index or AHI, time spent below 90% saturated or T90, and nadir oxygen) were significantly more severe in the obese group with OSA. Approximately 83% of patients in the NOOSA group had at least two metabolic risk factors, compared to the obese OSA group, in which 95% had two or more metabolic risk factors. Sixty-four percent of patients with NOOSA with lean waist had at least two metabolic risk factors. At BMI cut-offs of < 25, < 27 and < 30 kg/m2; 35, 46 and 57% of patients with OSA respectively had metabolic syndrome.

Conclusion

Metabolic syndrome was observed in approximately one in three patients with OSA and BMI < 25 kg/m². Approximately two of every three lean waist non-obese patients with OSA had at least two markers of metabolic syndrome. The role of OSA in the development of metabolic syndrome in non-obese individuals needs further exploration.

Agrawal S, Sharma SK, Sreenivas V, Lakshmy R (2011) Prevalence of metabolic syndrome in a north Indian hospital-based population with obstructive sleep apnoea. Indian J Med Res 134:639–644. https://doi.org/10.4103/0971-5916.90988CrossRefPubMedPubMedCentral

Akahoshi T, Uematsu A, Akashiba T et al (2010) Obstructive sleep apnoea is associated with risk factors comprising the metabolic syndrome: metabolic syndrome and OSA. Respirology 15:1122–1126. https://doi.org/10.1111/j.1440-1843.2010.01818.xCrossRefPubMed

American Heart Association, National Heart, Lung, and Blood Institute, Grundy SM et al (2005) Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement Executive summary. Cardiol Rev 13:322–327CrossRef

Anchala R, Kannuri NK, Pant H et al (2014) Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens 32:1170–1177. https://doi.org/10.1097/HJH.0000000000000146CrossRefPubMedPubMedCentral

Anjana RM, Deepa M, Pradeepa R et al (2017) Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR-INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol 5:585–596. https://doi.org/10.1016/S2213-8587(17)30174-2CrossRefPubMed

Barreiro B, Garcia L, Lozano L et al (2013) Obstructive sleep apnea and metabolic syndrome in spanish population. Open Respir Med J 7:71–76. https://doi.org/10.2174/1874306401307010071CrossRefPubMedPubMedCentral

Berry RB, Budhiraja R, Gottlieb DJ et al (2012) 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 8:597–619. https://doi.org/10.5664/jcsm.2172CrossRefPubMedPubMedCentral

Bouzerda A (2018) Cardiovascular risk and obstructive sleep apnea. Pan Afr Med J 29:47. https://doi.org/10.11604/pamj.2018.29.47.11267CrossRefPubMedPubMedCentral

Choudhary B, Patil R, Bhatt GC et al (2016) Association of sleep disordered breathing with mono-symptomatic nocturnal enuresis: a study among school children of Central India. PLoS ONE 11:e0155808. https://doi.org/10.1371/journal.pone.0155808CrossRefPubMedPubMedCentral

10.

Chaudhary P, Goyal A, Goel SK et al (2021) Women with OSA have higher chances of having metabolic syndrome than men: effect of gender on syndrome Z in cross sectional study. Sleep Med 79:83–87. https://doi.org/10.1016/j.sleep.2020.12.042CrossRefPubMed

11.

Coughlin SR, Mawdsley L, Mugarza JA et al (2007) Cardiovascular and metabolic effects of CPAP in obese males with OSA. Eur Respir J 29:720–727. https://doi.org/10.1183/09031936.00043306CrossRefPubMed

12.

Geetha L, Deepa M, Anjana RM, Mohan V (2011) Prevalence and clinical profile of metabolic obesity and phenotypic obesity in Asian Indians. J Diabetes Sci Technol. https://doi.org/10.1177/193229681100500235CrossRefPubMedPubMedCentral

13.

Goyal A, Agarwal N, Pakhare A (2017) Barriers to CPAP use in India: an exploratory study. J Clin Sleep Med 13:1385–1394. https://doi.org/10.5664/jcsm.6830CrossRefPubMedPubMedCentral

14.

Goyal A, Aswin P, Pakhare AP (2018) Poor knowledge and attitude regarding Obstructive Sleep Apnea (OSA) among medical students in India: a call for MBBS curriculum change. Sleep Vigilance 2:45–50. https://doi.org/10.1007/s41782-017-0028-3CrossRef

15.

Goyal A, Pakhare AP, Bhatt GC et al (2018) Association of pediatric obstructive sleep apnea with poor academic performance: a school-based study from India. Lung India 35:132–136. https://doi.org/10.4103/lungindia.lungindia_218_17CrossRefPubMedPubMedCentral

16.

Goyal A, Pakhare A, Chaudhary P (2019) Nocturic obstructive sleep apnea as a clinical phenotype of severe disease. Lung India 36:20–27. https://doi.org/10.4103/lungindia.lungindia_153_18CrossRefPubMedPubMedCentral

17.

Goyal A, Pakhare A, Tiwari IR et al (2020) Diagnosing obstructive sleep apnea patients with isolated nocturnal hypoventilation and defining obesity hypoventilation syndrome using new European Respiratory Society classification criteria: an Indian perspective. Sleep Med 66:85–91. https://doi.org/10.1016/j.sleep.2019.08.009CrossRefPubMed

18.

Gray EL, McKenzie DK, Eckert DJ (2017) Obstructive sleep apnea without obesity is common and difficult to treat: evidence for a distinct pathophysiological phenotype. J Clin Sleep Med 13:81–88. https://doi.org/10.5664/jcsm.6394CrossRefPubMedPubMedCentral

19.

Hadaegh F, Zabetian A, Harati H, Azizi F (2007) Metabolic syndrome in normal-weight Iranian adults. Ann Saudi Med 27:18–24. https://doi.org/10.5144/0256-4947.2007.18CrossRefPubMedPubMedCentral

20.

Heinzer R, Vat S, Marques-Vidal P et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310. https://doi.org/10.1016/S2213-2600(15)00043-0CrossRefPubMedPubMedCentral

21.

Hirotsu C, Haba-Rubio J, Togeiro SM et al (2018) Obstructive sleep apnoea as a risk factor for incident metabolic syndrome: a joined Episono and HypnoLaus prospective cohorts study. Eur Respir J. https://doi.org/10.1183/13993003.01150-2018CrossRefPubMed

22.

Howard WJ (2006) Diagnosis and management of the metabolic syndrome: an American heart association/national heart, lung, and blood institute scientific statement. Yearb Endocrinol 2006:113–114. https://doi.org/10.1016/S0084-3741(08)70316-0CrossRef

23.

Huang PL (2009) A comprehensive definition for metabolic syndrome. Dis Model Mech 2:231–237. https://doi.org/10.1242/dmm.001180CrossRefPubMedPubMedCentral

24.

Kar A, Saxena K, Goyal A et al (2020) Association of Obstructive Sleep Apnea and severity of COVID-19: a hospital based observational study. medRxiv:2020.11.12.20230631. https://doi.org/10.1101/2020.11.12.20230631

25.

Kono M, Tatsumi K, Saibara T et al (2007) Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome. Chest 131:1387–1392. https://doi.org/10.1378/chest.06-1807CrossRefPubMed

26.

Kritikou I, Basta M, Tappouni R et al (2013) Sleep apnoea and visceral adiposity in middle-aged male and female subjects. Eur Respir J 41:601–609. https://doi.org/10.1183/09031936.00183411CrossRefPubMed

27.

Kushida CA, Chediak A, Berry RB et al (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4(2):157–171CrossRefPubMed

28.

Lee K (2009) Metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) phenotypes in Koreans: characteristics and health behaviors. Asia Pac J Clin Nutr 18:280–284PubMed

29.

Leong WB, Arora T, Jenkinson D et al (2013) The prevalence and severity of obstructive sleep apnea in severe obesity: the impact of ethnicity. J Clin Sleep Med 9:853–858. https://doi.org/10.5664/jcsm.2978CrossRefPubMedPubMedCentral

30.

Lin Q-C, Zhang X-B, Chen G-P et al (2012) Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome in nonobese adults. Sleep Breath 16:571–578. https://doi.org/10.1007/s11325-011-0544-7CrossRefPubMed

31.

Malik JA, Masoodi SR, Shoib S (2017) Obstructive sleep apnea in Type 2 diabetes and impact of continuous positive airway pressure therapy on glycemic control. Indian J Endocrinol Metab 21:106–112. https://doi.org/10.4103/2230-8210.196005CrossRefPubMedPubMedCentral

32.

Meigs JB, Wilson PWF, Fox CS et al (2006) Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab 91:2906–2912. https://doi.org/10.1210/jc.2006-0594CrossRefPubMed

33.

Misra A, Khurana L (2011) Obesity-related non-communicable diseases: South Asians vs White Caucasians. Int J Obes 35:167–187. https://doi.org/10.1038/ijo.2010.135CrossRef

34.

Mukhopadhyay P, Ghosh S, Bhattacharjee K et al (2018) Lean metabolic syndrome: a concept or a reality? Indian J Endocrinol Metab 22:303. https://doi.org/10.4103/ijem.IJEM_639_17CrossRefPubMedPubMedCentral

35.

Park Y-W, Zhu S, Palaniappan L et al (2003) The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 163:427–436. https://doi.org/10.1001/archinte.163.4.427CrossRefPubMedPubMedCentral

36.

Pe P, Young T, Palta M et al (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. https://doi.org/10.1001/jama.284.23.3015CrossRef

37.

Peppard PE, Young T, Barnet JH et al (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014. https://doi.org/10.1093/aje/kws342CrossRefPubMedPubMedCentral

38.

Prasad K, Sehgal I, Agarwal R et al (2017) Assessing the likelihood of obstructive sleep apnea: a comparison of nine screening questionnaires. Sleep And Breathing. https://doi.org/10.1007/s11325-017-1495-4CrossRefPubMed

39.

R Core Team (2019) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

40.

Saxena K, Kar A, Goyal A (2020) COVID 19 and OSA: exploring multiple cross-ways. Sleep Med. https://doi.org/10.1016/j.sleep.2020.11.013CrossRefPubMedPubMedCentral

41.

Sharma SK, Reddy EV, Sharma A et al (2010) Prevalence and risk factors of syndrome Z in urban Indians. Sleep Med 11:562–568. https://doi.org/10.1016/j.sleep.2010.02.008CrossRefPubMed

42.

Sjoberg DD, Curry M, Hannum M et al (2020) gtsummary: presentation-ready data summary and analytic result tables. https://github.com/ddsjoberg/gtsummary

43.

Wickham H (2016) ggplot2: Elegant graphics for data analysis. Springer-Verlag, New York. https://ggplot2.tidyverse.org

44.

Zito A, Steiropoulos P, Barceló A et al (2011) Obstructive sleep apnoea and metabolic syndrome in Mediterranean countries. Eur Respir J 37:717–719. https://doi.org/10.1183/09031936.00120510CrossRefPubMed

Titel: Metabolic syndrome in non-obese patients with OSA: learning points of a cross-sectional study from a tertiary care hospital in Central India
verfasst von: Poonam Chaudhary
Abhishek Goyal
Abhijit Pakhare
S. K. Goel
Ashok Kumar
Mallu Abhinav Reddy
Vangala Anoohya
Publikationsdatum: 20.07.2021
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 2/2022
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02401-4

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Metabolic syndrome in non-obese patients with OSA: learning points of a cross-sectional study from a tertiary care hospital in Central India