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Published in: Obesity Surgery 5/2021

Open Access 01-05-2021 | Sleep Apnea | Original Contributions

Obstructive Sleep Apnea in Obese Patients: a UK Population Analysis

Authors: S. Erridge, O. Moussa, C. McIntyre, A. Hariri, N. Tolley, B. Kotecha, S. Purkayastha

Published in: Obesity Surgery | Issue 5/2021

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Abstract

Background

Obstructive sleep apnea (OSA) is an increasingly common disorder associated with increased cardiovascular disease, mortality, reduced productivity, and an increased risk of road traffic accidents. A significant proportion of patients with OSA in the UK are undiagnosed. This study aims to identify risk factors for OSA in an obese cohort.

Method

A population-based study was conducted of obese patients (BMI ≥ 30 kg/m2) from the Clinical Practice Research Datalink (CPRD). A logistic regression model was used to calculate odds ratios (ORs) for developing OSA according to other clinicopathological characteristics. Multivariate analysis was conducted of individual factors that affect the propensity to develop OSA. Statistical significance was defined as p < 0.050.

Results

From 276,600 obese patients identified during a data extraction of the CPRD in July 2017, the prevalence of OSA was 5.4%. The following risk factors were found to be independently associated with increased likelihood of OSA: male sex (OR = 3.273; p < 0.001), BMI class II (OR = 1.640; p < 0.001), BMI class III (OR = 3.768; p < 0.001), smoking (OR = 1.179; p < 0.001), COPD (OR = 1.722; p < 0.001), GERD (OR = 1.557; p < 0.001), hypothyroidism (OR = 1.311; p < 0.001), acromegaly (OR = 3.543; p < 0.001), and benzodiazepine use (OR = 1.492; p < 0.001). Bariatric surgery was associated with reduced risk of OSA amongst this obese population (OR = 0.260; p < 0.001).

Conclusions

In obese patients, there are numerous comorbidities that are associated with increased likelihood of OSA. These factors can help prompt clinicians to identify undiagnosed OSA. Bariatric surgery appears to be protective against developing OSA.
Literature
1.
go back to reference Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.CrossRef Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.CrossRef
2.
go back to reference Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. Journal of thoracic disease. 2015;7(8):1311–22.PubMedPubMedCentral Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. Journal of thoracic disease. 2015;7(8):1311–22.PubMedPubMedCentral
3.
go back to reference Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2010;57(5):423–38.CrossRef Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2010;57(5):423–38.CrossRef
4.
go back to reference Osman AM, Carter SG, Carberry JC, et al. Obstructive sleep apnea: current perspectives. Nat Sci Sleep. 2018:1021–34. Osman AM, Carter SG, Carberry JC, et al. Obstructive sleep apnea: current perspectives. Nat Sci Sleep. 2018:1021–34.
5.
go back to reference Young T, Evans L, Finn L, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705–6.CrossRef Young T, Evans L, Finn L, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705–6.CrossRef
6.
go back to reference Kapur V, Strohl KP, Redline S, et al. Underdiagnosis of sleep apnea syndrome in US communities. Sleep Breath. 2002;6(02):049–54.CrossRef Kapur V, Strohl KP, Redline S, et al. Underdiagnosis of sleep apnea syndrome in US communities. Sleep Breath. 2002;6(02):049–54.CrossRef
7.
go back to reference Romero-Corral A, Caples SM, Lopez-Jimenez F, et al. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711–9.CrossRef Romero-Corral A, Caples SM, Lopez-Jimenez F, et al. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711–9.CrossRef
8.
go back to reference Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. Jama. 2004;291(16):2013–6.CrossRef Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. Jama. 2004;291(16):2013–6.CrossRef
9.
go back to reference Cori JM, O’Donoghue FJ, Jordan AS. Sleeping tongue: current perspectives of genioglossus control in healthy individuals and patients with obstructive sleep apnea. Nat Sci Sleep. 2018:10169–79. Cori JM, O’Donoghue FJ, Jordan AS. Sleeping tongue: current perspectives of genioglossus control in healthy individuals and patients with obstructive sleep apnea. Nat Sci Sleep. 2018:10169–79.
10.
go back to reference Moyer CA, Sonnad SS, Garetz SL, et al. Quality of life in obstructive sleep apnea: a systematic review of the literature. Sleep Med. 2001;2(6):477–91.CrossRef Moyer CA, Sonnad SS, Garetz SL, et al. Quality of life in obstructive sleep apnea: a systematic review of the literature. Sleep Med. 2001;2(6):477–91.CrossRef
11.
go back to reference Marin JM, Soriano JB, Carrizo SJ, et al. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Am J Respir Crit Care Med. 2010;182(3):325–31.CrossRef Marin JM, Soriano JB, Carrizo SJ, et al. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Am J Respir Crit Care Med. 2010;182(3):325–31.CrossRef
12.
go back to reference Laratta CR, Ayas NT, Povitz M, et al. Diagnosis and treatment of obstructive sleep apnea in adults. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. 2017;189(48):E1481–8.CrossRef Laratta CR, Ayas NT, Povitz M, et al. Diagnosis and treatment of obstructive sleep apnea in adults. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. 2017;189(48):E1481–8.CrossRef
13.
go back to reference Turkington PM, Sircar M, Allgar V, et al. Relationship between obstructive sleep apnoea, driving simulator performance, and risk of road traffic accidents. Thorax. 2001;56(10):800–5.CrossRef Turkington PM, Sircar M, Allgar V, et al. Relationship between obstructive sleep apnoea, driving simulator performance, and risk of road traffic accidents. Thorax. 2001;56(10):800–5.CrossRef
14.
go back to reference Marshall NS, Wong KK, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31(8):1079–85.PubMedPubMedCentral Marshall NS, Wong KK, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31(8):1079–85.PubMedPubMedCentral
15.
go back to reference Ashrafian H, le Roux CW, Rowland SP, et al. Metabolic surgery and obstructive sleep apnoea: the protective effects of bariatric procedures. Thorax. 2012 May 1;67(5):442–9.CrossRef Ashrafian H, le Roux CW, Rowland SP, et al. Metabolic surgery and obstructive sleep apnoea: the protective effects of bariatric procedures. Thorax. 2012 May 1;67(5):442–9.CrossRef
16.
go back to reference Wong AM, Barnes HN, Joosten SA, et al. The effect of surgical weight loss on obstructive sleep apnoea: a systematic review and meta-analysis. Sleep Med Rev. 2018 Dec 1;42:85–99.CrossRef Wong AM, Barnes HN, Joosten SA, et al. The effect of surgical weight loss on obstructive sleep apnoea: a systematic review and meta-analysis. Sleep Med Rev. 2018 Dec 1;42:85–99.CrossRef
17.
go back to reference McGuigan RD, Wilkinson JM. Obesity and healthcare avoidance: a systematic review. AIMS Public Health. 2015;2(1):56–63.CrossRef McGuigan RD, Wilkinson JM. Obesity and healthcare avoidance: a systematic review. AIMS Public Health. 2015;2(1):56–63.CrossRef
18.
go back to reference Campbell J, Dedman D, Eaton S, et al. Is the CPRD GOLD population comparable to the UK population? Pharmacoepidemiol Drug Saf. 2013:22280–1. Campbell J, Dedman D, Eaton S, et al. Is the CPRD GOLD population comparable to the UK population? Pharmacoepidemiol Drug Saf. 2013:22280–1.
19.
go back to reference Nuttall FQ. Body mass index: obesity, BMI, and health: a critical review. Nutr Today. 2015;50(3):117–28.CrossRef Nuttall FQ. Body mass index: obesity, BMI, and health: a critical review. Nutr Today. 2015;50(3):117–28.CrossRef
20.
go back to reference Nagappa et al. Validation of the STOP-Bang Questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PLoS One. 2015;10(12):e0143697.CrossRef Nagappa et al. Validation of the STOP-Bang Questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PLoS One. 2015;10(12):e0143697.CrossRef
21.
go back to reference Oksenberg A, Arons E, Froom P. Does the severity of obstructive sleep apnea predict patients requiring high continuous positive airway pressure? Laryngoscope. 2006;116(6):951–5.CrossRef Oksenberg A, Arons E, Froom P. Does the severity of obstructive sleep apnea predict patients requiring high continuous positive airway pressure? Laryngoscope. 2006;116(6):951–5.CrossRef
22.
go back to reference Bearpark H, Elliott L, Grunstein R, et al. Snoring and sleep apnea. A population study in Australian men. Am J Respir Crit Care Med. 1995;151(5):1459–65.CrossRef Bearpark H, Elliott L, Grunstein R, et al. Snoring and sleep apnea. A population study in Australian men. Am J Respir Crit Care Med. 1995;151(5):1459–65.CrossRef
23.
go back to reference Kim J, In K, Kim J, et al. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med. 2004;170(10):1108–13.CrossRef Kim J, In K, Kim J, et al. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med. 2004;170(10):1108–13.CrossRef
24.
go back to reference Udwadia ZF, Doshi AV, Lonkar SG, et al. Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men. Am J Respir Crit Care Med. 2004;169(2):168–73.CrossRef Udwadia ZF, Doshi AV, Lonkar SG, et al. Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men. Am J Respir Crit Care Med. 2004;169(2):168–73.CrossRef
25.
go back to reference Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol. 2005;99(4):1592–9.CrossRef Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol. 2005;99(4):1592–9.CrossRef
26.
go back to reference Newman AB, Foster G, Givelber R, et al. Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med. 2005;165(20):2408–13.CrossRef Newman AB, Foster G, Givelber R, et al. Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med. 2005;165(20):2408–13.CrossRef
27.
go back to reference Peppard PE, Young T, Palta M, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. Jama. 2000;284(23):3015–21.CrossRef Peppard PE, Young T, Palta M, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. Jama. 2000;284(23):3015–21.CrossRef
28.
go back to reference Tishler PV, Larkin EK, Schluchter MD, et al. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. Jama. 2003;289(17):2230–7.CrossRef Tishler PV, Larkin EK, Schluchter MD, et al. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. Jama. 2003;289(17):2230–7.CrossRef
29.
go back to reference Sarkhosh K, Switzer NJ, El-Hadi M, et al. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg. 2013;23(3):414–23.CrossRef Sarkhosh K, Switzer NJ, El-Hadi M, et al. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg. 2013;23(3):414–23.CrossRef
30.
go back to reference Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. Jama. 2004;292(14):1724–37.CrossRef Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. Jama. 2004;292(14):1724–37.CrossRef
32.
go back to reference Shepertycky MR, Banno K, Kryger MH. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep. 2005;28(3):309–14.PubMed Shepertycky MR, Banno K, Kryger MH. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep. 2005;28(3):309–14.PubMed
33.
go back to reference Breugelmans JG, Ford DE, Smith PL, et al. Differences in patient and bed partner–assessed quality of life in sleep-disordered breathing. Am J Respir Crit Care Med. 2004;170(5):547–52.CrossRef Breugelmans JG, Ford DE, Smith PL, et al. Differences in patient and bed partner–assessed quality of life in sleep-disordered breathing. Am J Respir Crit Care Med. 2004;170(5):547–52.CrossRef
34.
go back to reference Bixler EO, Vgontzas AN, Lin H, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3):608–13.CrossRef Bixler EO, Vgontzas AN, Lin H, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3):608–13.CrossRef
35.
go back to reference Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ (Clinical research ed). 2000;320(7233):479–82.CrossRef Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ (Clinical research ed). 2000;320(7233):479–82.CrossRef
36.
go back to reference Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136–43.CrossRef Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136–43.CrossRef
37.
go back to reference Colao A, Grasso LF, Giustina A, et al. Acromegaly. Nature Reviews Disease Primers. 2019;5(1):20.CrossRef Colao A, Grasso LF, Giustina A, et al. Acromegaly. Nature Reviews Disease Primers. 2019;5(1):20.CrossRef
38.
go back to reference Herrett E, Gallagher AM, Bhaskaran K, et al. Data resource profile: clinical practice research datalink (CPRD). Int J Epidemiol. 2015;44(3):827–36.CrossRef Herrett E, Gallagher AM, Bhaskaran K, et al. Data resource profile: clinical practice research datalink (CPRD). Int J Epidemiol. 2015;44(3):827–36.CrossRef
39.
go back to reference Moussa OM, Erridge S, Chidambaram S, et al. Mortality of the severely obese: a population study. Ann Surg. 2018; Moussa OM, Erridge S, Chidambaram S, et al. Mortality of the severely obese: a population study. Ann Surg. 2018;
Metadata
Title
Obstructive Sleep Apnea in Obese Patients: a UK Population Analysis
Authors
S. Erridge
O. Moussa
C. McIntyre
A. Hariri
N. Tolley
B. Kotecha
S. Purkayastha
Publication date
01-05-2021
Publisher
Springer US
Published in
Obesity Surgery / Issue 5/2021
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-020-05196-7

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