The Role of the Metabolic Syndrome Criterias to Determine Moderate to Severe Sleep Apnea Patients

Merve Yumrukuz Şenel; Melike Bağnu Yüceege; Hikmet Fırat

doi:10.4274/jtsm.galenos.2020.74946

ABSTRACT

Objective:

Obstructive Sleep Apnea syndrome (OSAS) frequently seen in the adult population is an important public health problem. OSAS is related to increased cardiovascular morbidity and mortality. In studies, the relationship between OSAS, cardiovascular risk factors, and metabolic syndrome components is determined. This study aimed to evaluate the use of metabolic syndrome criteria to support prediagnosis of patients with sleep apnea who were admitted to sleep clinics.

Materials and Methods:

This study involved 247 patients (148 men, 99 women) admitted to our sleep clinic with prediagnosis of sleep apnea. The patients’ demographic features and evaluated National Cholesterol Education Program Adult Treatment Panel metabolic syndrome components were recorded.

Results:

After analysis of the relationship between Apne-hipopne index (AHI) and NCEP criteria separately, AHI was higher and more severe in men with waist circumference >102 cm (p=0.0001, kadınlarda x²=9.03, p=0.003 in women; x²=15.01, p<0.0001 in men respectively). No statistically significant relationship was found between dyslipidemia and AHI (p>0.05). Although AHI was significantly higher in hypertensive and hyperglycemic men (p=0.004 and p=0.002, respectively), no significant relationship was found in women for both groups (p>0.05). A statistically significant association was found between metabolic syndrome and sleep apnea (x²=5.82, p=0.016 in women; x²=8.017, p=0.005 in men).

Conclusion:

Our study showed that OSAS and metabolic syndrome components are clustered in patients. Patients diagnosed with OSAS must be followed closely. Besides, population with risk factors can be determined with simple anthropometric measurements and blood tests in primary health care centers and can be prioritized in sleep clinics.

Keywords:

Metabolic syndrome, Obstructive Sleep Apnea syndrome, Sleep apnea

References

Huang PL. A comprehensive definition for metabolic syndrome. Disease models & mechanisms. 2009;2:231-7.

Neeland IJ, Poirier P, Despres JP. Cardiovascular and Metabolic Heterogeneity of Obesity: Clinical Challenges and Implications for Management. Circulation 2018;137:1391-406.

Levy P, Kohler M, McNicholas WT, Barbe F, McEvoy RD, Somers VK, Lavie L, Pépin JL. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers 2015;1:15015.

White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med 2005;172:1363-70.

Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest 2007;132:325-37.

Wang F, Xiong X, Xu H, Huang H, Shi Y, Li X, Qian Y, Zou J, Yi H, Guan J, Yin S. The association between obstructive sleep apnea syndrome and metabolic syndrome: a confirmatory factor analysis. Sleep Breath 2019;23:1011-9.

Rodenstein D. Sleep apnea: traffic and occupational accidents--individual risks, socioeconomic and legal implications. Respiration 2009;78:241-8.

Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015;3:310-8.

Gabbay IE, Lavie P. Age- and gender-related characteristics of obstructive sleep apnea. Sleep Breathing 2012;16:453-60.

Heady JA, Morris JN, Raffle PA. Physique of London busmen; epidemiology of uniforms. Lancet 1956;271:569-70.

Despres JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature 2006;444:881-7.

Borel AL, Coumes S, Reche F, Ruckly S, Pepin JL, Tamisier R, Wion N, Arvieux C. Waist, neck circumferences, waist-to-hip ratio: Which is the best cardiometabolic risk marker in women with severe obesity? The SOON cohort. PloS One 2018;13:e0206617.

Li M, Li X, Lu Y. Obstructive Sleep Apnea Syndrome and Metabolic Diseases. Endocrinology 2018;159:2670-5.

Bozkurt NC, Beysel S, Karbek B, Unsal IO, Cakir E, Delibasi T. Visceral Obesity Mediates the Association Between Metabolic Syndrome and Obstructive Sleep Apnea Syndrome. Metabolic syndrome and related disorders 2016;14:217-21.

Sharma SK, Kumpawat S, Goel A, Banga A, Ramakrishnan L, Chaturvedi P. Obesity, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleep-disordered breathing. Sleep Medicine 2007;8:12-7.

Newman AB, Nieto FJ, Guidry U, Lind BK, Redline S, Pickering TG, Quan SF, Sleep Heart Health Study Research Group. Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol 2001;154:50-9.

Roche F, Sforza E, Pichot V, Maudoux D, Garcin A, Celle S, Picard-Kossovsky M, Gaspoz JM, Barthélémy JC, PROOF Study Group. Obstructive sleep apnoea/hypopnea influences high-density lipoprotein cholesterol in the elderly. Sleep Med 2009;10:882-6.

Xu H, Guan J, Yi H, Zou J, Meng L, Tang X, Zhu H, Yu D, Zhou H, Su K, Wang Y, Wang J, Yin S, The Shanghai Sleep Health Study Research Group. Elevated low-density lipoprotein cholesterol is independently associated with obstructive sleep apnea: evidence from a large-scale cross-sectional study. Sleep Breathing 2016;20:627-34.

de Lima FF, Mazzotti DR, Tufik S, Bittencourt L. The role inflammatory response genes in obstructive sleep apnea syndrome: a review. Sleep Breathing 2016;20:331-8.

Lévy P, Pépin JL, Arnaud C, Tamisier R, Borel JC, Dematteis M, Godin-Ribuot D, Ribuot C. Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives. Eur Respir J 2008;32:1082-95.

Liu A, Cardell J, Ariel D, Lamendola C, Abbasi F, Kim SH, Holmes TH, Tomasso V, Mojaddidi H, Grove K, Kushida CA, Reaven GM. Abnormalities of lipoprotein concentrations in obstructive sleep apnea are related to insulin resistance. Sleep 2015;38:793-9.

Mauvais-Jarvis F. Gender differences in glucose homeostasis and diabetes. Physiology behavior 2018;187:20-3.

Mazzuca E, Battaglia S, Marrone O, Marotta AM, Castrogiovanni A, Esquinas C, Barceló A, Barbé F, Bansignare MR. Gender-specific anthropometric markers of adiposity, metabolic syndrome and visceral adiposity index (VAI) in patients with obstructive sleep apnea. Journal of sleep research 2014;23:13-21.

Qian Y, Xu H, Wang Y, Yi H, Guan J, Yin S. Obstructive sleep apnea predicts risk of metabolic syndrome independently of obesity: a meta-analysis. AMS 2016;12:1077-87.

Pepin JL, Borel AL, Tamisier R, Baguet JP, Levy P, Dauvilliers Y. Hypertension and sleep: overview of a tight relationship. Sleep medicine reviews 2014;18:509-19.