Obstructive sleep apnea in a consecutive series of obese women

Sleep, eating disorder symptoms, and daytime functioning

OBJECTIVE

To investigate the relationship between eating disorders, body mass index (BMI), sleep disorders, and daytime functioning.

DESIGN

Survey.

SETTING

The Netherlands.

PARTICIPANTS

N=574 Dutch young adults (18-35 years old).

MEASUREMENTS

Participants completed a survey on eating and sleep habits including the Eating Disorder Screen for Primary care (ESP) and SLEEP-50 questionnaire subscales for sleep apnea, insomnia, circadian rhythm disorder (CRD), and daytime functioning. SLEEP-50 outcomes of participants who screened negative (≤2) and positive (>2) on the ESP were compared. In addition, SLEEP-50 scores of groups of participants with different ESP scores (0-4) and different BMI groups (ie, underweight, healthy weight, overweight, and obese) were compared using nonparametric statistics.

RESULTS

Almost 12% (n=67) of participants screened positive for having an eating disorder. Relative to participants without eating disorders, participants who screened positive for eating disorders reported significantly higher scores on sleep apnea (3.7 versus 2.9, P=0.012), insomnia (7.7 versus 5.5, P<0.0001), CRD (2.9 versus 2.3, P=0.011), and impairment of daytime functioning (8.8 versus 5.8, P=0.0001). ESP scores were associated with insomnia (r=0.117, P=0.005), sleep apnea (r=0.118, P=0.004), sleep quality (r=-0.104, P=0.012), and daytime functioning (r=0.225, P<0.0001), but not with CRD (r=0.066, P=0.112). BMI correlated significantly with ESP scores (r=0.172, P<0.0001) and scores on sleep apnea (r=0.171, P<0.0001). When controlling for BMI, the partial correlation between ESP and sleep apnea remained significant (r=0.10, P=0.015).

CONCLUSION

Participants who score positive for eating disorders scored significantly higher on sleep disorder scales, and reported significantly more impairment of daytime functioning.

Effects of maintained weight loss on sleep dynamics and neck morphology in severely obese adults

The goals of the study were to determine if moderate weight loss in severely obese adults resulted in (i) reduction in apnea/hypopnea index (AHI), (ii) improved pharyngeal patency, (iii) reduced total body oxygen consumption (VO(2)) and carbon dioxide production (VCO(2)) during sleep, and (iv) improved sleep quality. The main outcome was the change in AHI from before to after weight loss. Fourteen severely obese (BMI > 40 kg/m(2)) patients (3 males, 11 females) completed a highly controlled weight reduction program which included 3 months of weight loss and 3 months of weight maintenance. At baseline and postweight loss, patients underwent pulmonary function testing, polysomnography, and magnetic resonance imaging (MRI) to assess neck morphology. Weight decreased from 134 +/-6.6 kg to 118 +/- 6.1 kg (mean +/- s.e.m.; F = 113.763, P < 0.0001). There was a significant reduction in the AHI between baseline and postweight loss (subject, F = 11.11, P = 0.007). Moreover, patients with worse sleep-disordered breathing (SDB) at baseline had the greatest improvements in AHI (group, F = 9.00, P = 0.005). Reductions in VO(2) (285 +/- 12 to 234 +/-16 ml/min; F = 24.85, P < 0.0001) and VCO(2) (231 +/- 9 to 186 +/- 12 ml/min; F = 27.74, P < 0.0001) were also observed, and pulmonary function testing showed improvements in spirometry parameters. Sleep studies revealed improved minimum oxygen saturation (minSaO(2)) (83.4 +/- 61.9% to 89.1 +/- 1.2%; F = 7.59, P = 0.016), and mean SaO(2) (90.4 +/- 1.1% to 93.8 +/- 1.0%; F = 6.89, P = 0.022), and a significant increase in the number of arousals (8.1 +/- 1.4 at baseline, to 17.1 +/- 3.0 after weight loss; F = 18.13, P = 0.001). In severely obese patients, even moderate weight loss (approximately 10%) boasts substantial benefit in terms of the severity of SDB and sleep dynamics.

Sleep-wake cycles in obese children with and without binge-eating episodes

AIM

The aim of the study was to assess binge-eating episodes and to characterise sleep-wake cycles among obese children.

METHOD

The obese group consisted of 36 children. All participants received a diagnosis of primary obesity. The obese group was subdivided into two groups: obese with binge eating and without binge eating. A normal-weight control group was comprised of 25 normal-weight children. Sleep-wake patterns were monitored for 1 week, using mini-actigraphs and self-report questionnaires.

RESULTS

Thirty-seven per cent of the obese children reported uncontrolled binge-eating episodes. Actigraphic monitoring revealed significant differences in sleep quality between all three groups. Self-report questionnaires presented significantly more sleep disturbances in the obese group with binge eating and obese group without binge eating than in the normal-weight group.

CONCLUSION

Sleep disruption in obese children with binge eating is significantly more severe than in both obese non-binge-eating children and normal-weight controls.

The role of obesity in the increased prevalence of obstructive sleep apnea syndrome in patients with polycystic ovarian syndrome

OBJECTIVES

To determine the prevalence of obstructive sleep apnea syndrome (OSAS) in a population of premenopausal women with polycystic ovarian syndrome (PCOS) and to study the impact of obesity on the increased prevalence of OSAS in this population.

METHODS

Twenty-three premenopausal women with definite PCOS, and no prior diagnosis of a sleep disorder, were recruited from gynecology clinics. An investigator interviewed them, for symptoms of excessive sleepiness, their body mass index (BMI) was calculated, and they underwent overnight polysomnography.

RESULTS

Sixteen of 23 (69.6%) met criteria for OSAS. Five were treated with continuous positive airway pressure. Confidence interval was 47.7-84.5%. An increased respiratory disturbance index (RDI) did not correlate with higher BMI.

CONCLUSIONS

OSAS is significantly more prevalent in this population than in a population of obese women. There was no correlation between obesity and severity of the OSAS. Obesity is not the cause of this increased prevalence of OSAS in a population of women with PCOS.

Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects

OBJECTIVE

To investigate the prevalence of sleep breathing disorders, loud snoring and excessive daytime sleepiness in a group of obese subjects, and to identify the predictors of obstructive sleep apnea (OSA) severity in these patients.

SUBJECTS

A total of 161 consecutive obese patients (body mass index (BMI)> or =30.0 kg/m(2)), ranging between 30.0 and 67.3, represented by 57 men and 104 women, aged 16-75 y. Forty (15 men and 25 women) age-matched (20-70 y) nonobese (BMI<27 kg/m(2)) volunteers were also recruited for the study.

MEASUREMENTS

Respiratory function parameters, nocturnal sleep quality (evaluated by a specific questionnaire), nocturnal hypoventilation and OSA (evaluated by night polysomnography) were examined in all subjects. Anthropometric parameters (neck circumference, waist circumference, waist-to-hip ratio) were also investigated.

RESULTS

Eighty-three obese patients (51.5% of the obese group) had a respiratory disturbance index (RDI)> or =10, corresponding to a moderate or severe sleep apnea. In particular, 24.8% (40/161), ie a quarter of all obese patients, were affected by severe OSA and this alteration was present in 42.1% of obese men (24/57) and in 15.4% (16/104) of obese women. When a stepwise multiple regression analysis was performed, neck circumference in men and BMI in women were shown to be the strongest predictors of sleep apnea. Twenty-nine percent of all obese subjects (40.3% of men and 23.1% of women) showed nocturnal hypoventilation; however, it was present as a unique breathing alteration in only 5% of the obese population. The percentage of patients having excessive daytime sleepiness was significantly higher than in nonobese subjects, even when only nonapneic obese patients were considered (P<0.001).

CONCLUSION

This study shows that OSA is present in more than 50% of a population of obese patients with a mean BMI higher than 40.0, this percentage being much higher than that commonly reported in previous studies, particularly in women. Neck circumference in men and BMI in women seem to be the strongest predictors of the severity of OSA in obese patients. Nocturnal hypoventilation seems to be present in more than 29% of a severe obese population. Moreover, this study indicates that morbid obesity can be associated with excessive daytime sleepiness even in the absence of sleep apnea.

Sleep-wake cycles in women with binge eating disorder

OBJECTIVE

Binge eating disorder (BED) is a new diagnostic category in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The majority of studies on sleep characteristics in overweight women have used nonbinging obese women. The aim of this study was to evaluate sleep characteristics in obese BED patients in comparison to non-BED obese (OB) and nonbinging normal weight (NW) women.

METHOD

Eighteen females with BED, 13 OB, and 16 NW women were recruited. Sleep-wake patterns were monitored for 1 week using mini-actigraphs and self-report questionnaires.

RESULTS

Their ambulatory sleep data revealed that BED and OB subjects had significantly lower sleep efficiency, had more wake during sleep, and had less zero activity than the NW group. The self-report questionnaires presented significantly more sleep disturbances in the BED and OB groups than in the NW group.

DISCUSSION

The objective results support the subjective sleep disturbances reported by the two obese groups, the BED and the OB. A possible explanation for these findings could be weight-related physical discomfort or the existence of breathing disorders in sleep. Further research, for example, overnight polysomnography recordings and follow-up treatment, is required.