The Prevalence and Severity of Obstructive Sleep Apnea in Severe Obesity: The Impact of Ethnicity
1School of Clinical and Experimental Medicine and Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, UK; 2Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK; 3School of Health and Population Sciences, University of Birmingham, UK; 4Academic Department of Sleep and Ventilation, Heart of England NHS Foundation Trust, Birmingham, UK; 5Aston University, Aston Triangle, Birmingham, UK
The South Asian population is at increased risk of cardiovascular disease. We compared the prevalence and severity of obstructive sleep apnea (OSA) in South Asians and white Europeans with severe obesity.
Data from consecutive patients attending a specialist weight management service were analyzed. Self-reported age, gender, and ethnicity were recorded. Objective measurements of blood pressure, body mass index (BMI), and apneahypopnea index (AHI) were also acquired.
A total of 308 patients (72.7% women; 13% South Asian) were included, with mean age and BMI of 46 ± 12 y and 49 ± 8 kg/m2, respectively. South Asians had significantly increased prevalence of OSA compared to white Europeans (85% vs. 66% [p = 0.017]) and were more likely to have severe OSA (42.5% vs. 21.6% [p = 0.015]). South Asians had significantly higher median AHI (24 events/h: interquartile range [IQR] 9.3-57.6 vs. 9 events/h: IQR 3.4-26.6; p < 0.01), significantly lower minimum oxygen saturation (76%: IQR 64% to 84% vs. 83%: IQR 77% to 87%; p < 0.01), and spent a significantly greater amount of time < 90% oxygen saturation (8.4%: IQR 1.0% to 24.3% vs. 2.4%: IQR 0.2% to 16.0%; p = 0.03). South Asian ethnicity, independent of demographics, BMI, and comorbidities, was associated with β = 1.84 (95%CI: 1.27-2.65) increase in AHI+1 compared to white Europeans. Furthermore, we confirmed other independent OSA risk factors including increasing age, BMI, and male gender (all p < 0.001).
Severely obese South Asians had significantly greater prevalence and severity of OSA than white Europeans. OSA may contribute to increased cardiovascular risk in South Asians compared to white Europeans with severe obesity. Mechanisms mediating the observed associations between these ethnicities require further investigation.
A commentary on this article appears in this issue on page
Leong WB; Arora T; Jenkinson D; Thomas A; Punamiya V; Banerjee D; Taheri S. The prevalence and severity of obstructive sleep apnea in severe obesity: the impact of ethnicity. J Clin Sleep Med 2013;9(9):853-858.
Please login to continue reading the full article
Subscribers to JCSM get full access to current and past issues of the JCSM.
Login to JCSM
Not a subscriber?
Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership