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Sleep Apnea and Sleep Disruption in Obese Patients

Sleep Apnea and Sleep Disruption in Obese Patients Abstract Objectives: To describe the frequency and severity of sleep apnea in obese patients without a primary sleep complaint and to assess the sleep patterns of obese patients without apnea and compare them with the sleep patterns of nonobese controls. Design and Setting: Prospective case series with historical controls in an obesity and sleep disorders clinic. Subjects: Two hundred obese women and 50 obese men (mean body mass index, 45.3) consecutively referred for treatment of their obesity and 128 controls matched for age and sex. Main Outcome Measures: Eight-hour sleep laboratory recording, including electroencephalogram, electro-oculogram, electromyogram, and respirations. Subjectively reported sleep-related symptoms and signs were also recorded. Results: Twenty men (40%) and six women (3%) demonstrated sleep apnea warranting therapeutic intervention. Another four men (8%) and 11 women (5.5%) showed sleep apneic activity that warranted recommendation for evaluation in the sleep laboratory. In contrast, none of the 128 controls demonstrated sleep apneic activity severe enough for therapeutic intervention. The best clinical predictors of sleep apnea in the obese population were severity of snoring, subjectively reported nocturnal breath cessation, and sleep attacks. Obese patients, both men and women, without any sleep-disordered breathing demonstrated a significant degree of sleep disturbance compared with nonobese controls. Wake time after sleep onset, number of awakenings, and percentage of stage 1 sleep were significantly higher in obese patients than in controls, while rapid eye movement sleep was significantly lower. Conclusion: Severely or morbidly obese men are at extremely high risk for sleep apnea and should be routinely evaluated in the sleep laboratory for this condition, while for severely or morbidly obese women the physician should include a thorough sleep history in the clinical assessment.(Arch Intern Med. 1994;154:1705-1711) References 1. Kuczmarski RJ. Prevalence of overweight and weight gain in the United States . Am J Clin Nutr. 1992;55:495S-502S. 2. Guilleminault C, van den Hoed J, Mitler MM. Clinical overview of the sleep apnea syndromes . In: Guilleminault C, Dement WC, eds. Sleep Apnea Syndromes . New York, NY: Alan R Liss Inc; 1978:1-12. 3. Lugaresi E, Coccagna G, Montavani M. Hypersomnia with periodic apneas . In: Weitzman E, ed. Advances in Sleep Research . New York, NY: Spectrum Publications Inc; 1978;4. 4. Kales A, Caldwell AB, Cadieux RJ, Vela-Bueno A, Ruch LG, Mayes SD. Severe obstructive sleep apnea, II: associated psychopathology and psychosocial consequences . J Chronic Dis. 1985;38:427-434.Crossref 5. Harmann EM, Whinne JW, Block J. The effect of weight loss on sleep-disordered breathing and oxygen desaturation in morbidly obese men . Chest. 1982;82:291-294. 6. Lugaresi E, Coccagna G, Cirignotta F. Snoring and its clinical implications . In: Guilleminault C, Dement WC, eds. Sleep Apnea Syndromes . New York, NY: Alan R Liss Inc; 1978:13-21. 7. Peiser J, Lavie P, Ovnat A, Charuzi I. Sleep apnea syndrome in the morbidly obese as an indication for weight reduction surgery . Sleep . 1984;199:112-115. 8. Browmann CP, Sampson MG, Yolles SJ, et al. Obstructive sleep apnea and body weight . Chest . 1984;85:435-436.Crossref 9. Smith PL, Gold AR, Meyer DA, Haponik EF, Bleecker ER. Weight loss in mildly to moderately obese patients with obstructive sleep apnea . Ann Intern Med. 1985;103:850-855.Crossref 10. Suratt PM, McTier RF, Findley IJ, Pohl SL, Wilhoit SC. Changes in breathing and the pharynx after weight loss in obstructive sleep apnea . Chest . 1982;92:631-637.Crossref 11. Pasquali R, Colella P, Cirignotta F, et al. Treatment of obese patients with obstructive sleep apnea syndrome (OSAS): effect of weight loss and interference of otorhinolaryngoiatric pathology . Int J Obes. 1990;14:207-217. 12. Charuzi I, Ovnat A, Peiser J, Saltz H, Weitzman S, Lavie P. The effect of surgical weight reduction on sleep quality in obesity-related sleep apnea syndrome . Surgery . 1984;97:535-538. 13. Rajala R, Partinen M, Sane T, Pelkonen R, Huikuri K, Seppalainen AM. Obstructive sleep apnoea syndrome in morbidly obese patients . J Intern Med. 1991;230:125-129.Crossref 14. Rechtschaffen A, Kales A. A Manual of Standardized Terminology Techniques and Scoring System for Sleep Stages of Human Subjects . Washington, DC: National Institutes of Health; 1968. Publication 204. 15. Douglas NJ, Thomas S, Jan MA. Clinical value of polysomnography . Lancet . 1992;339:347-350.Crossref 16. Dunn OJ. Multiple comparison among means . J Am Stat Assoc. 1961;56:52-64.Crossref 17. Viner S, Szalai JP, Hoffstein V. Are history and physical examination a good screening test for sleep apnea? Ann Intern Med. 1991;115:356-359.Crossref 18. Guilleminault C, Quera-Salva M-A, Partinen M, Jamieson A. Women and the obstructive sleep apnea syndrome . Chest . 1988;92:104-109.Crossref 19. Metes A, Ohki M, Cole P, Haight JSJ, Hoffstein V. Snoring, apnea and nasal resistance in men and women . J Otolaryngol. 1991;20:57-61. 20. Thorpy MJ, ed. International classification of sleep disorders . In: Diagnostic and Coding Manual . Lawrence, Kan: Allen Press; 1990. 21. Ancoli-Israel S, Kripke DF, Mason W. Characteristics of obstructive and central sleep apnea in the elderly: an interim report . Biol Psychiatry . 1987;22:741-750.Crossref 22. Kripke DF, Ancoli-lsrael S. Epidemiology of sleep apnea among the aged: is sleep apnea a fatal disorder? In: Guilleminault C, Lugaresi E, eds. Sleep/Wake Disorders: Natural History, Epidemiology, and Long-term Evolution . New York, NY: Raven Press; 1983:137-142. 23. Young, T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults . N Engl J Med. 1993; 328:1230-1235.Crossref 24. Berry DTR, Webb WB, Block AJ. Sleep apnea syndrome: a critical review of the apnea index as a diagnostic criterion . Chest . 1984;86:529-531.Crossref 25. Kales A, Vela-Bueno A, Kales JD. Sleep disorders: sleep apnea and narcolepsy . Ann Intern Med. 1987;106:434-443.Crossref 26. Fletcher EC, ed. Abnormalities of Respiration During Sleep: Diagnosis, Pathophysiology, and Treatment . Orlando, Fla: Grune & Stratton; 1986. 27. Carskadon MA, Dement WC. Normal human sleep: an overview . In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1989:3-13. 28. Bliwise DL. Neuropsychological function and sleep . Clin Geriatr Med. 1989;5: 381-394. 29. Vela-Bueno A, Soldatos C, Kales A. Anxiety and disordered sleep . In: Roth M, Burrows G, Noyes R, eds. Handbook of Anxiety . Amsterdam, the Netherlands: Elsevier Science Publishers; 1988;2:509-544. 30. Guilleminault C, Stoohs R, Duncan S. Snoring, I: daytime sleepiness in regular heavy snorers . Chest . 1991;99:40-48.Crossref 31. Hoffstein V, Mateika JH, Mateika S. Snoring and sleep architecture . Am Rev Respir Dis. 1991;143:92-96.Crossref 32. Thorpy MJ. The clinical use of the Multiple Sleep Latency Test: the Standards of Practice Committee of the American Sleep Disorders Association . Sleep . 1992;15:268-276. 33. Erratum: Sleep . 1992;15:381. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420150073007
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Abstract

Abstract Objectives: To describe the frequency and severity of sleep apnea in obese patients without a primary sleep complaint and to assess the sleep patterns of obese patients without apnea and compare them with the sleep patterns of nonobese controls. Design and Setting: Prospective case series with historical controls in an obesity and sleep disorders clinic. Subjects: Two hundred obese women and 50 obese men (mean body mass index, 45.3) consecutively referred for treatment of their obesity and 128 controls matched for age and sex. Main Outcome Measures: Eight-hour sleep laboratory recording, including electroencephalogram, electro-oculogram, electromyogram, and respirations. Subjectively reported sleep-related symptoms and signs were also recorded. Results: Twenty men (40%) and six women (3%) demonstrated sleep apnea warranting therapeutic intervention. Another four men (8%) and 11 women (5.5%) showed sleep apneic activity that warranted recommendation for evaluation in the sleep laboratory. In contrast, none of the 128 controls demonstrated sleep apneic activity severe enough for therapeutic intervention. The best clinical predictors of sleep apnea in the obese population were severity of snoring, subjectively reported nocturnal breath cessation, and sleep attacks. Obese patients, both men and women, without any sleep-disordered breathing demonstrated a significant degree of sleep disturbance compared with nonobese controls. Wake time after sleep onset, number of awakenings, and percentage of stage 1 sleep were significantly higher in obese patients than in controls, while rapid eye movement sleep was significantly lower. Conclusion: Severely or morbidly obese men are at extremely high risk for sleep apnea and should be routinely evaluated in the sleep laboratory for this condition, while for severely or morbidly obese women the physician should include a thorough sleep history in the clinical assessment.(Arch Intern Med. 1994;154:1705-1711) References 1. Kuczmarski RJ. Prevalence of overweight and weight gain in the United States . Am J Clin Nutr. 1992;55:495S-502S. 2. Guilleminault C, van den Hoed J, Mitler MM. Clinical overview of the sleep apnea syndromes . In: Guilleminault C, Dement WC, eds. Sleep Apnea Syndromes . New York, NY: Alan R Liss Inc; 1978:1-12. 3. Lugaresi E, Coccagna G, Montavani M. Hypersomnia with periodic apneas . In: Weitzman E, ed. Advances in Sleep Research . New York, NY: Spectrum Publications Inc; 1978;4. 4. Kales A, Caldwell AB, Cadieux RJ, Vela-Bueno A, Ruch LG, Mayes SD. Severe obstructive sleep apnea, II: associated psychopathology and psychosocial consequences . J Chronic Dis. 1985;38:427-434.Crossref 5. Harmann EM, Whinne JW, Block J. The effect of weight loss on sleep-disordered breathing and oxygen desaturation in morbidly obese men . Chest. 1982;82:291-294. 6. Lugaresi E, Coccagna G, Cirignotta F. Snoring and its clinical implications . In: Guilleminault C, Dement WC, eds. Sleep Apnea Syndromes . New York, NY: Alan R Liss Inc; 1978:13-21. 7. Peiser J, Lavie P, Ovnat A, Charuzi I. Sleep apnea syndrome in the morbidly obese as an indication for weight reduction surgery . Sleep . 1984;199:112-115. 8. Browmann CP, Sampson MG, Yolles SJ, et al. Obstructive sleep apnea and body weight . Chest . 1984;85:435-436.Crossref 9. Smith PL, Gold AR, Meyer DA, Haponik EF, Bleecker ER. Weight loss in mildly to moderately obese patients with obstructive sleep apnea . Ann Intern Med. 1985;103:850-855.Crossref 10. Suratt PM, McTier RF, Findley IJ, Pohl SL, Wilhoit SC. Changes in breathing and the pharynx after weight loss in obstructive sleep apnea . Chest . 1982;92:631-637.Crossref 11. Pasquali R, Colella P, Cirignotta F, et al. Treatment of obese patients with obstructive sleep apnea syndrome (OSAS): effect of weight loss and interference of otorhinolaryngoiatric pathology . Int J Obes. 1990;14:207-217. 12. Charuzi I, Ovnat A, Peiser J, Saltz H, Weitzman S, Lavie P. The effect of surgical weight reduction on sleep quality in obesity-related sleep apnea syndrome . Surgery . 1984;97:535-538. 13. Rajala R, Partinen M, Sane T, Pelkonen R, Huikuri K, Seppalainen AM. Obstructive sleep apnoea syndrome in morbidly obese patients . J Intern Med. 1991;230:125-129.Crossref 14. Rechtschaffen A, Kales A. A Manual of Standardized Terminology Techniques and Scoring System for Sleep Stages of Human Subjects . Washington, DC: National Institutes of Health; 1968. Publication 204. 15. Douglas NJ, Thomas S, Jan MA. Clinical value of polysomnography . Lancet . 1992;339:347-350.Crossref 16. Dunn OJ. Multiple comparison among means . J Am Stat Assoc. 1961;56:52-64.Crossref 17. Viner S, Szalai JP, Hoffstein V. Are history and physical examination a good screening test for sleep apnea? Ann Intern Med. 1991;115:356-359.Crossref 18. Guilleminault C, Quera-Salva M-A, Partinen M, Jamieson A. Women and the obstructive sleep apnea syndrome . Chest . 1988;92:104-109.Crossref 19. Metes A, Ohki M, Cole P, Haight JSJ, Hoffstein V. Snoring, apnea and nasal resistance in men and women . J Otolaryngol. 1991;20:57-61. 20. Thorpy MJ, ed. International classification of sleep disorders . In: Diagnostic and Coding Manual . Lawrence, Kan: Allen Press; 1990. 21. Ancoli-Israel S, Kripke DF, Mason W. Characteristics of obstructive and central sleep apnea in the elderly: an interim report . Biol Psychiatry . 1987;22:741-750.Crossref 22. Kripke DF, Ancoli-lsrael S. Epidemiology of sleep apnea among the aged: is sleep apnea a fatal disorder? In: Guilleminault C, Lugaresi E, eds. Sleep/Wake Disorders: Natural History, Epidemiology, and Long-term Evolution . New York, NY: Raven Press; 1983:137-142. 23. Young, T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults . N Engl J Med. 1993; 328:1230-1235.Crossref 24. Berry DTR, Webb WB, Block AJ. Sleep apnea syndrome: a critical review of the apnea index as a diagnostic criterion . Chest . 1984;86:529-531.Crossref 25. Kales A, Vela-Bueno A, Kales JD. Sleep disorders: sleep apnea and narcolepsy . Ann Intern Med. 1987;106:434-443.Crossref 26. Fletcher EC, ed. Abnormalities of Respiration During Sleep: Diagnosis, Pathophysiology, and Treatment . Orlando, Fla: Grune & Stratton; 1986. 27. Carskadon MA, Dement WC. Normal human sleep: an overview . In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1989:3-13. 28. Bliwise DL. Neuropsychological function and sleep . Clin Geriatr Med. 1989;5: 381-394. 29. Vela-Bueno A, Soldatos C, Kales A. Anxiety and disordered sleep . In: Roth M, Burrows G, Noyes R, eds. Handbook of Anxiety . Amsterdam, the Netherlands: Elsevier Science Publishers; 1988;2:509-544. 30. Guilleminault C, Stoohs R, Duncan S. Snoring, I: daytime sleepiness in regular heavy snorers . Chest . 1991;99:40-48.Crossref 31. Hoffstein V, Mateika JH, Mateika S. Snoring and sleep architecture . Am Rev Respir Dis. 1991;143:92-96.Crossref 32. Thorpy MJ. The clinical use of the Multiple Sleep Latency Test: the Standards of Practice Committee of the American Sleep Disorders Association . Sleep . 1992;15:268-276. 33. Erratum: Sleep . 1992;15:381.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 8, 1994

References