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Association between obstructive sleep apnea syndrome and waist-to-height ratio

  • Sleep and Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obesity is among the known risk factors for obstructive sleep apnea syndrome (OSAS). In this study, our aim was to investigate the correlation of waist-to-height ratio, an indicator of central obesity, with presence and severity of OSAS; to compare the use of this ratio with the use of waist circumference and body mass index (BMI); and to determine OSAS-related cutoff values.

Methods

The patient records were retrospectively analyzed for whom a polysomnography was conducted at our sleep. Sex, age, Apnea-Hypopnea Index (AHI), waist circumference, height, and BMI values of those patients were recorded. AHI scores were used to classify severity of OSAS.

Results

The study included 437 OSAS patients and 72 control cases. Out of the patient group, OSAS was severe in 208 (47%) patients, moderate in 124 (28%), and mild in 105 (24%) of them. In the group of OSAS patients, waist-to-height ratio, waist circumference, and BMI were higher compared to the control group with a further difference of all three parameters among severe, moderate, mild OSAS, and controls both in males and females. Cutoff values for OSAS of females were 95.5 cm for waist circumference, 0.595 for waist-to-height ratio, and 27.75 for BMI whereas the cutoff values of males were 100.5 cm, 0.575, and 27.75, respectively.

Conclusions

A high value of waist circumference, waist-to-height ratio, and BMI is associated with the presence and severity of OSAS. We have determined the cutoff values of the studied anthropometric measurements in both sexes for OSAS and severe OSAS.

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Author information

Authors and Affiliations

  1. Department of Neurology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey

    Yasemin Unal, Dilek Aslan Ozturk & Gulnihal Kutlu

  2. Siena College, Loudonville, NY, 12211, USA

    Kursad Tosun

Authors
  1. Yasemin Unal
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  2. Dilek Aslan Ozturk
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  3. Kursad Tosun
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  4. Gulnihal Kutlu
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Corresponding author

Correspondence to Yasemin Unal.

Ethics declarations

Ethical approval

This study protocol was approved by the ethics committee of Mugla Sıtkı Kocman University.

Informed consent

Because this was a retrospective study, formal consent was not required.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Comment

As obstructive sleep apnea presents a large public health problem, there has been an ongoing search towards simpler measures to screen patients that may have obstructive sleep apnea (1-3). This study is an important addition to identify such a tool.

While neck circumference is established for its correlation to presence and severity of sleep apnea (4, 5), other measures of central obesity such as the waist circumference and waist-to-height ratio are noted for their correlation to cardio metabolic and mortality risk (6, 7). Some studies correlate waist circumference to neck circumference (8). Existing studies do not report correlation between waist-to-height ratio and OSA in adults although this was noted in a pediatric study in 2015 by DeSousa et al (9).

In this study Dr Unal et al aimed to investigate the correlation of waist-to-height ratio, with the presence and severity of obstructive sleep apnea syndrome and to compare its use with other indicators of central adiposity such as waist circumference and BMI. They also aimed to determine OSAS related cutoff values in patient’s between Jan 2014 and Dec 2016 in the inpatient setting at their Sleep Lab.

The need for this information is vital and interesting as these measurements may help screen patients with obstructive sleep apnea there by selecting candidates for further testing. In addition, as screening anthropometric measures are bound to have racial and gender differences it is important to find “cutoff points” for different populations (10).

The study found that as expected, in patients with OSAS the waist-to-height ratio, waist circumference, and BMI were higher compared to the control group. The AHI scores correlated with all 3 parameters, but the highest correlation was noted for the waist circumference. This was also noted on a prior study by Davidson and Patel (11) and likely represents the results of pattern of fat distribution—increased fat deposition in the center as opposed to the periphery may result in decreased size of the upper airway secondary to mass effect of the abdomen fat on the chest wall and tracheal traction (12). Interestingly, correlation was much stronger in the female population. As is well known, women have more body fat but men have a relatively more central distribution of fat (13, 14). This may suggest that in women if there was increase in waist size, it likely represented a significant increase in adiposity. It is noteworthy that majority of the patient’s in this study had moderate to severe OSA—75%.

Based on the area under the curve analysis, cutoff values were defined for men and women for waist circumference, waist-to-height ratio and the BMI, both for obstructive sleep apnea and severe obstructive sleep apnea.

As is to be expected, there was an age difference between control group and the group with obstructive sleep apnea.

In conclusion, for the waist-to-height circumference, in addition to previous knowledge of its ability to identify patient’s at risk for cardio metabolic disease and mortality, the current study adds to its use to predict the presence and severity of obstructive sleep apnea.

Toshita Kumar

Connecticut, USA

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Unal, Y., Ozturk, D.A., Tosun, K. et al. Association between obstructive sleep apnea syndrome and waist-to-height ratio. Sleep Breath 23, 523–529 (2019). https://doi.org/10.1007/s11325-018-1725-4

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