Prevalence of self-reported clinically diagnosed sleep apnea according to obesity status in men and women: National Health and Nutrition Examination Survey, 2005-2006.

OBJECTIVE To estimate the prevalence of self-reported clinically diagnosed sleep apnea (diagnosed sleep apnea) according to body mass index (BMI, measure of total obesity) and waist circumference (measure of abdominal obesity) in US adults. METHODS Data from a representative sample of 4309 US adults in the National Health and Nutrition Examination Surveys 2005-2006 were analyzed. Log-linear regression analyses with a robust variance estimator were performed to estimate the prevalence ratios (PR) and 95% confidence intervals (CIs). RESULTS The overall crude and age-adjusted prevalence estimates of diagnosed sleep apnea were 4.7% (95% CI=4.0%-5.5%) and 4.5% (95% CI=3.9%-5.2%) in adults. Age-adjusted prevalence in men (6.1%, 95% CI=5.0%-7.3%) was higher than that in women (3.1%, 95% CI=2.1%-4.0%; P<0.01). Age-adjusted prevalence was higher for persons with total obesity (i.e., BMI > or = 30 kg/m(2)) (12.1% vs. 3.0% in men, P<0.01; 7.0% vs. 0.7% in women, P<0.01) or abdominal obesity (10.9% vs. 1.9% in men, P<0.01; 4.6% vs. 0.6% in women, P<0.01) than that for those without total obesity (BMI <30 kg/m(2)) or without abdominal obesity. CONCLUSIONS These results from a nationally representative sample suggest that diagnosed sleep apnea is highly prevalent among adults with obesity in the general population, especially among men.

[1]  T. Young,et al.  Excess weight and sleep-disordered breathing. , 2005, Journal of applied physiology.

[2]  P. Hanly,et al.  Gender differences in the polysomnographic features of obstructive sleep apnea. , 2000, American journal of respiratory and critical care medicine.

[3]  T. Young,et al.  Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. , 1997, Sleep.

[4]  Adelaide M. Arruda-Olson,et al.  Sleep Apnea and Cardiovascular Disease , 2003, Herz.

[5]  S. Redline,et al.  Sleep apnea: a proinflammatory disorder that coaggregates with obesity. , 2008, The Journal of allergy and clinical immunology.

[6]  Claude Lenfant,et al.  Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition , 2004, Arteriosclerosis, thrombosis, and vascular biology.

[7]  Susan Redline,et al.  Underdiagnosis of Sleep Apnea Syndrome in U.S. Communities , 2002, Sleep and Breathing.

[8]  A. Malhotra,et al.  Mechanisms of apnea. , 2009, Progress in cardiovascular diseases.

[9]  Klein Rj,et al.  Age adjustment using the 2000 projected U.S. population. , 2001 .

[10]  Hartmut Schneider,et al.  Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. , 2008, Proceedings of the American Thoracic Society.

[11]  Chaoyang Li,et al.  Increasing Trends in Waist Circumference and Abdominal Obesity among U.S. Adults , 2007, Obesity.

[12]  O. Resta,et al.  Gender, age and menopause effects on the prevalence and the characteristics of obstructive sleep apnea in obesity , 2003, European journal of clinical investigation.

[13]  J. Hedner,et al.  Snoring and sleep apnoea in men: association with central obesity and hypertension. , 1993, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[14]  V. Mohsenin,et al.  Gender differences in the expression of sleep-disordered breathing : role of upper airway dimensions. , 2001, Chest.

[15]  G. Pillar,et al.  Abdominal Fat and Sleep Apnea , 2008, Diabetes Care.

[16]  W. W. Muir,et al.  Regression Diagnostics: Identifying Influential Data and Sources of Collinearity , 1980 .

[17]  K. Flegal,et al.  Prevalence of overweight and obesity in the United States, 1999-2004. , 2006, JAMA.

[18]  A. Lindberg,et al.  Gender differences in symptoms related to sleep apnea in a general population and in relation to referral to sleep clinic. , 2003, Chest.

[19]  E. Bixler,et al.  Selective effects of CPAP on sleep apnoea‐associated manifestations , 2008, European journal of clinical investigation.

[20]  A. Vgontzas.  Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance? , 2008, Archives of physiology and biochemistry.

[21]  Terry Young,et al.  Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. , 2002, Archives of internal medicine.

[22]  E. Bixler,et al.  Sleep apnea and sleep disruption in obese patients. , 1994, Archives of internal medicine.

[23]  A. Barros,et al.  Bmc Medical Research Methodology Open Access Alternatives for Logistic Regression in Cross-sectional Studies: an Empirical Comparison of Models That Directly Estimate the Prevalence Ratio Cox Regressioncross-sectional Studieslogistic Regressionodds Ratiopoisson Regressionprevalence Ratiorobust Varia , 2022 .

[24]  A. Fleischer,et al.  Increased physician-reported sleep apnea: the National Ambulatory Medical Care Survey. , 2002, Chest.

[25]  V. Somers,et al.  Obesity and obstructive sleep apnea. , 2003, Endocrinology and metabolism clinics of North America.

[26]  Y. Gustafson,et al.  Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. , 2008, Archives of internal medicine.

[27]  N. Punjabi.  The epidemiology of adult obstructive sleep apnea. , 2008, Proceedings of the American Thoracic Society.

[28]  S. Patel.  Physiology and Pathophysiology of Sleep Apnea Shared genetic risk factors for obstructive sleep apnea and obesity , 2005 .

[29]  Ian Marshall,et al.  Neck soft tissue and fat distribution: comparison between normal men and women by magnetic resonance imaging , 1999, Thorax.

[30]  T. Young,et al.  Epidemiology of obstructive sleep apnea: a population health perspective. , 2002, American journal of respiratory and critical care medicine.

[31]  Kazuomi Kario,et al.  Short sleep duration as an independent predictor of cardiovascular events in Japanese patients with hypertension. , 2008, Archives of internal medicine.