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Sleep & breathing = Schlaf & Atmung
06, 2022;26 (2): 675-680.

Risk factors for non-positional obstructive sleep apnea-hypopnea syndrome.

Xiao Jiao, Jianyin Zou, Lili Meng, Suru Liu, Jian Guan, Hongliang Yi, Shankai Yin
Author Information
  1. Xiao Jiao: Department of Otolaryngology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu, 322200, Zhejiang, China.
  2. Jianyin Zou: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China.
  3. Lili Meng: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China.
  4. Suru Liu: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China.
  5. Jian Guan: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China.
  6. Hongliang Yi: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China. yihongl@126.com.
  7. Shankai Yin: Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China.
PMID: 34278514 DOI: 10.1007/s11325-021-02430-z

Abstract

OBJECTIVE: To explore the main risk factors for non-positional obstructive sleep apnea (NPOSA).
METHODS: A total of 560 patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) were divided into non-positional obstructive sleep apnea (NPOSA) and positional obstructive sleep apnea (POSA) groups. All patients were assessed by the Friedman staging system and anthropometry before overnight polysomnography. Blood tests were performed to determine the fasting blood glucose level and lipid profile. Forward logistic regression analysis was performed to evaluate the effects of all parameters on positional dependency.
RESULTS: The study sample consisted of 318 NPOSA patients and 242 POSA patients (88% and 85% were men, respectively). The mean apnea-hypopnea index (AHI) was 57.0 events/h in the NPOSA group, compared with 25.7 events/h in the POSA group. The POSA group had a significantly smaller neck circumference (NC), waist circumference (WC), hip circumference (HC), lower body mass index (BMI), AHI, fasting blood glucose, and apolipoprotein-B (apoB) levels than did the NPOSA group (all, P < 0.01). The minimal nocturnal oxyhemoglobin saturation (minSpO) and apoB/apoA ratio were higher in the POSA group than in the NPOSA group (both, P < 0.001). The AHI, minSpO, WC, and fasting blood glucose level were included in the logistic regression models.
CONCLUSION: The AHI, WC, minSpO, and fasting blood glucose level are the main independent risk factors for NPOSA.

Keywords

Apnea–hypopnea index Fasting glucose Minimal saturation of pulse oximetry Obstructive sleep apnea–hypopnea syndrome Position-dependent Waist circumference

References

  1. Oksenberg A, Khamaysi I, Silverberg DS, Tarasiuk A, Tarasiuk A (2000) Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. Chest 118(4):1018–1024 [DOI: 10.1378/chest.118.4.1018]
  2. Lee CH, Jung HJ, Lee WH, Rhee CS, Yoon IY, Yun PY, Kim JW (2012) The effect of positional dependency on outcomes of treatment with a mandibular. Arch Otolaryngol Head Neck Surg 138(5):479–483 [DOI: 10.1001/archoto.2012.452]
  3. Li HY, Cheng WN, Chuang LP, Fang TJ, Hsin LJ, Kang CJ, Lee LA (2013) Positional dependency and surgical success of relocation pharyngoplasty among patients with severe obstructive sleep apnea. Otolaryngol Head Neck Surg 149(3):506–512 [DOI: 10.1177/0194599813495663]
  4. Levendowski DJ, Seagraves S, Popovic D, Westbrook PR (2014) Assessment of a neck-based treatment and monitoring device for positional obstructive sleep apnea. J Clin Sleep Med 10(8):863–871 [DOI: 10.5664/jcsm.3956]
  5. van Maanen JP, de Vries N (2014) Long-term effectiveness and compliance of positional therapy with the sleep position trainer in the treatment of positional obstructive sleep apnea syndrome. Sleep 37(7):1209–1215 [DOI: 10.5665/sleep.3840]
  6. de Vries GE, Hoekema A, Doff MH, Kerstjens HA, Meijer PM, van der Hoeven JH, Wijkstra PJ (2015) Usage of positional therapy in adults with obstructive sleep apnea. J Clin Sleep Med 11(2):131–137 [DOI: 10.5664/jcsm.4458]
  7. Cartwright R, Ristanovic R, Diaz F, Caldarelli D, Alder G (1991) A comparative study of treatments for positional sleep apnea. Sleep 14(6):546–552 [DOI: 10.1093/sleep/14.6.546]
  8. Oksenberg A, Ds S, Arons E, Radwan H (1997) Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest 112(3):629–639 [DOI: 10.1378/chest.112.3.629]
  9. Cuhadaroglu C, Utkusavas A, Ozturk L, Salman S, Ece T (2009) Effects of nasal CPAP treatment on insulin resistance, lipid profile, and plasma leptin in sleep apnea. Lung 187(2):75–81 [DOI: 10.1007/s00408-008-9131-5]
  10. Drager LF, Jun J, Polotsky VY (2010) Obstructive sleep apnea and dyslipidemia: implications for atherosclerosis. Curr Opin Endocrinol Diabetes Obes 17(2):161–165 [DOI: 10.1097/MED.0b013e3283373624]
  11. Friedman M, Ibrahim H, Joseph NJ (2004) Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope 114(3):454–459 [DOI: 10.1097/00005537-200403000-00013]
  12. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619 [DOI: 10.5664/jcsm.2172]
  13. Guan J, Yi H, Zou J, Meng L, Tang X, Zhu H, Yu D, Zhou H, Su K, Yang M, Chen H, Shi Y, Wang Y, Wang J, Yin S, Shanghai Sleep Health Study Research Group (2016) Distinct severity stages of obstructive sleep apnoea are correlated with unique dyslipidaemia: large-scale observational study. Thorax 71(4):347–355 [DOI: 10.1136/thoraxjnl-2015-207403]
  14. Oksenberg A, Gadoth N (2014) Are we missing a simple treatment for most adult sleep apnea patients? The avoidance of the supine sleep position. J Sleep Res 23(2):204–210 [DOI: 10.1111/jsr.12097]
  15. Teerapraipruk B, Chirakalwasan N, Simon R, Simon R, Hirunwiwatkul P, Jaimchariyatam N, Desudchit T, Charakorn N, Wanlapakorn C (2012) Clinical and polysomnographic data of positional sleep apnea and its predictors. Sleep Breath 16(4):1167–1172 [DOI: 10.1007/s11325-011-0627-5]
  16. Teerapraipruk B, Chirakalwasan N, Simon R, Hirunwiwatkul P, Jaimchariyatam N, Desudchit T, Charakorn N, Wanlapakorn C (2012) Clinical and polysomnographic data of positional sleep apnea and its predictors. Sleep Breath 16(4):1167–1172 [DOI: 10.1007/s11325-011-0627-5]
  17. Mador MJ, Tj K, Uj M, Sk R, Watwe V, Grant BJ (2005) Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest 128(4):2130–2137 [DOI: 10.1378/chest.128.4.2130]
  18. Iiyori N, Alonso LC, Li J, Sanders MH, Garcia-Ocana A, O’Doherty RM, Polotsky VY, O’Donnell CP (2007) Intermittent hypoxia causes insulin resistance in lean mice independent of autonomic activity. Am J Respir Crit Care Med 175(8):851–857 [DOI: 10.1164/rccm.200610-1527OC]
  19. Buxton OM, Pavlova M, Reid EW, Wang W, Simonson DC, Adler GK (2010) Sleep restriction for 1 week reduces insulin sensitivity in healthy men. Diabetes 59(9):2126–2133 [DOI: 10.2337/db09-0699]
  20. Russell RD, Hu D, Greenaway T, Blackwood SJ, Dwyer RM, Sharman JE, Jones G, Squibb KA, Brown AA, Otahal P, Boman M, Al-Aubaidy H, Premilovac D, Roberts CK, Hitchins S, Richards SM, Rattigan S, Keske MA-O (2017) Skeletal muscle microvascular-linked improvements in glycemic control from resistance training in individuals with type 2 diabetes. Diabetes Care 40(9):1256–1263 [DOI: 10.2337/dc16-2750]
  21. Pasarica M, Sereda OR, Redman LM, Albarado DC, Hymel DT, Roan LE, Rood JC, Burk DH, Smith SR (2009) Reduced adipose tissue oxygenation in human obesity: evidence for rarefaction, macrophage chemotaxis, and inflammation without an angiogenic response. Diabetes 58(3):718–725 [DOI: 10.2337/db08-1098]
  22. Hoffstedt J, Förster D, Löfgren P (2007) Impaired subcutaneous adipocyte lipogenesis is associated with systemic insulin resistance and increased apolipoprotein B/AI ratio in men and women. J Intern Med 262(1):131–139 [DOI: 10.1111/j.1365-2796.2007.01811.x]
  23. Xu H, Zheng X, Qian Y, Guan J, Yi H, Zou J, Wang Y, Meng L, Zhao A, Yin S, Jia W (2016) Metabolomics profiling for obstructive sleep apnea and simple snorers. Sci Rep 6:30958 [DOI: 10.1038/srep30958]
  24. Qian Y, Yi H, Zou J, Meng L, Tang X, Zhu H, Yu D, Zhou H, Su K, Guan J, Yin S (2016) Independent association between sleep fragmentation and dyslipidemia in patients with obstructive sleep apnea. Sci Rep 6:26089 [DOI: 10.1038/srep26089]
  25. Sadeghi M, Pourmoghaddas Z, Hekmatnia A, Sanei H, Tavakoli B, Tchernof A, Roohafza H, Sarrafzadegan N (2013) Association of apolipoprotein B, apolipoprotein A, and the its ratio with body fat distribution. J Res Med Sci 18(4):326–329 [PMID: 24124431]
  26. Saigusa H, Suzuki M, Higurashi N, Kodera K (2009) Three-dimensional morphological analyses of positional dependence in patients with obstructive sleep apnea syndrome. Anesthesiology 110(4):885–890 [DOI: 10.1097/ALN.0b013e31819b5d57]
  27. Cai C, Ahmad T, Valencia GB, Aranda JV, Xu J, Beharry KD (2018) Intermittent hypoxia suppression of growth hormone and insulin-like growth factor-I in the neonatal rat liver. Growth Horm IGF Res 41:54–63 [DOI: 10.1016/j.ghir.2018.03.001]
  28. Chen WC, Lee LA, Chen NH, Fang TJ, Huang CG, Cheng WN, Li HY (2015) Treatment of snoring with positional therapy in patients with positional obstructive sleep apnea syndrome. Sci Rep 5:18188 [DOI: 10.1038/srep18188]

MeSH Term

Apolipoproteins B
Blood Glucose
Female
Humans
Male
Polysomnography
Risk Factors
Sleep Apnea, Obstructive

Chemicals

Apolipoproteins B
Blood Glucose
Journal Article

Word Cloud

Created with Highcharts 10.0.0NPOSAsleepgroupPOSAglucoseobstructivepatientsfastingbloodAHIcircumferencefactorsnon-positionalapneaapnea-hypopneasyndromelevelindexWCminSpOmainriskpositionalperformedlogisticregressionevents/hP < 0saturationOBJECTIVE:exploreMETHODS:total560with obstructiveOSAHSdividedgroupsassessedFriedmanstagingsystemanthropometryovernightpolysomnographyBloodtestsdeterminelipidprofileForwardanalysisevaluateeffectsparametersdependencyRESULTS:studysampleconsisted31824288%85%menrespectivelymean570compared257significantlysmallerneckNCwaisthipHClowerbodymassBMIapolipoprotein-BapoBlevels01minimalnocturnaloxyhemoglobinapoB/apoAratiohigher001includedmodelsCONCLUSION:independentRiskApnea–hypopneaFastingMinimalpulseoximetryObstructiveapnea–hypopneaPosition-dependentWaist

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