title: Obstructive sleep apnea syndrome: are we missing an at-risk population?
abstract: OBJECTIVE
  While age and body-mass index (BMI) are well-established risk factors for obstructive sleep apnea syndrome (OSAS), this disorder occurs across a wide spectrum of ages and weights. Preconceptions regarding "classic" patients with OSAS may lead to underdiagnosis in at-risk populations, particularly younger nonoverweight individuals. We hypothesized that the severity of OSAS is independent of age and BMI in a younger less-obese population.
  
  
  METHODS
  Prospective study of consecutive patients diagnosed with OSAS. Active-duty military, National Guardsmen, and civilians were compared to determine if age and BMI correlated with disease severity.
  
  
  RESULTS
  Two hundred seventy subjects (120 active-duty, 80 National Guardsmen, 70 civilians) were included. Active-duty military members were significantly younger and less overweight than both National Guardsmen and civilians. Of the civilians, 64.3% and, of National Guardsmen, 48.8% were obese, whereas only 19.2% of active-duty had a BMI > or = 30 kg/m2 (p < .001). However, the prevalence of severe disease did not differ between groups. Disease severity showed no correlation with BMI among active-duty subjects (r = 0.09, p = .33). Of the active-duty subjects, 37.5% had severe disease, as compared with 42.5% of National Guard and 45.7% of civilian subjects (p = .18 and .09, respectively). BMI did not differ between active-duty subjects with severe disease and those with mild to moderate OSAS (26.7 kg/m2 versus 26.9 kg/m2, p = .40). There was a low but significant correlation between age and AHI (r = 0.21, p = .02) among all subjects.
  
  
  CONCLUSIONS
  OSAS occurs in young nonobese individuals and should be considered in patients reporting excessive daytime sleepiness, regardless of age or BMI.
authors.affiliation: Pulmonary, Critical Care and Sleep Medicine Service, Walter Reed Army Medical Center, Washington, DC 20307, USA. christopher.lettieri@us.army.mil
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lettieri
authors.forename: Am H
authors.initials: AH
authors.lastname: Eliasson
authors.forename: Teotimo
authors.initials: T
authors.lastname: Andrada
authors.forename: Andrei
authors.initials: A
authors.lastname: Khramtsov
authors.forename: Marc
authors.initials: M
authors.lastname: Raphaelson
authors.forename: David A
authors.initials: DA
authors.lastname: Kristo
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D017286:Polysomnography; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology