Sex differences in the association of regional fat distribution with the severity of obstructive sleep apnea.
OBJECTIVE
To describe sex differences in the associations between severity of obstructive sleep apnea (OSA) and measures of obesity in body regions defined using both dual-energy absorptiometry and traditional anthropometric measures in a sleep-clinic sample.


METHODS
A prospective case-series observational study.


METHODS
The Western Australian Sleep Health Study operating out of the Sir Charles Gairdner Hospital Sleep Clinic, Perth, Western Australia.


METHODS
Newly referred clinic patients (60 men, 36 women) suspected of having OSA.


METHODS
N/A.


RESULTS
Obstructive sleep apnea severity was defined by apnea-hypopnoea index from laboratory-based overnight polysomnography. Body mass index, neck, waist and hip circumference, neck-to-waist ratio, and waist-to-hip ratio were measured. Dual energy absorptiometry measurements included percentage fat and lean tissue. Multivariate regression models for each sex were developed. In women, percentage of fat in the neck region and body mass index together explained 33% of the variance in apnea-hypopnea index. In men, percentage of fat in the abdominal region and neck-to-waist ratio together accounted for 37% of the variance in apnea-hypopnea index.


CONCLUSIONS
Regional obesity is associated with obstructive sleep apnea severity, although differently in men and women. In women, a direct influence of neck fat on the upper airway patency is implicated. In men, abdominal obesity appears to be the predominant influence. The apnea-hypopnea index was best predicted by a combination of Dual Energy Absorptiometry-measured mass and traditional anthropometric measurements.
Simpson
Laila
L
Centre for Genetic Epidemiology and Biostatistics, University of Western Australia, Perth, Australia. Isimpson@meddent.uwa.edu.au
Mukherjee
Sutapa
S
Cooper
Matthew N
MN
Ward
Kim L
KL
Lee
Jessica D
JD
Fedson
Annette C
AC
Potter
Jane
J
Hillman
David R
DR
Hillman Fanzca
David R
DR
Eastwood
Peter
P
Palmer
Lyle J
LJ
Kirkness
Jason
J
D015502:Absorptiometry, Photon / Q000379:methods / Q000706:statistics & numerical data; D000273:Adipose Tissue; D000886:Anthropometry / Q000379:methods; D001315:Australia; D050218:Body Fat Distribution / Q000379:methods* / Q000706:statistics & numerical data*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D017286:Polysomnography / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D011860:Radiography, Abdominal / Q000379:methods / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012737:Sex Factors; D012891:Sleep Apnea Syndromes / Q000150:complications*; D049629:Waist-Hip Ratio
Int J Obes Relat Metab Disord. 1997 May;21(5):367-71
9152738
Int J Obes Relat Metab Disord. 2002 Jul;26(7):978-83
12080453
J Appl Physiol (1985). 2003 Oct;95(4):1560-6
12832428
Am J Respir Crit Care Med. 1998 Jan;157(1):280-3
9445310
Am J Respir Crit Care Med. 2004 Jun 15;169(12):1314-21
15070816
Am J Clin Nutr. 2003 Nov;78(5):902-3
14594773
Am J Respir Crit Care Med. 2002 May 1;165(9):1217-39
11991871
Anaesthesia. 1987 May;42(5):487-90
3592174
Nutrition. 2008 Jul-Aug;24(7-8):625-31
18485667
Gynecol Endocrinol. 2005 Nov;21(5):295-301
16373250
Nutrition. 1996 Jan;12(1):45-51
8838836
Am J Respir Crit Care Med. 1995 Nov;152(5 Pt 1):1673-89
7582313
JAMA. 2000 Dec 20;284(23):3015-21
11122588
Chest. 2008 Oct;134(4):704-711
18641101
Diabetes. 1996 May;45(5):633-8
8621015
Thorax. 1992 Feb;47(2):101-5
1549815
Thorax. 1999 Apr;54(4):323-8
10092693
Obes Res. 1999 May;7(3):256-64
10348496
Respiration. 2007;74(5):517-24
17148934
Am J Respir Crit Care Med. 2003 May 15;167(10):1427-32
12738600
J Otolaryngol Head Neck Surg. 2008 Dec;37(6):894-900
19128723
Am Rev Respir Dis. 1990 May;141(5 Pt 1):1228-31
2339843
J Appl Physiol (1985). 1996 Jun;80(6):2171-8
8806927
Am J Hum Genet. 2003 Feb;72(2):340-50
12506338
Am J Respir Crit Care Med. 2003 Sep 1;168(5):522-30
12746251
Eur Respir J. 2001 Jan;17(1):79-86
11307760
Sleep. 2003 Nov 1;26(7):851-6
14655919
Int J Obes Relat Metab Disord. 2002 Jul;26(7):984-93
12080454
Curr Opin Pulm Med. 2007 Nov;13(6):484-9
17901753
Thorax. 2005 Jun;60(6):504-10
15923252
Sleep. 2006 Jul;29(7):903-8
16895257
Obes Res. 2000 Jan;8(1):36-42
10678257
Sleep. 1999 Aug 1;22(5):667-89
10450601
Chest. 2002 Sep;122(3):829-39
12226021
Diabetes Care. 1999 Aug;22(8):1310-7
10480776
Int J Obes Relat Metab Disord. 1993 Sep;17(9):533-40
8220656
J Intern Med. 1997 Jan;241(1):11-8
9042088