title: The Impact of Sleep-Disordered Breathing on Body Mass Index (BMI): The Sleep Heart Health Study (SHHS).
abstract: INTRODUCTION: It is well known that obesity is a risk factor for sleep-disordered breathing (SDB). However, whether SDB predicts increase in BMI is not well defined. Data from the Sleep Heart Health Study (SHHS) were analyzed to determine whether SDB predicts longitudinal increase in BMI, adjusted for confounding factors.  METHODS: A full-montage unattended home polysomnogram (PSG) and body anthropometric measurements were obtained approximately five years apart in 3001 participants. Apnea-hypopnea index (AHI) was categorized using clinical thresholds: < 5 (normal), ≥ 5 to <15 (mild sleep apnea), and ≥ 15 (moderate to severe sleep apnea). Linear regression was used to examine the association between the three AHI groups and increased BMI. The model included age, gender, race, baseline BMI, and change in AHI as covariates.  RESULTS: Mean (SD) age was 62.2 years (10.14), 55.2% were female and 76.1% were Caucasian. Five-year increase in BMI was modest with a mean (SD) change of 0.53 (2.62) kg/m(2) (p=0.071). A multivariate regression model showed that subjects with a baseline AHI between 5-15 had a mean increase in BMI of 0.22 kg/m(2) (p=0.055) and those with baseline AHI ≥ 15 had a BMI increase of 0.51 kg/m(2) (p<0.001) compared to those with baseline AHI of <5.  CONCLUSION: Our findings suggest that there is a positive association between severity of SDB and subsequent increased BMI over approximately 5 years. This observation may help explain why persons with SDB have difficulty losing weight.
authors.affiliation: Department of Psychiatry, Kaiser Permanente, Portland, OR ( markbrownmd@gmail.com ).
authors.forename: Mark A
authors.initials: MA
authors.lastname: Brown
authors.forename: James L
authors.initials: JL
authors.lastname: Goodwin
authors.forename: Graciela E
authors.initials: GE
authors.lastname: Silva
authors.forename: Ajay
authors.initials: A
authors.lastname: Behari
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
authors.forename: Helaine E
authors.initials: HE
authors.lastname: Resnick
authors.forename: John A
authors.initials: JA
authors.lastname: Robbins
authors.forename: Stuart F
authors.initials: SF
authors.lastname: Quan