title: Comparison of polysomnographic and clinical presentations and predictors for cardiovascular-related diseases between non-obese and obese obstructive sleep apnea among Asians.
abstract: BACKGROUND
  Unlike Caucasians, many Asians with obstructive sleep apnea (OSA) are non-obese but are affected by the disease due to predisposing craniofacial structure. Therefore, non-obese and obese OSA may represent different disease entities. The associated risk factors for developing cardiovascular-related diseases, consequently, may be considered separately for the two types of OSA.
  
  
  METHODS
  We reviewed polysomnographic studies performed in adults (aged ≥ 18 years) diagnosed with OSA (respiratory disturbance index [RDI] ≥ 5). We divided the patients into obese (body mass index [BMI] ≥ 25) and non-obese (BMI < 25) groups. We aimed to determine the differences between these two groups in terms of clinical presentations, polysomno-graphic findings, and association with cardiovascular-related diseases including hypertension, diabetes mellitus, coronary artery disease, and/or cerebrovascular disease.
  
  
  RESULTS
  Among 194 patients with OSA (RDI ≥ 5), 63.4% were non-obese and 36.6% were obese. Compared with obese OSA patients, non-obese OSA patients were noted to have smaller neck size, less prevalence of hypertension, and less history of frequent nocturia (> 3-4/week), with equal prevalence of excessive daytime sleepiness. Overall, non-obese OSA patients were noted to have milder disease indicated by lower total, supine, and non-supine, NREM RDI and higher mean and nadir oxygen saturations. In the non-obese group, only total obstructive apnea index (OAI) was noted to be a predictor for developing any of the cardiovascular-related diseases after controlling for age, sex, and RDI (odds ratio = 9.7). However, in the obese OSA group, frequent snoring (> 50% of total sleep time), low sleep efficiency (≤ 90%), and low mean oxygen saturation (< 95%) were noted to be significant predictors of cardiovascular-related diseases (odds ratios = 12.3, 4.2, and 5.2, respectively).
  
  
  CONCLUSIONS
  Among Asians, most OSA patients were not obese. Compared to obese OSA patients, non-obese OSA patients were noted to have less prevalence of hypertension and less history of nocturia. They were also noted to have overall milder OSA. Only OAI was noted to be a significant predictor for cardiovascular-related disease in the non-obese OSA group.
authors.affiliation: Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital/Thai Red Cross Society, Bangkok, Thailand. narichac@hotmail.com
authors.forename: Naricha
authors.initials: N
authors.lastname: Chirakalwasan
authors.forename: Busarakum
authors.initials: B
authors.lastname: Teerapraipruk
authors.forename: Rosalind
authors.initials: R
authors.lastname: Simon
authors.forename: Prakobkiat
authors.initials: P
authors.lastname: Hirunwiwatkul
authors.forename: Nattapong
authors.initials: N
authors.lastname: Jaimchariyatam
authors.forename: Tayard
authors.initials: T
authors.lastname: Desudchit
authors.forename: Natamon
authors.initials: N
authors.lastname: Charakorn
authors.forename: Chaisiri
authors.initials: C
authors.lastname: Wanlapakorn
mesh_terms: D044466:Asian People; D002318:Cardiovascular Diseases / Q000208:ethnology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology*; D017286:Polysomnography; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000208:ethnology*; D013785:Thailand / Q000453:epidemiology
keywords: Obstructive sleep apnea; obesity