title: The prevalence and severity of obstructive sleep apnea in severe obesity: the impact of ethnicity.
abstract: OBJECTIVE
  The South Asian population is at increased risk of cardiovascular disease. We compared the prevalence and severity of obstructive sleep apnea (OSA) in South Asians and white Europeans with severe obesity.
  
  
  METHODS
  Data from consecutive patients attending a specialist weight management service were analyzed. Self-reported age, gender, and ethnicity were recorded. Objective measurements of blood pressure, body mass index (BMI), and apneahypopnea index (AHI) were also acquired.
  
  
  RESULTS
  A total of 308 patients (72.7% women; 13% South Asian) were included, with mean age and BMI of 46 ± 12 y and 49 ± 8 kg/m2, respectively. South Asians had significantly increased prevalence of OSA compared to white Europeans (85% vs. 66% [p = 0.017]) and were more likely to have severe OSA (42.5% vs. 21.6% [p = 0.015]). South Asians had significantly higher median AHI (24 events/h: interquartile range [IQR] 9.3-57.6 vs. 9 events/h: IQR 3.4-26.6; p < 0.01), significantly lower minimum oxygen saturation (76%: IQR 64% to 84% vs. 83%: IQR 77% to 87%; p < 0.01), and spent a significantly greater amount of time < 90% oxygen saturation (8.4%: IQR 1.0% to 24.3% vs. 2.4%: IQR 0.2% to 16.0%; p = 0.03). South Asian ethnicity, independent of demographics, BMI, and comorbidities, was associated with β = 1.84 (95% CI: 1.27-2.65) increase in AHI+1 compared to white Europeans. Furthermore, we confirmed other independent OSA risk factors including increasing age, BMI, and male gender (all p < 0.001).
  
  
  CONCLUSIONS
  Severely obese South Asians had significantly greater prevalence and severity of OSA than white Europeans. OSA may contribute to increased cardiovascular risk in South Asians compared to white Europeans with severe obesity. Mechanisms mediating the observed associations between these ethnicities require further investigation.
authors.affiliation: School of Clinical and Experimental Medicine and Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, UK.
authors.forename: Wen Bun
authors.initials: WB
authors.lastname: Leong
authors.forename: Teresa
authors.initials: T
authors.lastname: Arora
authors.forename: David
authors.initials: D
authors.lastname: Jenkinson
authors.forename: Ajit
authors.initials: A
authors.lastname: Thomas
authors.forename: Vikas
authors.initials: V
authors.lastname: Punamiya
authors.forename: Dev
authors.initials: D
authors.lastname: Banerjee
authors.forename: Shahrad
authors.initials: S
authors.lastname: Taheri
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000208:ethnology*; D017286:Polysomnography; D015995:Prevalence; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000208:ethnology* / Q000209:etiology; D044465:White People / Q000706:statistics & numerical data
keywords: Ethnicity; South Asian; diabetes mellitus; obstructive sleep apnea; sleep disordered breathing