Elsevier

Obesity Medicine

Volume 17, March 2020, 100185
Obesity Medicine

Original research
Association of overweight and obesity with obstructive sleep apnoea: A systematic review and meta-analysis

https://doi.org/10.1016/j.obmed.2020.100185Get rights and content

Highlights

  • This was the first study to examine the magnitude of association of overweight and obesity in different population groups.

  • Obesity is significantly associated with increased risk of apnoea-hypopnea index (AHI).

  • Overweight and obesity are important risk factors for OSA in both adults and children.

Abstract

Background

Research evidence suggests a close relationship between overweight and obesity with obstructive sleep apnoea (OSA); however, the extent of this relationship among different population groups is relatively unknown. The aim of this paper was to conduct a systematic review and meta-analysis to determine the magnitude of association of overweight and obesity with OSA in different population groups.

Methods

We searched five electronic databases (Medline, Embase, Cochrane Library, CBM and CNKI) from inception to December 2017 for comparative epidemiological studies assessing the relation between overweight and obesity with OSA. Studies were included if they reported OSA by polysomnography and overweight/obesity by body mass index. Two authors independently screened titles and abstracts, selected studies and extracted data. Study quality was assessed using the Newcastle-Ottawa Scale. Random effects meta-analysis was used to estimate pooled effect sizes with 95% confidence intervals (CI). Heterogeneity was examined using Cochrane's Q statistic and I2 test and explored using subgroup analyses for adults and children, adjusting for potential confounders. Publication bias was assessed using a funnel plot.

Results

Twelve case-control studies encompassing a total of 3214 participants (Obese group n = 773, Non-Obese group n = 315; OSA group n = 1742, Non-OSA group n = 384) were analyzed. Results showed that increased body mass index was associated with higher risk of OSA in the adult group. The Obese group was associated with increased risk of apnoea-hypopnoea index (AHI) compared to the Non-Obese group and the differences were statistically significant in both children (Mean Difference = 12.29; 95% CI 8.46–16.11; P < 0.00001) and adults (Mean Difference = 12.11; 95% CI 4.35–19.85; P = 0.002).

Conclusions

These findings suggest that overweight and obesity are important risk factors for OSA in both adults and children. Future studies are required to determine the effects of weight loss interventions in the development of obesity-related OSA.

Introduction

Obstructive sleep apnoea (OSA) is the most common serious sleep disorder globally with prevalence between 9% and 38% in the general population (Senaratna et al., 2017). OSA is characterized by repeated episodes of upper airway obstruction during sleep, resulting in repetitive hypoxemia and intermittent pauses in breathing causing oxygen desaturation, arousal from sleep and excessive daytime sleepiness (Yaggi et al., 2005; Adams et al., 2012). People with OSA are often unaware of their condition. Long-term suffering from OSA can lead to hypertension, cardiovascular disease, stroke, diabetes, abnormal glucose metabolism, and sudden-death during sleep (Iqbal et al., 2008; Punjabi, 2008).

There are well identified risk factors for OSA; prevalence of OSA increases in elderly populations, male populations and in those who are overweight or obese (Senaratna et al., 2017). Links between increased weight and OSA have been well established in both children and adults. In children, obesity and morbid obesity increase the severity of OSA (Scott et al., 2016; Tamanyan et al., 2016) with prevalence of OSA in obese children and adolescents ranging from 46 to 60% (Verhulst et al., 2008; Marcus et al., 1996). In obese adults, prevalence of OSA is nearly double (Peppard et al., 2000; Romero-Corral et al., 2010) or higher (Quintas et al., 2013) compared to those who are normal weight. Underlying mechanisms of OSA in overweight people include airway narrowing caused by increased neck circumference and airway obstruction caused from relaxed tongue soft tissue and throat muscles during sleep (Ma et al., 2016; Stuck and Maurer, 2017).

As obesity rates have increased to pandemic levels (World Health Organization, 2019), conjointly OSA will also burden both people who are overweight or obese and in turn, the healthcare system. Although several studies have been conducted examining the prevalence and risk factors of OSA, the association between overweight and obesity in different population groups such as children with OSA has not been well-established. Additionally, over time there has been changes and advances in respiratory measurement techniques and classification which makes comparison between study outcomes difficult (Force, 1999; BaHammam et al., 2014). We therefore performed a systematic review and meta-analysis to clarify and quantify the association between overweight and obesity with OSA in different population groups.

Section snippets

Methods

This systematic review was conducted and reported in accordance with the Cochrane Collaboration reporting items for systematic reviews and meta-analysis guidelines (Egger et al., 2001; Stroup et al., 2000).

Data sources and search strategy: Relevant literature was searched from five electronic databases (PubMed, Embase, Cochrane Library, CBM- China Biological Medicine Database, and CNKI- Chinese National Knowledge Infrastructure Database) using Medical Subject Heading and keywords. The following

Results

Study selection and description: A total of 771 studies were identified: 107 from PubMed, 295 from EMBASE, 18 from CENTRAL, and 351 from Chinese Databases (CBM-Chinese Biological Medicine Database and CNKI- China National Knowledge Infrastructure) (Fig. 1). After title and abstract screening, 705 studies were excluded and 66 potentially studies were selected for full-text review. A further 52 studies were excluded after full-text evaluation due to study design (i.e., case series, non-related

BMI in OSA group versus Non-OSA group

Children group: There was a single study with 76 OSA cases in children. The fixed-effects model showed no statistically significant difference in BMI (MD = 0.05; 95% CI -0.33–0.43; P = 0.80).

Adult group: Seven studies including a total of 2050 participants (1688 cases and 362 controls) with OSA versus Non-OSA were included for analysis. Heterogeneity was high using fixed-effects model (Chi-square = 309.93, P < 0.00001; I2 = 98%). A sensitivity analysis was performed to estimate the stability of

Discussion

Overall, results from our meta-analysis showed that overweight and obesity are closely associated with OSA, and that obesity is an important risk factor for OSA. The association between obesity and OSA were separate into two sets of observations, one with high prevalence of OSA among obese, and the other with high proportion of obese participants with OSA. There were no differences in BMI between the OSA and Non-OSA groups in children, but BMI was significantly associated with increased risk of

What is already known about this subject?

  • Obstructive Sleep Apnoea (OSA) is the most common type of potentially serious sleep disorder.

  • The prevalence of OSA in obese patients is nearly twice than that of normal-weight adults.

  • Evidence suggests a close relationship of overweight and obesity with OSA

What does this study add?

  • Obesity is associated with increased risk of apnea-hypopnea index (AHI).

  • Overweight and obesity are important risk factors for OSA in both adults and children.

  • Preventing and managing obesity may have a role in reducing obesity-related OSA.

CRediT authorship contribution statement

Zhiyong Dong: Conceptualization, Methodology, Formal analysis, Investigation, Writing - original draft, Writing - review & editing. Xiling Xu: Conceptualization, Methodology, Formal analysis, Investigation, Writing - original draft. Cunchuan Wang: Conceptualization, Methodology, Writing - original draft, Supervision, Project administration. Susie Cartledge: Writing - original draft, Writing - review & editing, Visualization. Ralph Maddison: Writing - review & editing, Supervision. Sheikh

Declaration of competing interest

The authors have no conflicts of interest to declare.

Acknowledgments

The authors thank Jun Bai, the Affiliated Hospital of Jinan University for supporting this study.

References (56)

  • C.P. Wilhelm

    The nose, upper airway, and obstructive sleep apnea

    Ann. Allergy Asthma Immunol.

    (2015)
  • Z. Xu

    A case-control study of obstructive sleep apnea-hypopnea syndrome in obese and nonobese Chinese children

    Chest

    (2008)
  • R. Adams

    High prevalence of undiagnosed OSA in a community sample of men aged 40 years and over

    Sleep Biol. Rhythm.

    (2012)
  • A.S. BaHammam

    A comparison between the AASM 2012 and 2007 definitions for detecting hypopnea

    Sleep Breath.

    (2014)
  • D. Baltzis

    Obstructive sleep apnea and vascular diseases

    Compr. Physiol.

    (2011)
  • J.G. Barone

    Nocturnal enuresis and overweight are associated with obstructive sleep apnea

    Pediatrics

    (2009)
  • O.K. Basoglu

    Obstructive sleep apnea syndrome and gastroesophageal reflux disease: the importance of obesity and gender

    Sleep Breath.

    (2015)
  • L. Bazzano

    Childhood obesity patterns and relation to middle‐age sleep apnoea risk: the Bogalusa Heart Study

    Pediatr. Obes.

    (2016)
  • [Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents]

    Zhonghua Liuxingbingxue Zazhi

    (2004)
  • X. Deng

    Age-group-specific associations between the severity of obstructive sleep apnea and relevant risk factors in male and female patients

    PLoS One

    (2014)
  • E. Dilektasli et al.

    Laparoscopic sleeve gastrectomy improves excessive daytime sleepiness and sleep quality 6 Months following surgery: a prospective cohort study

    Adv. Ther.

    (2016)
  • M. Egger et al.

    Systematic Reviews of Observational Studies. Systematic Reviews in Health Care: Meta‐analysis in Context

    (2001)
  • A.A.o.S.M.T. Force

    Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research

    Sleep

    (1999)
  • C.L. Hanis

    Beyond type 2 diabetes, obesity and hypertension: an axis including sleep apnea, left ventricular hypertrophy, endothelial dysfunction, and aortic stiffness among Mexican Americans in Starr County, Texas

    Cardiovasc. Diabetol.

    (2016)
  • M. Iqbal

    Obesity, obstructive sleep apnea, and cardiovascular risk

    Curr. Cardiovasc. Risk Rep.

    (2008)
  • S. Jalilolghadr

    Sleep architecture and obstructive sleep apnea in obese children with and without metabolic syndrome: a case control study

    Sleep Breath.

    (2016)
  • K. Johansson

    Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial

    BMJ

    (2009)
  • J. JP

    The effect on plasma inflammatory markers of obstructive sleep apnea hypopnea syndrome in obese

    Chin. J. Gen. Pract.

    (2014)
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    The authors contributed equally to this work.

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