Original researchAssociation of overweight and obesity with obstructive sleep apnoea: A systematic review and meta-analysis
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?
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Obstructive Sleep Apnoea (OSA) is the most common type of potentially serious sleep disorder.
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The prevalence of OSA in obese patients is nearly twice than that of normal-weight adults.
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Evidence suggests a close relationship of overweight and obesity with OSA
What does this study add?
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Obesity is associated with increased risk of apnea-hypopnea index (AHI).
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Overweight and obesity are important risk factors for OSA in both adults and children.
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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.
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The authors contributed equally to this work.