Do Patients with Obstructive Sleep Apnea Have Thick Necks?

Katz, Ian; Stradling, John; Sljutsky, A. S.; Zamel, Noé; Hoffstein, V.

doi:10.1164/ajrccm/141.5_pt_1.1228

Cited by 277 publications

(189 citation statements)

References 3 publications

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“…Accumulation of adipose tissue in the neck and enlarged neck have been proposed as possible causes of OSA in obese patients. 34 Neck circumference was a better predictor of RDI than waist circumference, and this result is apparently opposite to that reported by Grunstein et al in obese men. 26 However, it is notable that these authors investigated overweight and moderately obese patients, whereas we investigated severely obese patients; therefore, it is possible that waist circumference looses and neck circumference maintains its predictive power on sleep apnea in very fat men.…”

Section: Discussioncontrasting

confidence: 64%

Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects

et al. 2001

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OBJECTIVE:To investigate the prevalence of sleep breathing disorders, loud snoring and excessive daytime sleepiness in a group of obese subjects, and to identify the predictors of obstructive sleep apnea (OSA) severity in these patients. SUBJECTS: A total of 161 consecutive obese patients (body mass index (BMI) ! 30.0 kgam 2 ), ranging between 30.0 and 67.3, represented by 57 men and 104 women, aged 16 ± 75 y. Forty (15 men and 25 women) age-matched (20 ± 70 y) nonobese (BMI`27 kgam 2 ) volunteers were also recruited for the study. MEASUREMENTS: Respiratory function parameters, nocturnal sleep quality (evaluated by a speci®c questionnaire), nocturnal hypoventilation and OSA (evaluated by night polysomnography) were examined in all subjects. Anthropometric parameters (neck circumference, waist circumference, waist-to-hip ratio) were also investigated. RESULTS: Eighty-three obese patients (51.5% of the obese group) had a respiratory disturbance index (RDI) ! 10, corresponding to a moderate or severe sleep apnea. In particular, 24.8% (40a161), ie a quarter of all obese patients, were affected by severe OSA and this alteration was present in 42.1% of obese men (24a57) and in 15.4% (16a104) of obese women. When a stepwise multiple regression analysis was performed, neck circumference in men and BMI in women were shown to be the strongest predictors of sleep apnea. Twenty-nine percent of all obese subjects (40.3% of men and 23.1% of women) showed nocturnal hypoventilation; however, it was present as a unique breathing alteration in only 5% of the obese population. The percentage of patients having excessive daytime sleepiness was signi®cantly higher than in nonobese subjects, even when only nonapneic obese patients were considered (P`0.001). CONCLUSION: This study shows that OSA is present in more than 50% of a population of obese patients with a mean BMI higher than 40.0, this percentage being much higher than that commonly reported in previous studies, particularly in women. Neck circumference in men and BMI in women seem to be the strongest predictors of the severity of OSA in obese patients. Nocturnal hypoventilation seems to be present in more than 29% of a severe obese population. Moreover, this study indicates that morbid obesity can be associated with excessive daytime sleepiness even in the absence of sleep apnea.

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Section: Discussioncontrasting

confidence: 64%

Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects

et al. 2001

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“…Similar increased fat deposition in the neck may explain why, in our sample, men had larger neck circumferences than women at similar BMIs. Such fat deposition has been associated with the development of SAHS [20][21][22]. It is noteworthy that the differences in neck circumference between the sexes were similar at all body masses and that it was not merely that obese men had larger necks while thin men and women had similar neck sizes.…”

Section: Discussionmentioning

confidence: 95%

The effect of age, sex, obesity and posture on upper airway size

Martin¹,

Mathur²,

Marshall³

et al. 1997

Eur Respir J

282

166

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Most patients with sleep apnoea/hypopnoea syndrome (SAHS) are middle-aged men. As there are conflicting data on the effects of age and gender on upper airway calibre, we tested the hypothesis that increasing age and the male sex predispose to upper airway narrowing in normal subjects.We measured upper airway calibre using acoustic reflection in 60 men and 54 women (median 35, range 16-74 yrs) both seated and supine.All upper airway dimensions, except oropharyngeal junction (OPJ), decreased with increasing age in both men and women (r>-0.24, p≤0.05) while supine (r 2 >0.06). Men had greater changes in airway area at OPJ on lying down (mean (SEM) 0.5 (0.1), 0.2 (0.1) cm 2 ; p<0.02). Men had greater body mass indices (mean (SD) 26 (4), 24 (4) kg·m -2 ; p=0.04), and larger neck circumferences (mean (SD) 38 (3), 33 (2) cm; p<0.0001) than women. For any body mass index, neck circumference was larger in men than women (p<0.001).This study shows that upper airway size decreases with increasing age in both men and women, and that men have greater upper airway collapsibility on lying down at oropharyngeal junction than women. Eur Respir J 1997; 10: 2087-2090 The effects of age and gender on upper airway calibre are unclear. Clarification of their influences is important because the clinical condition associated with upper airway narrowing, the sleep apnoea/hypopnoea syndrome (SAHS), is predominantly a condition of middle-aged men [1]. BROOKS and STROHL [2] reported men to have larger upper airway calibre than women when seated and awake. Studies performed in the sitting position have indicated that upper airways resistance increases, and pharyngeal area decreases [3] with age in men but not in women. In contrast, computed tomography (CT) scan studies in supine men have shown no age-related increase in upper airway collapsibility in men [4]. In order to clarify this, we tested the hypothesis that increasing age and the male sex predispose to upper airway narrowing in the normal population. Methods SubjectsWe aimed to select a cross section of the local population and therefore recruited 60 male and 54 female subjects from the hospital workforce using an advertisement that did not refer to sleep. Their height, weight and neck circumference at the cricothyroid membrane were measured (table 1). Subjects were asked whether they snored and in which position, and whether they suffered from uncontrollable daytime sleepiness. Responses were noted but no one was excluded from the analysis as this was a population-based study. However, subjects with gross retrognathia were assessed clinically and excluded from the analysis. The study was approved by the local Ethics Advisory Committee.

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“…[34][35][36][37] Katz et al 38 found that BMI, age and NC are significant predictors of OSAS. The incidence of OSAS peaks in the age group 50-60 years, but in individuals with a high BMI, this trend tends to peak in the age group 40-50.…”

Section: Discussionmentioning

confidence: 99%

“…It is a fact, however, that OSAS can affect individuals in any age group. 2,6,14,38 The presence of only one population sample profile, such as obesity, limits the study with respect to comparing anthropometric characteristics with the risk of developing OSAS. Nevertheless, we were able to detect that minimal variations in BMI, neck circumference, waist circumference, and waist-to-hip ratio may alter the risk of developing OSAS: the higher these values, the greater the risk of developing OSAS.…”

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea syndrome among obese individuals: A cross-sectional study

Modena

Cazzo

Cândido

et al. 2017

Rev. Assoc. Med. Bras.

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Introduction: The obstructive sleep apnea syndrome (OSAS) is a respiratory illness, characterized by recurrent episodes of apnea and hypopnea, leading to reduction or cessation of the airflow. Obesity is one of the major risk factors for the development of OSAS. To help in the diagnosis of this disease, easily applicable and low-cost questionnaries were developed, such as the Berlin Questionnaire (BQ). Objective: To evaluate the efficacy of the BQ for the screening of OSAS among candidates to bariatric surgery in a multidisciplinary preoperative program. Method: This is an observational, descriptive and cross-sectional study which evaluated obese individuals that were being prepared for bariatric surgery by means of the BQ. Results: BQ was able to detect that minimal variations in the body mass index, neck circumference and hip-to-waist ratio lead to changes in the risk to develop OSAS; the higher the values of these variables, the higher the risk for OSAS development. Conclusion: BQ was an efficient and reliable tool to demonstrate the high risk for OSAS development in individual with obesity.

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Do Patients with Obstructive Sleep Apnea Have Thick Necks?

Cited by 277 publications

References 3 publications

Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects

Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects

The effect of age, sex, obesity and posture on upper airway size

Obstructive sleep apnea syndrome among obese individuals: A cross-sectional study

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