Anthropometric Characteristics of Korean Patients with Obstructive Sleep Apnea

Jae Hoon Cho; Ji Ho Choi; Bora Lee; Sue-Jean Mun; Woo Yong Bae; Sung Wan Kim; Seok Hyun Cho

doi:10.18787/jr.2018.25.2.80

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Cho, Choi, Lee, Mun, Bae, Kim, and Cho: Anthropometric Characteristics of Korean Patients with Obstructive Sleep Apnea

ORIGINAL ARTICLE

J Rhinol 2018;25(2):80-85.

Published online: 19 January 2018

DOI: https://doi.org/10.18787/jr.2018.25.2.80

Anthropometric Characteristics of Korean Patients with Obstructive Sleep Apnea

Jae Hoon Cho, MD^1,^∗, Ji Ho Choi, MD^2,^∗, Bora Lee³, Sue-Jean Mun, MD⁴, Woo Yong Bae, MD⁵, Sung Wan Kim, MD^6,, Seok Hyun Cho, MD^7,

¹Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konkuk University, Seoul, Korea

²Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

³Department of Biostatistics, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

⁴Department of Otorhinolaryngology, Pusan National University Yangsan Hospital, Yangsan, Korea

⁵Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Korea

⁶Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School, Kyung Hee University, Seoul, Korea

⁷Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea

Address for correspondence: Seok Hyun Cho, MD, PhD, Departments of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222-Wangshimni-ro, Seongdong-gu, Seoul 04763, Korea Tel: +82-2-2290-8583, Fax: +82-2-2290-8588, E-mail: shcho@hanyang.ac.kr

Address for correspondence: Sung Wan Kim, MD, PhD, Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-958-8471, Fax: +82-2-958-8470, E-mail: drkimsw@hanmail.net

^∗ The first two authors (Jae Hoon Cho and Ji Ho Choi) contributed equally to this work.

Received 18 December 2018 Revised 27 January 2018 Accepted 16 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives:

Obesity is one of the most important risk factors for obstructive sleep apnea (OSA). There is limited evidence regarding the obesity-related anthropometric characteristics of Korean patients.

Materials and Method:

Medical records of 984 patients referred to 3 tertiary referral hospitals for habitual snoring or sleep apnea were analyzed. We defined OSA as apnea-hypopnea index (AHI) ≥5 and analyzed data to determine the anthropometric characteristics of patients with OSA such as neck circumference (NC), waist circumference (WC), hip circumference (HC), and waist to hip ratio (WHR).

Results:

A total of 952 patients (719 men) were included in the analysis. The main findings were: 1) BMI, WC, NC, HC, and WHR were greater among patients with OSA than among controls (AHI ＜5); 2) for both sexes, the proportion of patients with an OSA diagnosis increased with age; it increased steeply for women aged ＞50 years; 3) WC and WHR were most strongly correlated with AHI for men and women, respectively.

Conclusion:

OSA is associated with anthropometric characteristics, although different patterns were observed between men and women. OSA was more strongly associated with NC or WC among men and with WHR among women.

Keywords: obstructive sleep apnea, Body mass index, Neck circumference, Waist circumference, Waist to hip ratio.

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Fig. 1

Frequency of obstructive sleep apnea according to sex and age.

Fig. 2

ROC curves of anthropometric variables for obstructive sleep apnea in men and women.

Table 1.

Sex-specific characteristics of Korean patients with obstructive sleep apnea

Variable	Men			Women
Variable	OSA (n=649)	Simple snorer (n=70)	p	OSA (n=173)	Simple snorer (n=60)	p
Clinical factor
Age (year)	44.8±13.2	36.0±12.3	＜0.001	54.5±11.9	41.0±13.1	＜0.001
Smoking	285 (43.9%)	29 (41.4%)	0.786	4 (2.3%)	5 (8.3%)	0.09
HTN	192 (29.6%)	8 (11.4%)	0.002	61 (35.3%)	3 (5.0%)	＜0.001
DM	62 (9.6%)	2 (2.9%)	0.099	18 (10.4%)	0 (0.0%)	0.02
ESS	8.3±4.5	9.2±4.8	0.141	8.0±5.0	8.4±5.7	0.846
PSQI	7.5±3.4	7.6±3.4	0.738	7.7±3.7	8.4±4.1	0.261
Anthropometry
Weight (kg)	78.4±13.0	71.6±11.0	＜0.001	63.2±11.0	58.2±7.5	0.001
BMI (kg/m²)	26.7±3.8	24.3±3.0	＜0.001	25.9±4.3	23.0±3.2	＜0.001
NC (cm)	39.8±4.3	36.8±3.5	＜0.001	35.5±8.6	34.0±4.0	0.01
WC (cm)	94.2±9.9	87.4±8.3	＜0.001	89.6±9.7	82.1±8.1	＜0.001
HC (cm)	99.7±7.8	96.7±6.5	0.007	97.0±7.3	94.1±6.0	0.005
WHR	0.94±0.06	0.90±0.05	＜0.001	0.92±0.06	0.87±0.06	＜0.001
Sleep index
TST (min)	350.4±72.6	362.4±77.5	0.477	362.5±74.6	339.7±71.8	0.041
SE (%)	84.5±13.4	87.7±10.3	0.077	85.3±11.4	85.7±10.6	0.993
N3 (%)	11.6±11.6	17.6±17.8	0.024	18.0±14.5	17.0±17.5	0.388
REM	16.0±8.3	16.9±8.9	0.276	16.5±7.9	16.8±7.9	0.809
Arousal index	34.3±20.9	11.7±10.2	＜0.001	26.7±16.4	10.0±6.6	＜0.001
Respiratory index
AI	22.5±23.3	0.5±0.6	＜0.001	11.6±16.5	0.5±0.6	＜0.001
HI	13.5±10.6	1.5±1.3	＜0.001	15.4±12.3	1.1±1.2	＜0.001
AHI	35.8±24.7	2.0±1.5	＜0.001	27.0±21.0	1.7±1.5	＜0.001
Supine AHI	46.1±28.5	2.6±2.6	＜0.001	35.2±25.8	2.4±2.2	＜0.001
Minimum SaO₂ (%)	80.7±9.1	90.9±4.1	＜0.001	83.3±7.2	92.0±3.2	＜0.001
Mean SaO₂ (%)	95.0±2.7	96.7±1.1	＜0.001	95.8±1.8	97.4±1.1	＜0.001
ODI3	31.6±25.1	2.1±1.7	＜0.001	22.7±20.8	1.5±1.6	＜0.001

p-values were calculated by independent t-test or Mann-Whitney U test for continuous variables and chi-square test or Fisher's exact test for categorical variables. Data were presented as mean±standard deviation for continuous variables and frequency (percentage) for categorical variables. OSA: obstructive sleep apnea, HTN: hypertension, DM: diabetes mellitus, ESS: Epworth sleepiness scale, PSQI: Pittsburgh sleep quality index, BMI: body mass index, NC: neck circumference, WC: waist circumference, HC: hip circumference, WHR: waist-to-hip ratio, TST: total sleep time, SE: sleep efficiency, N3: non-REM stage 3, REM: rapid eye movement, SaO₂: arterial oxygen saturation, ODI: oxygen desaturation index

Table 2.

Correlation of anthropometric variables with AHI after adjusting age

Parameter	All (n=952)	Men (n=719)	Women (n=233)
BMI	0.495∗∗	0.517∗∗	0.337∗∗
NC	0.283∗∗	0.328∗∗	0.076
WC	0.523∗∗	0.520∗∗	0.342∗∗
HC	0.403∗∗	0.420∗∗	0.188∗
WHR	0.428∗∗	0.385∗∗	0.364∗∗

Values are Pearson's correlation coefficient. ∗: p＜0.01, ∗: p＜0.001. BMI: body mass index, NC: neck circumference, WC: waist circumference, HC: hip circumference, WHR: waist-to-hip ratio

Table 3.

Diagnostic performance for OSA

Variable	Men					Women
Variable	THR∗	SE	SP	AUC (95%CI)	p	THR∗	SE	SP	AUC (95%CI)	p
BMI (kg/m²)	≥23.35	0.54	0.77	0.69 (0.63-0.75)	＜0.001	≥23.15	0.75	0.6	0.72 (0.65-0.80)	＜0.001
NC (cm)	≥36.25	0.87	0.54	0.74 (0.67-0.81)	＜0.001	≥36.90	0.25	0.98	0.61 (0.54-0.68)	0.175
WC (cm)	≥89.25	0.71	0.6	0.7 (0.63-0.76)	＜0.001	≥85.50	0.65	0.68	0.72 (0.65-0.79)	＜0.001
HC (cm)	≥98.30	0.55	0.59	0.6 (0.53-0.67)	0.002	≥95.50	0.58	0.65	0.62 (0.54-0.70)	0.007
WHR	≥0.925	0.65	0.73	0.71 (0.64-0.77)	＜0.001	≥0.935	0.46	0.9	0.75 (0.68-0.81)	＜0.001

Sensitivity and specificity were calculated using the threshold obtained by Youden's index. ∗: The threshold was derived by Youden's index. BMI: body mass index, NC: neck circumference, WC: waist circumference, HC: hip circumference, WHR: waist-hip ratio, SE: sensitivity, SP: specificity, AUC: area under the curve, CI: confidence interval, THR: threshold

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