Chest
Volume 107, Issue 2, February 1995, Pages 362-366
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Clinical Investigations: Sleep and Breathing
Body Fat Distribution and Sleep Apnea Severity in Women

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The contribution of body fat distribution to sleep-disordered breathing in women has not been examined in detail (to our knowledge). Fifty women under 65 years of age were diagnosed as having obstructive sleep apnea (OSA) by all-night polysomnography in a 6-month period. Twenty-five women underwent body fat measurements of skin folds and circumferences. The 12 premenopausal and 13 postmenopausal women did not differ in regard to apnea hypopnea index (AHI), SaO2 nadir, body mass index (BMI), or anthropometric measurements. The AHI for these 25 patients was related to the severity of obesity assessed by triceps and subscapular skin folds, the sum of the skin folds, waist circumference, and BMI. The SaO2 nadir correlated with triceps and subscapular skin folds, the sum of the skin folds, and neck skin fold. Clinical features of this same group of 25 women were then compared with those of 45 men with OSA previously described by our laboratory. The women, despite similar age, had less severe OSA than the men (AHI of 34.4±5.4 vs 51.1±4.9, p<0.05). Despite similar BMIs and waist circumference, the men had evidence of a greater degree of upper body obesity with a larger subscapular skin fold thickness, waist-hip ratio, and neck circumference. In addition, for a given degree of upper-body obesity, men had more severe sleep apnea. These findings may explain, at least in part, the greater severity of OSA in the men.

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METHODS

All women 18 to 65 years of age were eligible to be candidates for the study if they had been given a diagnosis of OSA by all-night polysomnography at the Sleep Disorders Center of Rhode Island Hospital during the period from January to June 1992. All subjects had been referred for the evaluation of daytime sleepiness, loud snoring, or observed apneas during sleep. Women were classified as premenopausal if they were still having menstrual periods, and postmenopausal if both ovaries had been

RESULTS

Of the 117 women in this age range examined in our laboratory during this 6-month evaluation period, 50 were diagnosed as having OSA. The characteristics of this group were as follows: age, 46.6±1.4 years (mean ± SEM); BMI, 37.0±1.3 kg/m2; AHI, 37.0±4.0 events per hour; and SaO2 nadir, 84.7± 1.3%. All the women were white. Half of the women were actively menstruating; the other half were postmenopausal. Menopause had been induced surgically in nine of the women (36%). Only four of the women

DISCUSSION

In this study, we attempted to define the pattern of fat distribution in our female patients with OSA and also tried to determine whether there were any correlations between fat distribution and disease severity. Our female patients with OSA had, in general, higher BMIs and a greater degree of body fat as measured by skin fold sum than the general population described in the NHANES studies. Furthermore, this study demonstrated that upper-body obesity is a significant correlate of sleep apnea

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Manuscript revision accepted May 27.

Reprint requests: Dr. Millman, Div. of Pulmonary and Critical Care Medicine, APC-479A, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903

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