Download PDF
CC BY-NC-ND 4.0 · Sleep Sci 2019; 12(01): 2-9
DOI: 10.5935/1984-0063.20190048
ORIGINAL ARTICLE

Gender differences in the application of anthropometric measures for evaluation of obstructive sleep apnea

Daniel Ninello Polesel
1   Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
,
Karen Tieme Nozoe
1   Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
,
Sergio Brasil Tufik
1   Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
,
Andreia Gomes Bezerra
1   Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
,
Maria Teresa Bechere Fernandes
2   Universidade de São Paulo, Departamento de Pediatria - São Paulo - São Paulo - Brazil.
,
Lia Bittencourt
1   Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
,
Sergio Tufik
2   Universidade de São Paulo, Departamento de Pediatria - São Paulo - São Paulo - Brazil.
,
Monica Levy Andersen
1   Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
,
Helena Hachul
1   Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
› Author Affiliations
› Further Information
Also available at
  Permissions and Reprints

This study aims to investigate anthropometric measures and their effectiveness as screening method for diagnosing obstructive sleep apnea (OSA) in each gender. We also evaluated which measures were associated with OSA in the adult population of a large metropolitan city, Sao Paulo, Brazil. 552 women and 450 men were submitted to polysomnography (PSG), and the anthropometric measurements as body mass index (BMI), waist-to-height ratio, neck and waist circumference were collected. The measurements were then compared with the OSA classification established by the PSG. In women, waist circumference and waist-to-height ratio were found to be the best predictor, while in men, the factors with great potential for identification varied according to severity of the disease, highlighting waist-to-height ratio, neck circumference and BMI had strongest association. The accuracy of the classification in relation to mild-to-severe OSA based on cut-off values of 92.5cm for waist circumference was greater than 72.9% in men, and 78.9% in women based on cut off values of 95cm. Regarding severe OSA, cut-off values of 116.1cm were greater than 91.3% accurate in the male population, and 95.1% in the female population with a cut-off value of 126.5cm. The study found waist circumference and waist-to-height ratio to be the best measure to assess sleep-disordered breathing in women. Waist-to-height ratio and neck circumferences were the best measures in men with mild OSA, but BMI was more closely associated with severe OSA. The present study identified the anthropometric variables with the highest risk for OSA and their respective cutoff value, according to gender.

Sleep - Abdominal Obesity - Body Mass Index - Waist Circumference - Waist-Height Ratio


Publication History

Received: 29 November 2017

Accepted: 25 November 2018

Article published online:
31 October 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • REFERENCES

  • 1 Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010;11(5):441-6.
  • 2 Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22(5):667-89.
  • 3 Black J. Sleepiness and residual sleepiness in adults with obstructive sleep apnea. Respir Physiol Neurobiol. 2003;136(2-3):211-20.
  • 4 Ljunggren M, Byberg L, Theorell-Haglöw J, Lindahl B, Michaëlsson K, Lindberg E. Increased risk of heart failure in women with symptoms of sleep-disordered breathing. Sleep Med. 2016;17:32-7.
  • 5 Drager LF, Lorenzi-Filho G. CPAP for obstructive sleep apnea and the metabolic syndrome. N Engl J Med. 2012;366(10):964.
  • 6 Kapur V, Blough DK, Sandblom RE, Hert R, de Maine JB, Sullivan SD, et al. The medical cost of undiagnosed sleep apnea. Sleep. 1999;22(6):749-55.
  • 7 Wittmann V, Rodenstein DO. Health care costs and the sleep apnea syndrome. Sleep Med Rev. 2004;8(4):269-79.
  • 8 Pillar G, Shehadeh N. Abdominal fat and sleep apnea: the chicken or the egg? Diabetes Care. 2008;31 Suppl 2:S303-9.
  • 9 World Health Organization - WHO. Obesity and overweight. Geneva: World Health Organization; 2016.
  • 10 Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA. 2003;289(14):1785-91.
  • 11 Wolk A, Gridley G, Svensson M, Nyrén O, McLaughlin JK, Fraumeni JF, et al. A prospective study of obesity and cancer risk (Sweden). Cancer Causes Control. 2001;12(1):13-21.
  • 12 Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76-9.
  • 13 Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002;287(3):356-9.
  • 14 Onat A, Hergenç G, Yüksel H, Can G, Ayhan E, Kaya Z, et al. Neck circumference as a measure of central obesity: associations with metabolic syndrome and obstructive sleep apnea syndrome beyond waist circumference. Clin Nutr. 2009;28(1):46-51.
  • 15 Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz GA, Stampfer MJ, et al. Abdominal adiposity and coronary heart disease in women. JAMA. 1998;280(21):1843-8.
  • 16 Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004;79(3):379-84.
  • 17 Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295(13):1549-55.
  • 18 Santos-Silva R, Tufik S, Conway SG, Taddei JA, Bittencourt LR. Sao Paulo Epidemiologic Sleep Study: rationale, design, sampling, and procedures. Sleep Med. 2009;10(6):679-85.
  • 19 Korn EL, Graubard BI. Analyses of health surveys. Hoboken: John Wiley & Sons; 1999.
  • 20 International Classification of Sleep Disorders: Diagnostic and Coding Manual (ICSD-2). 2nd ed. Westchester: American Academy of Sleep Medicine; 2005.
  • 21 Rechtschaffen A, Kales A, eds. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles: University of California Los Angeles Brain Information Service;1968.
  • 22 Iber C, Ancoli-Israel S, Cheeson A, Quan SF. The AASM manual for scoring of sleep associated events: rules, terminology and techical specifications. Wetchester: American Academy of Sleep Medicine; 2007.
  • 23 Polesel DN, Nozoe KT, Decleva DVL, Tufik S, Andersen ML. Obesity, dyslipidemia, and sleep disorders: complexity requires complementary analysis. Chest. 2013;143(4):1187-8.
  • 24 Kawaguchi Y, Fukumoto S, Inaba M, Koyama H, Shoji T, Shoji S, et al. Different impacts of neck circumference and visceral obesity on the severity of obstructive sleep apnea syndrome. Obesity (Silver Spring). 2011;19(2):276-82.
  • 25 Polesel DN, Okazaki KM, Nozoe KT, Andersen ML, Tufik S. Obstructive sleep apnea as a potential confounding factor in atherosclerosis in the Asian population. J Neurol Sci. 2014;346(1-2):333-4.
  • 26 Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116(1):39-48.
  • 27 Marcouiller F, Boukari R, Laouafa S, Lavoie R, Joseph V. The nuclear progesterone receptor reduces post-sigh apneas during sleep and increases the ventilatory response to hypercapnia in adult female mice. PLoS One. 2014;9(6):e100421.
  • 28 Polesel DN, Hirotsu C, Nozoe KT, Boin AC, Bittencourt L, Tufik S, et al. Waist circumference and postmenopause stages as the main associated factors for sleep apnea in women: a cross-sectional population-based study. Menopause. 2015;22(8):835-44.
  • 29 Naimark A, Cherniack R. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol. 1960;15:377-82.
  • 30 Hoffstein V, Zamel N, Phillipson EA. Lung volume dependence of pharyngeal cross-sectional area in patients with obstructive sleep apnea. Am Rev Respir Dis. 1984;130(2):175-8.
  • 31 Whittle AT, Marshall I, Mortimore IL, Wraith PK, Sellar RJ, Douglas NJ. Neck soft tissue and fat distribution: comparison between normal men and women by magnetic resonance imaging. Thorax. 1999;54(4):323-8.
  • 32 Brown LK. A waist is a terrible thing to mind: central obesity, the metabolic syndrome, and sleep apnea hypopnea syndrome. Chest. 2002;122(3):774-8.
  • 33 Davidson TM, Patel MR. Waist circumference and sleep disordered breathing. Laryngoscope. 2008;118(2):339-47.
  • 34 Song X, Jousilahti P, Stehouwer CD, Söderberg S, Onat A, Laatikainen T, et al.; DECODE Study Group. Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity in Europeans. Nutr Metab Cardiovasc Dis. 2015;25(3):295-304.
  • 35 Examination Committee of Criteria for ‘Obesity Disease’ in Japan; Japan Society for the Study of Obesity. New criteria for ‘obesity disease’ in Japan. Circ J. 2002;66(11):987-92.
  • 36 Luchnikova E, Shchekotov V. 7a.05: Visceral fat level determined using the bioelectrical impedance as a method to assess obstructive sleep apnea risk. J Hypertens. 2015;33 Suppl 1:e90.
  • 37 Simpson L, Mukherjee S, Cooper MN, Ward KL, Lee JD, Fedson AC, et al. Sex differences in the association of regional fat distribution with the severity of obstructive sleep apnea. Sleep. 2010;33(4):467-74.
  • 38 Kritikou I, Basta M, Tappouni R, Pejovic S, Fernandez-Mendoza J, Nazir R, et al. Sleep apnoea and visceral adiposity in middle-aged male and female subjects. Eur Respir J. 2013;41(3):601-9.
  • 39 Mazzuca E, Battaglia S, Marrone O, Marotta AM, Castrogiovanni A, Esquinas C, et al. Gender-specific anthropometric markers of adiposity, metabolic syndrome and visceral adiposity index (VAI) in patients with obstructive sleep apnea. J Sleep Res. 2014;23(1):13-21.
  • 40 Hirotsu C, Bittencourt L, Garbuio S, Andersen ML, Tufik S. Sleep complaints in the Brazilian population: Impact of socioeconomic factors. Sleep Sci. 2014;7(3):135-42.