Abstract


BACKGROUND. Obesity is associated with numerous metabolic abnormalities including insulin resistance, hypertension, dyslipidemia, and fatty liver disease, leading to accelerated cardiovascular disease (CVD). The prevalence of obstructive sleep apnea (OSA) increases with obesity, and OSA is linked to increased CVD risk. Proposed mechanisms by which OSA negatively impacts the cardiovascular system include hypoxemia, sleep disruption, activation of the sympathetic nervous system, and inflammatory activation, all factors implicated in the mediation of obesity-related complications. view more

BACKGROUND. Obesity is associated with numerous metabolic abnormalities including insulin resistance, hypertension, dyslipidemia, and fatty liver disease, leading to accelerated cardiovascular disease (CVD). The prevalence of obstructive sleep apnea (OSA) increases with obesity, and OSA is linked to increased CVD risk. Proposed mechanisms by which OSA negatively impacts the cardiovascular system include hypoxemia, sleep disruption, activation of the sympathetic nervous system, and inflammatory activation, all factors implicated in the mediation of obesity-related complications. We hypothesized that if OSA contributes to CVD, then obese individuals with OSA will have more cardio-metabolic abnormalities compared to those without OSA.
METHODS: We prospectively recruited successive patients with obesity undergoing bariatric surgery that had formal testing for OSA with polysomnography. Subjects were stratified by the absence (negative polysomnography) or presence (positive polysomnography or use of continuous positive airway pressure CPAP) of OSA, and each group was further analyzed for the presence of cardio-metabolic abnormalities: hypertension, type 2 diabetes mellitus/pre diabetes, dyslipidemia and elevated liver function tests. RESULTS: 83 subjects with obesity (BMI 48.6±8.8 kg/m2) were included in the analyses: 57 (68.7%) patients had OSA and 26 (31.3%) patients did not have OSA. While 78.9% of patients with OSA and 53.3% without OSA had ≥2 metabolic abnormalities (ᵪ2= 5.47, p<0.02), when adjusted for age and BMI the difference was nonsignificant (p=0.36). Among all metabolic complications, HTN was the most frequent in patients with OSA (ᵪ2= 6.70; p-value=0.01), but when adjusted for age and BMI the difference was also nonsignificant (p=0.29).
CONCLUSION:  OSA is not independently associated with overall cardio-metabolic health in patients with obesity.  The strongest predictors of overall metabolic health were age and BMI, so that with higher BMI and more advanced age individuals are more likely to develop a metabolically abnormal profile. Although OSA is associated with higher CVD risk, our data suggests it is not a causative factor. One caveat is that the CPAP treated patients may have less inflammation and oxidative stress, which could attenuate the relationship to metabolic abnormalities.

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