SLEEP-APNEA AND SLEEP DISRUPTION IN OBESE PATIENTS

Objectives: To describe the frequency and severity of sleep apnea in o bese patients without a primary sleep complaint and to assess the slee p patterns of obese patients without apnea and compare them with the s leep patterns of nonobese controls. Design and Setting: Prospective ca se series with historical controls in an obesity and sleep disorders c linic. Subjects: Two hundred obese women and 50 obese men (mean body m ass index, 45.3) consecutively referred for treatment of their obesity and 128 controls matched for age and sex. Main Outcome Measures: Eigh t-hour sleep laboratory recording, including electroencephalogram, ele ctro-oculogram, electromyogram, and respirations. Subjectively reporte d sleep-related symptoms and signs were also recorded. Results: Twenty men (40%) and six women (3%) demonstrated sleep apnea warranting ther apeutic intervention. Another four men (8%) and 11 women (5.5%) showed sleep apneic activity that warranted recommendation for evaluation in the sleep laboratory. In contrast, none of the 128 controls demonstra ted sleep apneic activity severe enough for therapeutic intervention. The best clinical predictors of sleep apnea in the obese population we re severity of snoring, subjectively reported nocturnal breath cessati on, and sleep attacks. Obese patients, both men and women, without any sleep-disordered breathing demonstrated a significant degree of sleep disturbance compared with nonobese controls. Wake time after sleep on set, number of awakenings, and percentage of stage 1 sleep were signif icantly higher in obese patients than in controls, while rapid eye mov ement sleep was significantly lower. Conclusion: Severely or morbidly obese men are at extremely high risk for sleep apnea and should be rou tinely evaluated in the sleep laboratory for this condition, while for severely or morbidly obese women the physician should include a thoro ugh sleep history in the clinical assessment.