Clinical and Polysomnographic Phenotypes of Obstructive Sleep Apnea in Non-Obese Versus Obese Patients
Osa Phenotypes in Obese vs Non-Obese
DOI:
https://doi.org/10.31584/psumj.2026281781Keywords:
clinical, obstructive sleep apnea, phenotype, polysomnography, sleep apneaAbstract
Objective: This study aimed to compare clinical and polysomnographic features between obese and non-obese obstructive sleep apnea (OSA) patients.
Material and Methods: This retrospective cohort study included: adult patients having undergone type I polysomnography; from 2017 until 2022. Participants were categorized as: obese (body mass index [BMI] ≥30 kg/m²) and non-obese (BMI <30 kg/m²). Clinical features and sleep study parameters were compared. Correlation analyses were performed to assess any relationships between apnea hypopnea index (AHI) and body weight, BMI and neck circumference (NC). The diagnostic performance of STOP-Bang in obese individuals was additionally investigated.
Results: There were 573 patients; of which 359 (62.7%) were obese and 214 (37.3%) were non-obese. The prevalence of OSA and OSAS were 94.9% and 38.9%, respectively, increasing with BMI. Obese patients were significantly younger and had higher BMI, neck and waist circumferences, STOP-Bang and Epworth sleepiness scale, and more frequent symptoms; such as fatigue and choking. Polysomnographic findings revealed that obese patients had higher AHI, oxygen desaturation index (ODI) and T90, lower minimum SpO₂, and shorter total sleep time. NC showed a modest correlation with AHI (r=0.442, p-value<0.001). In obese patients, a STOP-Bang score ≥3 yielded 80.3% sensitivity and 62.5% specificity for detecting OSA.
Conclusions: Obesity markedly increases OSA severity, correlating strongly with higher AHI and more pronounced clinical and polysomnographic abnormalities. NC is the predictor of OSA severity, and a STOP-Bang of ≥3 has an acceptable performance in identifying OSA in obese patients.
References
World Health Organization. Obesity among adults, BMI ≥30, prevalence (age-standardized estimate) (%) [homepage on the Internet]. Geneva: WHO; 2025 [cited 2024 Fed 29] Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-obesity-among-adults-bmi-=-30-(age-standardized-estimate)-(-)
Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 2017;34:70-81.
Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019;7:687-98.
Won CHJ, Qin L, Selim B, Yaggi HK. Varying hypopnea definitions affect obstructive sleep apnea severity classification and association with cardiovascular disease. J Clin Sleep Med 2018;14:1987-94.
Dredla BK, Castillo PR. Cardiovascular consequences of obstructive sleep apnea. Curr Cardiol Rep 2019;21:137.
Hou H, Zhao Y, Yu W, Dong H, Xue X, Ding J, et al. Association of obstructive sleep apnea with hypertension: a systematic review and meta-analysis. J Glob Health 2018;8:010405.
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006-14.
Kositanurit W, Muntham D, Udomsawaengsup S, Chirakalwasan N. Prevalence and associated factors of obstructive sleep apnea in morbidly obese patients undergoing bariatric surgery. Sleep Breath 2018;22:251-6.
Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep disordered breathing. JAMA 2000;284:3015-21.
Fernandes VM, Rocha GRD, Milet TC, Barreto DM, Santos JFM, Oliveira MM. Polysonographic changes in obese patients with indication of bariatric surgery. Rev Col Bras Cir 2021;48:e20213030.
Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, et al. AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med 2017;13:665-6.
International classification of sleep disorders. 3rd ed. American Academy of Sleep Medicine. 2014.
Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med 2017;13:479-504.
Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 2002;162:893-900.
Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. chest 2016;149:631-8.
Kim SE, Park BS, Park SH, Shin KJ, Ha SY, Park J, et al. Predictors for presence and severity of obstructive sleep apnea in snoring patients: Significance of neck circumference. J Sleep Med 2015;12:34–8.
Irman S, Mohamad H, Amran M, Mohamad I. Association between neck circumference and the severity of obstructive sleep apnea. Pol Ann Med 2020;27:1-6.
Reddy S, Koul PA, Bhat MH, Shah S, Ganie MA. Comparison of clinical, biochemical, and polysomnographic parameters between obese and nonobese obstructive sleep Apnea. Lung India 2022;39:261-6.
Zou H, Jia Q, Yang W, Zhang Z, Miao J. Clinical and polysomnographic characteristics of nonobese and obese Chinese patients with obstructive sleep apnea. J Clin Neurophysiol 2022;39:631-6.
Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2021;144:e56-67.
Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, et al. Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. J Am Coll Cardiol 2017;69:841-58.
Fernandes VM, Rocha GRD, Milet TC, Barreto DM, Santos JFM, Oliveira MM. Polysomnographic changes in obese patients with indication of bariatric surgery. Rev Col Bras Cir 2021;48:e20213030.
Theerakittikul T, Laksananun N, Inchai J, Pothirat C, Liwsrisakun C, Bumroongkit C, el al. Comparative Study of clinical and polysomnographic characteristics of obstructive sleep apnea among obese and non-obese patients at Chiang Mai university hospital. Sci&Tech Res 2019;14:10894-9.
Jo JH, Park JW, Jang JH, Chung JW. Polysomnographic and cephalometric evaluation of patients with obstructive sleep apnea according to obesity level. J Oral Med Pain 2022;47:135-43.
Eckert DJ. Phenotypic approaches to obstructive sleep apnoea - New pathways for targeted therapy. Sleep Med Rev 2018;37:45-59.
Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A. Sleep apnea and sleep disruption in obese patients. Arch Intern Med 1994;154:1705–11.
Cho T, Yan E, Chung F. The STOP-Bang questionnaire: a narrative review on its utilization in different populations and settings. Sleep Med Rev 2024;78:102007.
Mergen H, Altındağ B, Zeren Uçar Z, Karasu Kılıçaslan I. The predictive performance of the STOP-Bang questionnaire in obstructive sleep Apnea screening of obese population at sleep clinical setting. Cureus 2019;11:e6498.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Author and Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
