Lee Yeow Hian, Johan Azman, Wong Keith Keat Huat, Edwards Natalie, Sullivan Colin
Division of Respiratory Medicine, Department of Medicine, Alexandra Hospital, 378 Alexandra Road, Singapore 159964, Singapore.
Sleep Med. 2009 Feb;10(2):226-32. doi: 10.1016/j.sleep.2008.01.005. Epub 2008 Apr 1.
Obesity is becoming more prevalent world wide. Bariatric surgery is one treatment option for patients with severe or morbid obesity. There have been few comprehensive studies examining prevalence and risk factors for obstructive sleep apnea (OSA) in the multiracial Singaporean bariatric surgery population.
We performed full polysomnography on 176 consecutive patients undergoing assessment for bariatric surgery. Questionnaires regarding snoring, the presence of witnessed apneas and the Epworth Sleepiness Scale (ESS) were administered. Anthropometric and demographic measurements include age, sex, race, body mass index (BMI) and neck circumference.
The prevalence of OSA was 72%, and 49% of the 176 patients had an AHI >= 15. There was a male predominance of OSA (X(2) = 29.7; p<0.001). OSA subjects had larger neck circumference (43.9 +/- 4.5 vs. 39.4 cm +/- 3.3; p<0.001) and higher BMI (43.1 +/- 7.6 vs. 39.1 +/- 5.4 kg/m(2); p<0.001). The neck circumference (OR = 1.37; p<0.001), presence of snoring (OR = 8.25; p<0.001) and an ESS >10 (OR = 3.24; p = 0.03) were significant independent predictors of an AHI >= 15. A neck circumference of 43 cm had an 80% sensitivity and 83% specificity for predicting an AHI >= 15.
OSA is common amongst Singaporeans undergoing evaluation for bariatric surgery, with a high prevalence of moderate and severe disease. An increased neck circumference is a strong independent predictor for an AHI >= 15, with a neck circumference of greater than 43 cm being a sensitive and specific predictor. Race was not found to be a risk factor.
肥胖在全球范围内正变得越来越普遍。减重手术是重度或病态肥胖患者的一种治疗选择。针对新加坡多种族减重手术人群中阻塞性睡眠呼吸暂停（OSA）的患病率及危险因素，此前鲜有全面研究。
我们对176例连续接受减重手术评估的患者进行了全夜多导睡眠监测。发放了关于打鼾、观察到的呼吸暂停情况及爱泼华嗜睡量表（ESS）的问卷。人体测量和人口统计学测量包括年龄、性别、种族、体重指数（BMI）和颈围。
OSA的患病率为72%，176例患者中有49%的呼吸暂停低通气指数（AHI）≥15。OSA存在男性优势（X(2)=29.7；p<0.001）。OSA患者的颈围更大（43.9±4.5对39.4 cm±3.3；p<0.001）且BMI更高（43.1±7.6对39.1±5.4 kg/m(2)；p<0.001）。颈围（比值比[OR]=1.37；p<0.001）、打鼾情况（OR=8.25；p<0.001）及ESS>10（OR=3.24；p=0.03）是AHI≥15的显著独立预测因素。颈围43 cm对预测AHI≥15具有80%的敏感性和83%的特异性。
OSA在接受减重手术评估的新加坡人中很常见，中重度疾病的患病率很高。颈围增加是AHI≥15的有力独立预测因素，颈围大于43 cm是一个敏感且特异的预测指标。未发现种族是危险因素。
