Vgontzas A N, Tan T L, Bixler E O, Martin L F, Shubert D, Kales A
Sleep Research and Treatment Center, Pennsylvania State University College of Medicine, Hershey.
Arch Intern Med. 1994 Aug 8;154(15):1705-11.
To describe the frequency and severity of sleep apnea in obese patients without a primary sleep complaint and to assess the sleep patterns of obese patients without apnea and compare them with the sleep patterns of nonobese controls.
Prospective case series with historical controls in an obesity and sleep disorders clinic.
Two hundred obese women and 50 obese men (mean body mass index, 45.3) consecutively referred for treatment of their obesity and 128 controls matched for age and sex.
Eight-hour sleep laboratory recording, including electroencephalogram, electro-oculogram, electromyogram, and respirations. Subjectively reported sleep-related symptoms and signs were also recorded.
Twenty men (40%) and six women (3%) demonstrated sleep apnea warranting therapeutic 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 demonstrated sleep apneic activity severe enough for therapeutic intervention. The best clinical predictors of sleep apnea in the obese population were severity of snoring, subjectively reported nocturnal breath cessation, 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 onset, number of awakenings, and percentage of stage 1 sleep were significantly higher in obese patients than in controls, while rapid eye movement sleep was significantly lower.
Severely or morbidly obese men are at extremely high risk for sleep apnea and should be routinely evaluated in the sleep laboratory for this condition, while for severely or morbidly obese women the physician should include a thorough sleep history in the clinical assessment.
描述无原发性睡眠主诉的肥胖患者睡眠呼吸暂停的频率和严重程度，并评估无呼吸暂停的肥胖患者的睡眠模式，并将其与非肥胖对照组的睡眠模式进行比较。
在肥胖与睡眠障碍诊所进行的有历史对照的前瞻性病例系列研究。
连续转诊接受肥胖治疗的200名肥胖女性和50名肥胖男性（平均体重指数为45.3），以及128名年龄和性别匹配的对照组。
8小时睡眠实验室记录，包括脑电图、眼电图、肌电图和呼吸。还记录了主观报告的与睡眠相关的症状和体征。
20名男性（40%）和6名女性（3%）表现出需要治疗干预的睡眠呼吸暂停。另外4名男性（8%）和11名女性（5.5%）表现出睡眠呼吸暂停活动，需要推荐到睡眠实验室进行评估。相比之下，128名对照组中没有人表现出严重到需要治疗干预的睡眠呼吸暂停活动。肥胖人群中睡眠呼吸暂停的最佳临床预测指标是打鼾的严重程度、主观报告的夜间呼吸暂停和睡眠发作。与非肥胖对照组相比，没有任何睡眠呼吸紊乱的肥胖患者，无论男女，都表现出明显的睡眠障碍。肥胖患者入睡后的清醒时间、觉醒次数和1期睡眠百分比均显著高于对照组，而快速眼动睡眠则显著低于对照组。
重度或病态肥胖男性患睡眠呼吸暂停的风险极高，应常规在睡眠实验室对其进行评估，而对于重度或病态肥胖女性，医生应在临床评估中纳入全面的睡眠病史。
