Abstract
Obstructive sleep apnoea syndrome (OSAS) is a type of breathing disorder with upper airway obstruction, leading to oxy-haemoglobin desaturations and sleep disturbance. However awareness regarding various anthropometric parameters used to analyse OSA syndrome pre-clinically is inadequate. In developing nations, like India, resources are not adequate for analysis of sleep disturbances. That is why the prevalence and validity of various anthropometric parameters including neck circumference, Body mass index and waist circumference to be established and verified regularly. We have also seen the data from oral aspect and its anomalies. Various articles from Pubmed, scopus, google scholar were searched for data. These body measurements may provide pre-clinical aspect of OSA, whether it is present or not. Discussion was done on these anthropometric parameters and which parameter is gold standard for the pre-clinical investigations.
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Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thoracic Soc. 2008;5:136–43. https://doi.org/10.1513/pats.200709-155MG.
Medicine AAoS. International classification of sleep disorders 2nd ed: Diagnostic and coding manual. Westchester IL: American Academy of Sleep Medicine. 2005.
Xia Y, Fu Y, Xu H, Guan J, Yi H, Yin S. Changes in cerebral metabolites in obstructive sleep apnea: a systemic review and meta-analysis. Sci Rep. 2016;6:28712. https://doi.org/10.1038/srep28712.
Fornadi K, Ronai KZ, Turanyi CZ, Malavade TS, Shapiro CM, Novak M, Mucsi I, Molnar MZ. Sleep apnea is not associated with worse outcomes in kidney transplant recipients. Sci Rep. 2014;4:6987. https://doi.org/10.1038/srep06987.
Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, et al. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 ( first edition) Lung India. 2015;32:422–34.
Ashna M Pinto, Uma Devaraj, Priya Ramachandran, Bobby Joseph, and George A D'Souza. Obstructive Sleep Apnea in a rural population in South India: Feasibility of health care workers to administer level III sleep study. Lung India. 2018; 35(4): 301–306.
Léger D, Poursain B, Neubauer D, Uchiyama M. An international survey of sleeping problems in the general population. Curr Med Res Opin. 2008;24(1):307–17.
Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. 2013;62:569–76. https://doi.org/10.1016/j.jacc.2013.05.045.
Reddy EV, Kadhiravan T, Mishra HK, Sreenivas V, Handa KK, Sinha S, et al. Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: a community-based study. Sleep Med. 2009;10:913–8.
Vijayan VK, Patial K. Prevalence of obstructive sleep apnoea syndrome in Delhi. India Chest. 2006;130:149–56.
Singh A, Prasad R, Garg R, Kant S, Hosmane GB, Dubey A, et al. A study to estimate prevalence and risk factors of obstructive sleep apnoea syndrome in a semi-urban Indian population. Monaldi Arch Chest Dis. 2017;87:773.
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(8):687–98. https://doi.org/10.1016/S2213-2600(19)30198-5Epub 2019 Jul 9.
Silber MH, Ancoli-Israel S, Bonnet MH, Chokroverty S, Grigg-Damberger MM, et al. The visual scoring of sleep in adults. J Clin Sleep Med. 2007;3(2):121–31.
Carskadon M, Dement W. Normal human sleep: an overview. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. 4th ed. Philadelphia: Elsevier Saunders; 2005. p. 13–23.
Gais S, Molle M, Helms K, Born J. Learning-dependent increases in sleep spindle density. J Neurosci. 2002;22(15):6830–4.
Ayappa I, Rapoport DM. The upper airway in sleep: physiology of the pharynx. Sleep Med Rev. 2003;7(1):9–33.
Bader G, Gillberg C, Johnson M, Kadesjö B, Rasmussen P. Activity and sleep in children with ADHD. Sleep. 2003;26:A136.
Mortimore IL, Marshall I, Wraith PK. Neck and total body fat deposition in non-obese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med. 1998;57:280–3.
Onat A, Hergenç G, Yüksel H, Can G, Ayhan E, Kaya Z, Dursunoğlu D. Neck circumference as a measure of central obesity: Associations with metabolic syndrome and obstructive sleep apnea syndrome beyond waist circumference. Clin Nutrition. 2009;28:146–51.
Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing: significance of the lateral pharyngeal walls. Am J Respir Crit Care Med. 1995;152:1673–89.
Mezzanotte WS, Tangel DJ, White DP. Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism). J Clin Invest. 1992;89:1571–9.
Horner RL, Innes JA, Holden HB, Guz A. Afferent pathway(s) for pharyngeal dilator reflex to negative pressure in man: a study using upper airway anaesthesia. J Physiol. 1991;436:31–44.
Mathur R, Mortimore IL, Jan MA, Douglas NJ. Effect of breathing, pressure and posture on palatoglossal and genioglossal tone. Clin Sci (Lond). 1995;89(4):441–5.
Jennifer C, Hsia MD. Anatomy and physiology of the upper airway in obstructive sleep apnea. Oper Tech Otolaryngol. 2015. https://doi.org/10.1016/j.otot.2015.03.005.
McWhorter AJ, Rowley JA, Eisele DW, Smith PL, Schwartz AR. The effect of tensor veli palatini stimulation on upper airway patency. Arch Otolaryngol Head Neck Surg. 1999;125(9):937–40.
Van de Graaff WB, Gottfried SB, Mitra J, van Lunteren E, Cherniack NS, Strohl KP. Respiratory function of hyoid muscles and hyoid arch. J Appl Physiol Respir Environ Exerc Physiol. 1984;57:197–204.
Gleeson K, Zwillich CW, Braier K, White DP. Breathing route during sleep. Am Rev Respir Dis. 1986;134(1):115–20.
Georgalas C. The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol. 2011;268(9):1365–73.
Schwartz AR, Smith PL, Wise RA, Gold AR, Permutt S. Induction of upper airway occlusion in sleeping individuals with subatmospheric nasal pressure. J Appl Physiol. 1985;64(2):535–42.
Ahmed SBH, Tripat S, Smitha G, Karen LA, Kashmira B, Divinagracia EG. Choosing the right interface for positive airway pressure therapy in patients with obstructive sleep apnea. Sleep Breath. 2017. https://doi.org/10.1007/s11325-017-1490-9.
Gleadhill IC, Schwartz AR, Schubert N, et al. Upper airway collapsibility in snorers and in patients with obstructive hypopnea and apnea. Am Rev Respir Dis. 1991;143:1300–3.
Pham LV, Schwartz AR. The pathogenesis of obstructive sleep apnea. J Thorac Dis. 2015;7(8):1358–72. https://doi.org/10.3978/j.issn.2072-1439.2015.07.28.
Brouillette RT, Thach BT. A neuromuscular mechanism maintaining extrathoracic airway patency. J Appl Physiol Respir Environ Exerc Physiol. 1979;46:772–9.
Marcus CL, Moreira GA, Bamford O, et al. Response to inspiratory resistive loading during sleep in normal children and children with obstructive apnea. J Appl Physiol. 1985;1999(87):1448–544.
Resta O, Carpanano GE, Lacedonia D, et al. Gender difference in sleep profile of severely obese patients with obstructive sleep apnea (OSA). Respir Med. 2005;99:91–6.
Schwartz AR, Thut DC, Brower RG, et al. Modulation of maximal inspiratory airflow by neuromuscular activity: effect of CO2. J Appl Physiol. 1985;1993(74):1597–605.
Seelagy MM, Schwartz AR, Russ DB, et al. Reflex modulation of airflow dynamics through the upper airway. J Appl Physiol. 1985;1994(76):2692–700.
Schneider H, Boudewyns A, Smith PL, et al. Modulation of upper airway collapsibility during sleep: influence of respiratory phase and flow regimen. J Appl Physiol. 1985;2002(93):1365–76.
Qaseem A, et al. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(3):210–20.
Epstein LJ, Kristo D, Strollo PJ Jr., et al.; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263–276
John M. Eisenberg Center for Clinical Decisions and Communications Science. Comparative effectiveness of diagnosis and treatment of obstructive sleep apnea in adults. August 8, 2011. In: Comparative Effectiveness Review Summary Guides for Clinicians. Rockville, Md.: Agency for Healthcare Research and Quality (US); 2011. https://www.ncbi.nlm.nih.gov/books/NBK63965/. Accessed January 15, 2016.
Steriade M, McCormick DA, Sejnowski TJ. Thalamocortical oscillations in the sleeping and aroused brain. Science. 1993;262:679–85.
Al Oweidat K, AlRyalat SA, Al-Essa M, Obeidat N. Comparing REM- and NREM-related obstructive sleep apnea in Jordan: a cross-sectional study. Hindawi. Can Respir J Volume 2018, Article ID 9270329, 6 pages https://doi.org/10.1155/2018/9270329
Grace KP, Hughes SW, Horner RL. Identification of the mechanism mediating genioglossus muscle suppression in REM sleep. Am J Respir Crit Care Med. 2013;187(3):311–9.
Kaparianos A, Sampsonas F, Karkoulias K, Spiropoulos K. Obstructive sleep apnoea syndrome and genes. Neth J Med. 2006;64(8):280–9.
Redline S, Tishler PV. The genetics of sleep apnea. Sleep Med Rev. 2000;4(6):583–602. https://doi.org/10.1053/smrv.2000.0120.
Carmelli D, Bliwise DL, Swan GE, Reed T. Genetic factors in self-reported snoring and excessive daytime sleepiness: a twin study. Am J Respir Crit Care Med. 2001;164:949–52.
Ghosh S, Feingold E, Dey SK. Etiology of Down syndrome: Evidence for consistent association among altered meiotic recombination, nondisjunction, and maternal age across populations. Am J Med Genet A. 2009;149A(7):1415–20.
Tewfik TL, Der Kaloustian VM. Congenital anomalies of the ear, nose, and throat. New York, NY: Oxford University Press; 1997. p. 517.
Hollister DW, Godfrey M, Sakai LY, Pyeritz RE. Immunohistologic abnormalities of the microfibrillar-fiber system in the Marfan syndrome. N Engl J Med. 1990;323:152–9.
Saarelainen S, Lehtimaki T, Kallonene E, Laasonein K, Poussa T, Neiminen MM. No relation between apolipoprotein E alleles and obstructive sleep apnea. Clin Genet. 1998;53:147–8.
Oğretmenoğlu O, Süslü AE, Yücel OT, Onerci TM, Sahin A. Body fat composition: a predictive factor for obstructive sleep apnea. Laryngoscope. 2005;115(8):1493–8.
Katz I, Stradling J, Slutsky AS, Zamel N, Hoffstein V. Do patients with obstructive sleep apnea have thick necks? Am Rev Respir Dis. 1990;141(5 Pt 1):1228–311.
Van Gaal LF. Body fat, body fat distribution and the respiratory system: a “fat neck” syndrome? Eur Respir J. 1992;5(4):375–6.
Obesity: Preventing and managing the global epidemic. Geneva: World health organization; 1997. World health organization. Report of a WHO consultation on obesity; p. 158.
Nuzhat A, Sailaja DK, Praveen Kumar N. Implication of revised consensus body mass indices for Asian Indians on clinical obstetric. Pract J Clin Diagn Res. 2014; 8(5):OC01-OC03
Douglas NJ, Polo O. Pathogenesis of obstructive sleep apnoea/hypopnoea syndrome. The Lancet. 1994;344(8923):653–5.
Kwan SYL, Fleetham JA, Enarson DA, Chan-Yeung M. Snoring, obesity, smoking and systemic hypertension in a working population in British Columbia. Am Rev Respir Dis 1991; 143, article A380.
Martins AB, Tufik S, Moura SM. Physiopathology of obstructive sleep apnea-hypopnea syndrome. J Br Pneumol. 2007;33:93–100.
Soylu AC, Levent E, Sarıman N, Yurtlu S, Alparslan S, et al. Obstructive sleep apnea syndrome and anthropometric obesity indexes. Sleep Breath. 2012;16:1151–8.
No authors listed. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Resp Ser. 2000;894:1–253.
Hyeon HK, Ji YK, Jick HH, Jongmin L, Sung KK, Hwa SM, Sang HL. The associations between anthropometric indices and obstructive sleep apnea in a Korean population. PLoS ONE. 2014;9(12):e114463. https://doi.org/10.1371/journal.pone.0114463.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.
Van Boxem TJ, de Groot GH. Prevalence and severity of sleep disordered breathing in a group of morbidly obese patients. Neth J Med. 1999;54:202.
Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002;162:893.
Shelton KE, Woodson H, Gay S, Suratt PM. Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis. 1993;148(2):462–6.
Naimark A, Cherniack RM. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol. 1960;15:377–82.
Malhotra A, White DP. Obstructive sleep apnoea. Lancet. 2002;360(9328):237–45.
Davidson TM, Patel MR. Waist circumference and sleep disordered breathing. Laryngoscope. 2008;118(2):339–47.
Davies RJ, Ali NJ, Stradling JR. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. Thorax. 1992;47(2):101–5.
Hoffstein V, Mateika S. Differences in abdominal and neck circumferences in patients with and without obstructive sleep apnoea. Eur Respir J. 1992;5(4):377–81.
Tufik S, Silva RS, Taddei JA, et al. Obstructive sleep apnoea syndrome in the sao paulo epidemiolgic sleep study. Sleep Med. 2010;11:441–6.
Schwab RJ, Goldberg AN, Pack AL. Sleep apnea syndromes. In: Fishman AP, editor. Fishman's pulmonary diseases and disorders. McGraw-Hill Book: New York, NY, USA; 1998. p. 1617–1637.
Dixon JB, Schachter LM, OBrien PE. Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography. Chest. 2003;123(4):1134–41.
No authors listed. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult TreatmentPanel III). JAMA. 2001;285:2486–97.
Snijder MB, Zimmet PZ, Visser M, Dekker JM, Seidell JC, Shaw JE. Independent and opposite associations of waist and hip circumferences with diabetes, hypertension and dyslipidemia: the AusDiab Study. Int J Obes Relat Metab Disord. 2004;28:402–9.
Manolopoulos KN, Karpe F, Frayn KN. Gluteofemoral body fat as a determinant of metabolic health. Int J Obes. 2010;34:949–59.
Despres JP, Lemieux I, Prud’homme D. Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ 2001;322:716–20.
Miles PG, Vig PS, Weyant RJ, Forrest TD, Rockette HE Jr. Craniofacial structure and obstructive sleep apnea syndrome: a qualitative analysis and meta-analysis of the literature. Am J Orthod Dentofacial Orthop. 1996;109:163–72.
Bacon WH, Kreiger J, Turlot JC, Stierle JL. Craniofacial characteristics in patients with obstructive sleep apnea syndrome. Cleft Palate J. 1988;25:374–8.
Lowe AA, Gionhaku N, Takeuchi K, Fleetham JA. Three dimensional CT reconstructions of tongue and airway in adult subjects with OSA. Am J Orthod Dentofacial Orthop. 1986;90:364–74.
Lowe AA, Fleetham JA, Adachi S, Ryan CF. Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod Dentofacial Orthop. 1995;107:589–95.
Solow B, Skov S, Ovesen J, Norup PW, Wildschiψdtz G. Airway dimensions and head posture in obstructive sleep apnea. Eur J Orthod. 1996;18:571–9.
Fairbanks DN, Fujita S. Snoring and obstructive sleep apnea. 2nd ed. New York: Raven Press; 1994.
Friedman M, Tanyeri H, LaRosa M, Landsberg R, Vaidyanathan K, Pieri S, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope. 1999;109:1901–7.
Bailey DR, Attanasio R. Dentistry's role in the management of sleep disorders. Recognition and management. Dent Clin North Am. 2001;45:619–30.
George T. A new instrument for functional appliance bite registration. J Clin Orthod. 1992;2:721–3.
George T. Breathing disorders in sleep. Clin Chest Med. 1992;13:383–554.
Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep. 1995;18:501–10.
Liu YH, Lowe A, Fleetham J, Park YC. Cephalometric and physiological predictors of the efficacy of an adjustable oral appliance for the treatment of obstructive sleep apnea. Am J Orthod Dentofac Orthop. 2001;120:639–47.
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Thukral, H., Gupta, G., Sinha, S. et al. Anthropometric Correlation with Pathophysiology of Obstructive Sleep Apnea (OSA): A Review. Sleep Vigilance 4, 95–103 (2020). https://doi.org/10.1007/s41782-020-00089-2
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DOI: https://doi.org/10.1007/s41782-020-00089-2