Endotypic Trait Differences in Class 2/3 Obese Patients With and Without Obstructive Sleep Apnea: A Preliminary Analysis of Preoperative Bariatric Surgery Patients
Year: 2024
Type: article
Abstract: PatientsTo the Editor: Both obesity and obstructive sleep apnea (OSA) are common and evolving global health problems.OSA is estimated to affect 1 billion individuals globally (1).Obesity is a strong risk factor for OSA (2).However, not all individuals with obesity develop OSA, which likely reflects individual physiological differences (3).Prior work using invasive measurements indicated that differences in upper airway collapsibility and the responsiveness of upper airway dilator muscles explain why only some individuals with obesity develop OSA (3, 4).Our goal was to validate prospectively these findings using a noninvasive technique that estimates mechanisms underlying OSA from routine polysomnography (5-7). MethodsThe aim of the SLIM-OSA (Underlying Mechanisms of Obesityinduced Obstructive Sleep Apnea) trial (NCT 04793334; institutional review board #191948) is to elucidate the mechanisms that explain why weight loss alleviates OSA in some but not all people with class 2 (body mass index [BMI] >35 to ,40 kg/m 2 ) and class 3 (BMI > 40 kg/m 2 ) obesity.For this single-center trial, we enrolled participants 18-65 years of age with BMIs >35 kg/m 2 , who were nonsmokers, without major comorbidities, who planned to undergo sleeve gastrectomy.Participants underwent in-laboratory polysomnography before and after surgery.For this cross-sectional analysis, we included data from participants who completed presurgical polysomnography (an analysis of changes in upper airway anatomy/function will be the subject of a subsequent paper).As before (3), OSA was defined as an apnea-hypopnea index (AHI) .15events/h, with hypopneas based on reductions in flow of >30% for >10 seconds associated with a >3% desaturation or arousal.Physiological mechanisms underlying each person's OSA ("traits") were estimated from polysomnography using published techniques (5-7).To quantify upper airway collapsibility, we used primarily Vmin, which estimates flow as a percentage of eupneic ventilation at nadir drive.Vmin correlates well (r = 20.54) with passive closing pressure, which is arguably the gold standard to Supported by U.
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: U.S. Department of Veterans Affairs, American Heart Association, American Academy of Sleep Medicine Foundation, National Institutes of Health, University of California, San Diego, Veterans Affairs San Diego Healthcare System, Clinical Science Research and Development, National Institute on Aging, National Heart, Lung, and Blood Institute, National Center for Advancing Translational Sciences, NHLBI Division of Intramural Research
Awards: G1568512157, G1717643930, Is Obstructive Sleep Apnea Important in the Development of Alzheimer's Disease, G2633688113, G2714352180, G2928778974, G3108789268, G3540638098, San Diego Clinical and Translational Research Institute, G4191368634, G4380977247, G4950536974, G676769140, G8021374757, G8048327242, G806246556, Acetazolamide to Improve Obstructive Sleep Apnea and Cardiovascular Outcomes in Young Adults, G9000222291, The Impact of Sleep Disordered Breathing in People who use Opioids, The cardiovascular consequences of sleep apnea plus COPD (Overlap syndrome), VentNet: A Real-Time Multimodal Data Integration Model for Prediction of Respiratory Failure in Patients with COVID-19, Sleep Apnea Endophenotypes: One Size Does Not Fit All, Acetazolamide to Improve Clinically Important Outcomes in Obstructive Sleep Apnea Patients with a High Loop Gain Endotype
OpenAlex ID: W4400917629