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Background: Although sex differences in the prevalence of sleep disordered breathing (SDB) is recognized, whether a sex difference exists among obese individuals with SDB with or without comorbidities has not been well investigated. This study aimed to explore the relationships of sex differences among SDB, obesity, and metabolic comorbidities., Methods: This study evaluated 7713 community participants with nocturnal oximetry ≥2 nights. SDB was assessed by the 3% oxygen desaturation index corrected for sleep duration obtained by wrist actigraphy (Acti-ODI3%), and moderate-to-severe SDB was defined as Acti-ODI3% levels ≥15/h. Obesity was defined as body mass index ≥25 kg/m 2 ., Results: The prevalence of moderate-to-severe SDB was 21.6%/0% among those with obesity/without obesity in women under 40 years old. The adjusted odds ratios for moderate-to-severe SDB in those with both diabetes/metabolic syndrome and obesity compared to others were 86.4 (95%CI 24.2-308.8)/40.4 (95%CI 15.0-108.8) in pre-menopausal women. The association among SDB, obesity, and metabolic comorbidities showed significant interactions between pre-menopausal women and men or post-menopausal women., Conclusions: Sex differences exist among the prevalence of SDB and the relationships among SDB, obesity, and metabolic comorbidities. Especially, pre-menopausal women are more vulnerable to the consequences of obesity. SDB prevalence may be impacted by the coexistence of obesity and diabetes or metabolic syndrome in pre-menopausal women., Competing Interests: Conflicts of interest Takeshi Matsumoto, Takuma Minami, Osamu Kanai, Kiminobu Tanizawa, Tomoko Wakamura, Naoko Komenami, Kazuya Setoh, Takahisa Kawaguchi, Satoshi Morita, Yoshimitsu Takahashi, and Toyohiro Hirai have nothing to disclosure. Hironobu Sunadome and Naomi Takahashi reports grants from Philips Japan, grants from ResMed, grants from Fukuda Denshi, grants from Fukuda Lifetec Keiji, outside the submitted work. Kimihiko Murase reports grants from Philips Japan, grants from Teijin Pharma, grants from Fukuda Denshi, grants from Fukuda Lifetec Keiji, outside the submitted work. Yasuharu Tabara reports grants from the Ministry of Education, Culture, Sports, Science & Technology in Japan, grants from Japan Science and Technology Agency, grants from Mitsubishi Foundation, grants from Daiwa Securities Health Foundation, and grants from Sumitomo Foundation, outside the submitted work. Satoshi Hamada reports grants from Teijin Pharma, outside the submitted work. Takeo Nakayama reports grants from Special Health Check-up Research Group from the Ministry of Health, Labor and Welfare of Japan, personal fees from Pfizer Japan Inc., personal fees from MSD K.K., personal fees from Ohtsuka Pharmaceutical co., personal fees from Dainippon Sumitomo Pharmaceutical co., personal fees from Ono Pharmaceutical co., personal fees from Chugai Pharmaceutical co., personal fees from Dentsu co., personal fees from Takeda Pharmaceutical co., personal fees from Novo Nordisk Pharma. co., personal fees from Janssen Pharmaceutical K.K., personal fees from Boehringer Ingelheim International GmbH, personal fees from Nikkei Business Publications, Inc., personal fees from Eli Lilly Japan K.K., personal fees from Novartis Pharma K.K., personal fees from Baxter, personal fees from Alexion Pharma, personal fees from Mitsubishi Tanabe Pharma Corporation, grants for the collaborative study from HANSHIN Dispensing Holding Co. Ltd., grants from Nakagawa Pharmacy Co., Ltd., grants from Konica Minolta, Inc., donations for the department from Nakamura hospital, donations from Japan Medical Data Center Toyota, donations from Tsusho All Life Co., outside the submitted work. Susumu Sato reports grants from Philips Japan, ResMed, Fukuda Denshi, Fukuda Lifetec Keiji, Fuji Film corporation and Nippon Boehringer Ingelheim, outside the submitted work. Fumihiko Matsuda reports grants from Kyoto University, grants from the Ministry of Education, Culture, Sports, Science and Technology in Japan, grants from the Center of Innovation Program, grants from Japan Science and Technology Agency, from the Practical Research Project for Rare/Intractable Diseases, during the conduct of the study. Kazuo Chin reports grants from the Japanese Ministry of Education, Culture, Sports, Science and Technology, grants from the Intractable Respiratory Diseases and Pulmonary Hypertension Research Group, the Ministry of Health, Labor and Welfare, Japan, grants from the Japan Vascular Disease Research Foundation, grants from Health, Labour and Welfare Sciences Research Grants, Research on Region Medical, during the conduct of the study; grants and personal fees from Philips Japan, grants and personal fees from Teijin Pharma, grants and personal fees from Fukuda Denshi, grants and personal fees from Fukuda Lifetec Keiji, grants from KYORIN Pharmaceutical Co., Ltd, grants from Nippon Boehringer Ingelheim Co., Ltd, grants and personal fees from GlaxoSmithKline, personal fees from MSD, personal fees from Resmed, personal fees from Astellas Pharma, personal fees from Eisai Co., Ltd., outside the submitted work., (Copyright © 2024. Published by Elsevier B.V.)

Sleep-related breathing disorder (SRBD) causes hypertension, and obesity has been highly associated with SRBD, which has become a serious health problem in young and middle-aged Japanese males. However, the relation between SRBD and hypertension considering the effects of obesity remains unknown. In this cross-sectional study, we examined the relationship between SRBD and hypertension, with consideration for the effects of obesity, in Japanese occupational population. Using 3% oxygen desaturation index (3%ODI) obtained by simplified polysomnography (PSG), participants were classified into low (0 ≤ 3%ODI < 5), medium (5 ≤ 3%ODI < 15), and high (15 ≤ 3%ODI) 3%ODI groups. We excluded employees who had not undergone medical examination with simplified PSG in the same year from 2012 to 2018. Logistic regression analysis was performed to calculate odds ratios for having hypertension according to 3%ODI levels. In total, 2532 employees were included. Among them, 25% and 4% were categorized into the medium and high 3%ODI groups, respectively. The odds ratio for hypertension increased significantly with higher 3%ODI levels after adjustment for age, sex, alcohol drinking status and smoking status (p for trend < 0.0001). However, further adjustment for obesity status (body mass index ≥ 25 kg/m 2 ) attenuated the associations. When we performed the stratified analysis by obesity status, the odds ratio for hypertension increased significantly with higher 3%ODI only for non-obese individuals, with significant interaction (p for interaction = 0.014). Higher 3%ODI was significantly associated with higher prevalence of hypertension especially in non-obese participants, suggesting the importance of vigilance for the presence of SRBD even in non-obese individuals. We investigated the association between SRBD and hypertension considering the effects of obesity, which would suggest the need to keep in mind the presence of SRBD even in non-obese individuals., (© 2024. The Author(s).)

Introduction: We aimed to determine whether obesity or metabolic syndrome (MetS) modify associations between sleep-disordered breathing (SDB), self-reported sleep duration (SD), and phenotypes of combined SDB/SD with 7-year neurocognitive decline (ND) in a community based-cohort of U.S. Hispanic/Latinos (N = 5500) in different age and sex groups., Methods: The exposures were baseline SDB (respiratory event index ≥ 15), sleepiness (Epworth Sleepiness Scale ≥ 10), SD (< 6 hours, 6-9 hours, ≥ 9 hours). The outcome was 7-year ND., Results: Mean age was 56.0 years, 54.8% were females. Obesity modified the association between SDB/SD and ND in memory (F = 21.49, P < 0.001) and global cognition (F = 9.14, P < 0.001) in the oldest age group. Women without MetS with combined long sleep/SDB exhibited most pronounced decline in global cognition (F = 3.07, P = 0.010)., Discussion: The association between combined SDB/long sleep and declines in memory and global cognition was most pronounced in obese older adults. Among women, MetS status modified the association between long sleep/SDB and decline in global cognition., (© 2021 the Alzheimer's Association.)

Objective: Asthma, a major cause of disability and reduced quality of life, has a high global prevalence and burden of death. Despite the propitious guidelines, a substantial portion of asthmatics reportedly have poorly controlled disease. In the current study, we have examined risk factors for uncontrolled asthma in specialty clinics and its association with impaired quality of life., Methods: A multicentre cross-sectional survey of asthma patients, 18 years and older, was conducted in Trinidad. Asthma Control Test (ACT) and the Juniper Mini Asthma Quality of Life Questionnaire (Mini AQLQ-J) were used to assess the disease control and quality of life, respectively. Data were analyzed using the Chi-square test and multivariable logistic regression controlling for gender., Results: Of a total of 428 patients included, asthma was uncontrolled in 72.4% and asthma related quality of life was moderate to severely impaired in 86% of the studied population. In the multivariate regression models, poorly controlled asthma was associated with obesity (OR 2.25; 95% CI 1.30-3.39), late-onset asthma (OR 1.72; 95% CI 1.04-2.84), features of sleep apnea (OR 1.77; 95% CI 1.01-3.07) and depression (OR 2.01; 95% CI 1.04-3.86). Impaired quality of life was associated with Indo-Caribbean ethnicity (OR 3.19; 95% CI = 1.68-6.06)., Conclusions: In this Caribbean population, uncontrolled asthma was independently associated with obesity, late-onset disease, and comorbidities of sleep apnea and depression. Poor asthma-related quality of life was independently associated with Indo-Caribbean ethnicity.

The interest on a potential association between cancer and sleep-disordered breathing (SDB) has clearly gained substantial traction over the last several years. This novel relationship was initially explored in experimental models of obstructive sleep apnea (OSA) and showed that both intermittent hypoxia and sleep fragmentation, the two main hallmarks of OSA, promoted alterations in both tumorigenesis and tumor malignant properties. In parallel, an intriguing role of obesity as a major interactive player in the relationship between cancer and OSA was postulated in the following contextual settings: (1) obesity (with or without OSA) is associated with increased risk of some types of cancer (both incidence and aggressiveness), whereas obesity could be protective for others ("obesity paradox"); (2) OSA has been associated with increased risk for some types of cancer (independent of obesity), but not with others; (3) More than 80% of adult patients with OSA are overweight and >50% are obese; (4) both OSA and obesity exhibit oscillations in tissue oxygen tensions in peripheral organs such as adipose tissues. Further understanding these complex relationships become all the more important considering that the prevalence of obesity, cancer and OSA are all increasing worldwide. In parallel, experimental models of OSA provide biological plausibility constructs to the clinical and epidemiological findings, suggesting that the metabolic and inflammatory changes induced by chronic intermittent hypoxia and sleep fragmentation may foster or exacerbate immune and biomechanical alterations of the tumor microenvironment, including the expression of extracellular matrix components facilitating tumor progression.

Background: Previous clinical trials and institutional studies have demonstrated that surgery for the treatment of obesity (termed bariatric or metabolic surgery) reduces all-cause mortality and the development of obesity-related diseases such as type 2 diabetes mellitus (T2DM), hypertension, and dyslipidaemia. The current study analysed large-scale population studies to assess the association of bariatric surgery with long-term mortality and incidence of new-onset obesity-related disease at a national level., Methods and Findings: A systematic literature search of Medline (via PubMed), Embase, and Web of Science was performed. Articles were included if they were national or regional administrative database cohort studies reporting comparative risk of long-term mortality or incident obesity-related diseases for patients who have undergone any form of bariatric surgery compared with an appropriate control group with a minimum follow-up period of 18 months. Meta-analysis of hazard ratios (HRs) was performed for mortality risk, and pooled odds ratios (PORs) were calculated for discrete variables relating to incident disease. Eighteen studies were identified as suitable for inclusion. There were 1,539,904 patients included in the analysis, with 269,818 receiving bariatric surgery and 1,270,086 control patients. Bariatric surgery was associated with a reduced rate of all-cause mortality (POR 0.62, 95% CI 0.55 to 0.69, p < 0.001) and cardiovascular mortality (POR 0.50, 95% CI 0.35 to 0.71, p < 0.001). Bariatric surgery was strongly associated with reduced incidence of T2DM (POR 0.39, 95% CI 0.18 to 0.83, p = 0.010), hypertension (POR 0.36, 95% CI 0.32 to 0.40, p < 0.001), dyslipidaemia (POR 0.33, 95% CI 0.14 to 0.80, p = 0.010), and ischemic heart disease (POR 0.46, 95% CI 0.29 to 0.73, p = 0.001). Limitations of the study include that it was not possible to account for unmeasured variables, which may not have been equally distributed between patient groups given the non-randomised design of the studies included. There was also heterogeneity between studies in the nature of the control group utilised, and potential adverse outcomes related to bariatric surgery were not specifically examined due to a lack of available data., Conclusions: This pooled analysis suggests that bariatric surgery is associated with reduced long-term all-cause mortality and incidence of obesity-related disease in patients with obesity for the whole operated population. The results suggest that broader access to bariatric surgery for people with obesity may reduce the long-term sequelae of this disease and provide population-level benefits., Competing Interests: The authors have declared that no competing interests exist.

One-seventh of the world's adult population, or approximately one billion people, are estimated to have OSA. Over the past four decades, obesity, the main risk factor for OSA, has risen in striking proportion worldwide. In the past 5 years, the WHO estimates global obesity to affect almost two billion adults. A second major risk factor for OSA is advanced age. As the prevalence of the ageing population and obesity increases, the vulnerability towards having OSA increases. In addition to these traditional OSA risk factors, studies of the global population reveal select contributing features and phenotypes, including extreme phenotypes and symptom clusters that deserve further examination. Untreated OSA is associated with significant comorbidities and mortality. These represent a tremendous threat to the individual and global health. Beyond the personal toll, the economic costs of OSA are far-reaching, affecting the individual, family and society directly and indirectly, in terms of productivity and public safety. A better understanding of the pathophysiology, individual and ethnic similarities and differences is needed to better facilitate management of this chronic disease. In some countries, measures of the OSA disease burden are sparse. As the global burden of OSA and its associated comorbidities are projected to further increase, the infrastructure to diagnose and manage OSA will need to adapt. The use of novel approaches (electronic health records and artificial intelligence) to stratify risk, diagnose and affect treatment are necessary. Together, a unified multi-disciplinary, multi-organizational, global approach will be needed to manage this disease., (© 2020 Asian Pacific Society of Respirology.)

Study Objectives: To investigate the prevalence and neurophysiological correlates of obstructive sleep disordered breathing (OSA) in type 1 narcolepsy (NT1) children and adolescents., Methods: Thirty-eight, drug-naïve, NT1 children and adolescents and 21 age- and sex-balanced clinical controls underwent nocturnal polysomnography (PSG) and multiple sleep latency test (MSLT). According to the rules for pediatric population, an obstructive apnea-hypopnea index (Obstructive AHI) ≥ 1 (comprising obstructive and mixed events), defined comorbid OSA., Results: NT1 children showed higher prevalence of overweight/obesity and severe nocturnal sleep disruption (lower sleep efficiency, and increased N1 sleep stage percentage) coupled with higher motor activity (periodic limb movement index [PLMi] and REM atonia index) compared to clinical controls. Sleep-related respiratory variables did not differ between NT1 and clinical controls (OSA prevalence of 13.2% and 4.8%, respectively). NT1 children with OSA were younger and showed lower N2 sleep stage percentage and higher PLMi than NT1 children without comorbid OSA. Overweight/obesity was not associated with OSA in NT1., Conclusions: Despite higher body mass index (BMI), OSA prevalence did not differ between children with NT1 and clinical controls. OSA in pediatric NT1 patients is a rare and mild comorbidity, further contributing to nocturnal sleep disruption without effects on daytime sleepiness., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Obesity is a major and growing global health problem. It is associated with increased mortality as a result of an increasing number of complications, including type 2 diabetes, dyslipidaemia, hypertension, non-alcoholic hepatic steatosis, cardiovascular disease, sleep apnoea, gallbladder disease, obesity-related renal disease, increased risk of falls and injuries, and mental health problems as well as increased risk of certain malignancies. This article discusses the metabolic derangements associated with obesity. These include insulin resistance, dysglycaemia, low and dysfunctional high-density lipoprotein, formation of small dense and oxidised low-density lipoprotein, and high circulating levels of free fatty acids. This article reviews the aetiology of these derangements and their relationship to cardiovascular disease, and discusses the concept of metabolic health.

Study Objectives: There are significant discrepancies between the prevalence of snoring and that of objectively defined sleep disordered breathing among pregnant women, suggesting subtle airflow limitations that may not be captured by conventional scoring. This study examined the performance of pulse transit time, an indirect measure of arterial stiffness and sympathetic activation, in pregnancy., Methods: Pregnant women with obesity and snoring and a group of controls without symptoms of sleep disordered breathing were recruited in the first trimester. Women underwent a level III in-laboratory sleep monitoring study including an electrocardiogram and pulse oximetry, and pulse transit time was measured. Sleep disordered breathing was defined as an apnea-hypopnea index at least five events per hour of sleep. Statistical analysis was performed using Spearman correlation, Fisher's exact t-test, and univariate analysis., Results: Of the 222 women, 38 met criteria for sleep disordered breathing. Pulse transit time drops were very prevalent (95% of participants with snoring had > 5 drops per hour). Median apnea-hypopnea index was 0.7 (interquartile range [IQR]: 2.6) events per hour whereas median pulse transit time drop index was 20.70 (IQR: 35.90) events per hour. Pulse transit time index was significantly higher in snorers with apnea-hypopnea index less than five events per hours and participants with apnea-hypopnea index greater than five events per hour compared to controls. Examination of random epochs with pulse transit time drops showed that 95% of pulse transit time drops were associated with airflow limitation., Conclusions: Pulse transit time ascertains frequent events of sympathetic activation in at-risk women with and without sleep disordered breathing beyond conventional apneas and hypopneas. Pulse transit time may be an important addition to the identification of clinically significant sleep disordered breathing in pregnant women, and may identify more sleep disordered breathing than apnea-hypopnea index., (© Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: The exact mechanisms underlying the established association between ADHD and obesity remain unclear. Food addiction and binge eating may contribute to this link. We examined for the first time the association between childhood/adult ADHD and food addiction/binge eating in patients with obesity, as well as the association between ADHD and sleep apnea syndrome., Methods: We included 105 obese patients from the Nutrition Department of the University Hospital of Tours (France) between January and December 2014. We assessed categorical diagnoses of childhood/adulthood ADHD (semi-structured interview DIVA 2.0), food addiction (Yale Food Addiction Scale 2.0), binge eating (Binge Eating Scale), obstructive sleep apnea (clinical assessment), and BMI (clinical assessment)., Results: Patients with adult ADHD were at significantly higher risk of food addiction than patients without adult ADHD (28.6% vs. 9.1%; p = .016). Adult and childhood ADHD were significantly associated with self-reported food addiction, food addiction scores and binge eating scores, with a larger effect size for adult (ORs: 4.00 [1.29-12.40], 1.37 [1.14-1.65] and 1.08 [1.03-1.14], respectively) than childhood (ORs: 3.32 [1.08-10.23], 1.29 [1.08-1.55] and 1.06 [1.01-1.11], respectively) ADHD. ADHD diagnosis was not significantly correlated to obstructive sleep apnea. Mean age of onset of ADHD preceded mean age of onset of obesity., Conclusion: ADHD diagnosis is associated with food addiction and binge eating, with a larger effect size for adult than childhood ADHD. Our results provide a strong rationale for further longitudinal research on the link between ADHD, food addiction, binge eating and obesity, paving the way for evidence-based therapeutic interventions for these patients., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence., (Copyright © 2018 American Academy of Dermatology, Inc. All rights reserved.)

Background: The prevalence of obese children with sleep disordered breathing (SDB) is increasing. Obesity and SDB are independent cardiovascular risk factors, of which arterial stiffness is an early sign. Pulse wave velocity (PWV), is a marker of arterial stiffness and central systolic blood pressure (cSBP) is a better predictor of cardiovascular outcome than peripheral blood pressure. Therefore, we aimed to determine PWV and cSBP in overweight/obese or normal weight children with sleep disordered breathing (SDB), and non-snoring normal weight controls., Methods: Children (3-18 y) with SDB (overweight/obese [BMI z-scores ≥ 1.04], n = 48; normal weight n = 44) referred for clinical assessment of SDB and normal weight non-snoring controls recruited from the community (n = 38) underwent overnight polysomnography. PWV was calculated using photoplethysmography. cSBP was calculated using applanation tonometry in a subset of children older than 8 y (n = 55) who had usable waveforms., Results: Overweight/obese SDB group had higher PWV (mean cm/s (95% CI); wake: 366 (355-380); sleep: 340 (324-357)), than the normal-weight SDB group (wake: 257 (247-267), p = 0.002; sleep: 255 (242-269), p = 0.005), and non-snoring controls (wake: 238 (226-249), p = 0.002; sleep: 235 (220-250), p < 0.001). The normal-weight SDB group had higher PWV than controls (p = 0.03). Overweight/obese children with SDB had higher cSBP (105 (100-110) mmHg) compared with the normal weight children with SDB (96 (90-102)) and the non-snoring controls (97 (91-104); p < 0.05 for both)., Conclusion: This study suggests that overweight/obesity substantially worsens the cardiovascular sequelae of SDB, highlighting the imperative to treat obesity and SDB in children early in order to reduce future cardiovascular disease risk., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Study Objectives: The individual prevalence of sleep-disordered breathing (SDB), short sleep duration, and obesity is high and increasing. The study aimed to investigate potential associations between SDB, objective sleep duration, obesity, diabetes and hypertension across genders, and the effect of pre- or post-menopausal status., Methods: A cross-sectional study evaluated 7051 community participants with wrist actigraphy for a week, and nocturnal oximetry ≥ 2 nights. SDB was assessed by 3 per cent oxygen desaturation index (ODI) corrected for sleep duration obtained from wrist actigraphy. Moderate-to-severe SDB was defined as ODI3% levels ≥ 15 per hour., Results: Both logODI3% and body mass index showed independent negative associations with sleep duration (β = -0.16, p < 0.001 and β = -0.07, p < 0.001, respectively). Moderate-to-severe SDB (men/premenopausal women/postmenopausal women; 23.7/1.5/9.5%, respectively) was associated with a higher risk of diabetes in premenopausal women (OR 28.1; 95%CI 6.35-124.6; p < 0.001) and postmenopausal women (OR 3.25; 95%CI 1.94-5.46; p < 0.001), but not in men (OR 1.47; 95%CI 0.90-2.40; p = 0.119). Moderate-to-severe SDB was associated with a higher risk of hypertension in men (OR 3.11; 95%CI 2.23-4.33; p < 0.001), premenopausal women (OR 3.88; 95%CI 1.42-10.6; p = 0.008), and postmenopausal women (OR 1.96; 95%CI 1.46-2.63; p < 0.001). Short sleep duration was not associated with diabetes or hypertension. The associations of obesity with diabetes or hypertension were indirectly mediated by SDB (24.0% and 21.5%, respectively), with possible sex differences emerging (men/women; 15.3/27.8% and 27.0/16.9%, respectively)., Conclusions: Notwithstanding the cross-sectional design, SDB and obesity, but not short sleep duration, were independently associated with diabetes and hypertension, with gender and menopausal status-related differences in risk emerging.

Study Objectives: Sleep disorders are frequent in stroke patients. The prevalence of sleep-disordered breathing (SDB), excessive daytime sleepiness (EDS), and restless legs syndrome (RLS) among stroke survivors is up to 91%, 72%, and 15%, respectively. Although the relationship between EDS and SDB is well described, there are insufficient data regarding the association of EDS with RLS. The aim of this study was to explore the association between EDS, SDB, and RLS in acute ischemic stroke., Methods: We enrolled 152 patients with acute ischemic stroke. Epworth Sleepiness Scale (ESS) was used to assess EDS. SDB was assessed using standard overnight polysomnography. All patients filled in a questionnaire focused on RLS. Clinical characteristics and medication were recorded on admission., Results: EDS was present in 16 (10.5%), SDB in 90 (59.2%) and RLS in 23 patients (15.1%). EDS was significantly more frequent in patients with RLS in comparison with the patients without RLS (26.1% versus 7.8%, P = .008). ESS was significantly higher in the population with RLS compared to the population without RLS (7 [0-14] versus 3 [0-12], P = .032). We failed to find any significant difference in the frequency of EDS and values of ESS in the population with SDB compared to the population without SDB. Presence of RLS (beta = 0.209; P = .009), diabetes mellitus (beta = 0.193; P = .023), and body mass index (beta = 0.171; P = .042) were the only independent variables significantly associated with ESS in multiple linear regression analysis., Conclusions: Our results suggest a significant association of ESS with RLS, diabetes mellitus, and obesity in patients with acute ischemic stroke., (© 2018 American Academy of Sleep Medicine)

Introduction: Sleep disorders include a number of different processes, of which the most prevalent is the sleep apnea-hypopnea syndrome (SAHS). Prevalence of SAHS has increased worldwide, and has a significant social and health impact because of the increased cardiometabolic risk attributed to obesity and the associated metabolic syndrome., Material and Methods: A cross-sectional epidemiological study of 1110 workers from public service companies in the Spanish Mediterranean area (Balearic Islands and Valencian Community) was conducted between January and December 2015. Cardiovascular risk was calculated using the Castelli, Kannel and TG/HDL indices, and prevalence of obesity using body mass index, waist circumference, waist-height ratio, and visceral fat. SAHS risk was assessed using the Stop-Bang questionnaire., Results: Risk of SAHS was low in 77% of patients and intermediate-high in 23% of patients. All obesity parameters showed a statistically significant association (p value <.001) with intermediate/high risk of SAHS. Obesity prevalence is higher the worse the quality of sleep. There was a statistically significant relationship between risk of SAHS and cardiovascular risk with the atherogenic indexes found., Conclusions: Twenty-three percent of workers had intermediate/high SAHS risk. The results of this study support the relationship of SAHS with an increased CVR and with obesity parameters. Further prospective studies in different productive sectors may be useful to confirm the results of this research., (Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: This study aimed to determine whether overweight and obesity increased the detrimental effects of pediatric sleep-disordered breathing (SDB) on cognition, behavior, mood, and quality of life., Methods: Children and adolescents (8-16 years) with clinically diagnosed SDB were categorized into two groups: healthy weight (Body Mass Index (BMI) z-score <1.04, N = 11) and overweight/obese (BMI z-score ≥ 1.04, N = 10). Age-matched healthy weight, non-snoring controls (N = 25) were recruited from the community. All participants underwent overnight laboratory polysomnography (PSG). Cognitive, behavioral, and quality of life assessments were conducted in the home following the PSG. Analysis of Covariance (ANCOVA) was used to assess group differences in cognitive outcomes, controlling for socio-economic status. Kruskal-Wallis ANOVA was used to determine group differences in behavior and quality of life. Where group differences were found, hierarchical linear regressions determined the effect of weight on outcomes., Results: Children with SDB had significantly poorer behavior and quality of life than controls, with overweight/obese children with SDB having the greatest dysfunction. No group differences were found in cognitive outcomes. The obstructive apnea hypopnea index (OAHI) was a significant predictor of withdrawn behavior (R 2  = 0.42), inattention (R 2  = 0.43), and aggressive behavior (R 2  = 0.30). BMI z-score added significantly to aggressive behavior (R 2  = 0.22) and was an independent predictor of externalizing behaviors (R 2  = 0.26). The OAHI predicted school functioning (R 2  = 0.30). BMI z-score predicted social functioning (R 2  = 0.38) and significantly added to physical functioning over the OAHI (OAHI R 2  = 30; BMI z-score R 2  = 0.37)., Conclusions: Overweight and obesity comorbid with SDB increase the risk of externalizing behaviors such as aggression but do not affect other behavioral associates of SDB such as inattention and school functioning., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Evidence-based screening tools are required for detection of daytime hypercapnia in high-risk patient populations., Aims: To determine the validity of supine awake oximetry as a test for daytime hypercapnia and severe sleep disordered breathing (SDB) in super-obese patients., Methods: This was a cross-sectional diagnostic test evaluation of super-obese adults (body mass index >50 kg/m 2 ) presenting to Liverpool Hospital, Australia, between 2009 and 2015 for diagnostic polysomnography (PSG) and arterial blood gas measurement. Supine awake oxygen saturation (SpO 2 ) was determined using oximetry measurements from the first three awake epochs of raw PSG data. Sensitivity and specificity of SpO 2 for detecting patients with daytime hypercapnia (PaCO 2 >45 mmHg) and severe SDB (respiratory disturbance index (RDI) >30 events/h) were assessed at various cut-off points and displayed using a receiver operating characteristic (ROC) curve. Area under the ROC curve and positive and negative predictive values (PPV and NPV) in the present patient population were derived., Results: Of 52 patients, 23 (44%) had daytime hypercapnia. SpO 2 measured awake in the supine position was associated with the presence of daytime hypercapnia but not with the presence of severe SDB. Overall, awake supine SpO 2 <91.2% had 34.8% sensitivity, 96.6% specificity and 88.8% PPV, and SpO 2 <96.7% had 87.0% sensitivity, 20.7% specificity and 66.7% NPV for the presence of daytime hypercapnia., Conclusion: Awake supine oximetry is an easily performed test that may have novel use in identifying patients at high risk of respiratory failure. Future studies are required to evaluate prospectively its role in screening patients at risk of daytime hypercapnia., (© 2017 Royal Australasian College of Physicians.)

Idiopathic leg edema is subject to a lot of debates among physicians. Recently sleep apnea was stated to be the cause. We sought to investigate this matter in a sample of Iranian patients with idiopathic leg edema. In this case-control study, 110 patients were selected based on our inclusion/exclusion criteria and allocated to the case (with idiopathic edema, n=55) and control (without edema, n=55) groups. Sex, age, weight, height, and body mass index (BMI) of all subjects were recorded. We evaluated daytime somnolence of all patients using Epworth sleepiness scale and then calculated Apnea, hypopnea index (AHI) using ResMed ApneaLink and AHI≥15 were considered as sleep apnea. Age and sex of both groups were not significantly different. Cases had higher BMI than control groups (P=0.03), but they were not significantly different for obesity (P=0.197). AHI was significantly higher in cases (17.85±24.31 vs. 9±7.37 P=0.012). Daytime somnolence (cases 8.18±5.3 vs. controls 6.5±3.3) was also higher in cases. Overall Odds ratio of leg edema and sleep apnea was 3.068 (P=0.025), but it wasn't significant in the two genders. Idiopathic bilateral leg edema is strongly associated with sleep apnea. Routine sleep apnea assessment in patients with idiopathic bilateral leg edema is recommended for both genders.

Study Objectives: There is evidence that cardiometabolic disease associated with obesity and sleep-disordered breathing (SDB) in adults is present in youth. SDB is often treated with positive airway pressure (PAP) in youth with obesity. Our aims were to determine: (1) the prevalence of cardiometabolic disease and (2) whether PAP improves markers of cardiometabolic disease, in youth with obesity and newly diagnosed moderate-severe SDB., Methods: A prospective multicenter cohort study was conducted in youth (8 to 16 years old) with obesity, prescribed PAP therapy for newly diagnosed moderate-severe SDB. Assessments occurred at baseline and at 6 and 12 months. Outcomes included markers of insulin resistance (change in homeostasis model assessment of insulin resistance (HOMA-IR) at 6 months = primary outcome), hypertension (24-hour ambulatory/blood pressure) and inflammation (high-sensitivity C-reactive protein: hs-CRP)., Results: Twenty-seven participants were enrolled. Of those with baseline testing available, 10/25 (40%) had HOMA-IR above the 97th percentile, 10/23 (44%) were hypertensive, 16/23 (70%) had loss of nocturnal blood pressure dip and hs-CRP was elevated in 16/27 (64%). There were no significant changes over time in markers of metabolic dysfunction or blood pressure, nor between PAP-adherent and non-adherent subgroups., Conclusions: In youth with obesity and SDB, metabolic dysfunction and hypertension were highly prevalent. There were no statistically significant improvements in cardiometabolic markers 1 year after the prescription of PAP therapy, although clinically relevant improvements were seen in insulin resistance and systolic blood pressure load, important predictors of future risk of cardiovascular disease. Larger, longer-term studies are needed to determine whether PAP improves cardiometabolic outcomes in obese youth., Commentary: A commentary on this article appears in this issue on page 1025., (© 2017 American Academy of Sleep Medicine)

Background: Because the interrelationships of objectively ascertained sleep-disordered breathing (SDB), postcardiac surgery atrial fibrillation (PCSAF), and obesity remain unclear, we aimed to further investigate the interrelationships in a clinic-based cohort., Methods: Patients with polysomnography and cardiac surgery (coronary artery bypass surgery and/or valvular surgery) within 3 years, from January 2009 to January 2014, were identified, excluding those with preexisting atrial fibrillation. Logistic models were used to determine the association of SDB (apnea hypopnea index [AHI] per 5-unit increase) and secondary predictors (central sleep apnea [CSA] [central apnea index ≥ 5] and oxygen desaturation index [ODI]) with PCSAF. Models were adjusted for age, sex, race, BMI, and hypertension. Statistical interaction and stratification by median BMI was performed. ORs and 95% CIs are presented., Results: There were 190 patients who comprised the analytic sample (mean age, 60.6 ± 11.4 years; 36.1% women; 80% white; BMI, 33.3 ± 7.5 kg/m 2 ; 93.2% had an AHI ≥ 5; 30% had PCSAF). Unlike unadjusted analyses (OR, 1.06; 95% CI, 1.01-1.1), in the adjusted model, increasing AHI was not significantly associated with increased odds of PCSAF (OR, 1.04; 95% CI, 0.98-1.1). Neither CSA nor ODI was associated with PCSAF. A significant interaction with median BMI was noted (P = .015). Effect modification by median BMI was observed; those with a higher BMI > 32 kg/m 2 had 15% increased odds of PCSAF (OR, 1.15; 95% CI, 1.05-1.26; P < .003)., Conclusions: SDB was significantly associated with PCSAF in unadjusted analyses, but not after taking into account obesity; those with both SDB and obesity may represent a vulnerable subgroup to target to reduce PCSAF and its associated morbidity., (Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

The world is in the midst of an unprecedented epidemic of obesity. This epidemic has changed the presentation and etiology of common diseases. For example, steatohepatitis, directly attributable to obesity, is now the most common cause of cirrhosis in the United States. Type 2 diabetes is increasingly being diagnosed in children. Pulmonary researchers and clinicians are just beginning to appreciate the impact of obesity and altered metabolism on common pulmonary diseases. Obesity has recently been identified as a major risk factor for the development of asthma and for acute respiratory distress syndrome. Obesity is associated with profound changes in pulmonary physiology, the development of pulmonary hypertension, sleep-disordered breathing, and altered susceptibility to pulmonary infection. In short, obesity is leading to dramatic changes in lung health and disease. Simultaneously, the rapidly developing field of metabolism, including mitochondrial function, is shifting the paradigms by which the pathophysiology of many pulmonary diseases is understood. Altered metabolism can lead to profound changes in both innate and adaptive immunity, as well as the function of structural cells. To address this emerging field, a 3-day meeting on obesity, metabolism, and lung disease was convened in October 2015 to discuss recent findings, foster research initiatives, and ultimately guide clinical care. The major findings arising from this meeting are reported in this document.

Background: The alarming progression of pediatric obesity is associated with the development of sleep-disordered breathing (SDB), and both exhibit similar adverse cardiometabolic health outcomes. Physical activity level (PAL) may counteract sleep and metabolic disturbances. The present study investigates i) the association between the metabolic syndrome in childhood obesity and SDB, ii) the impact of SDB severity on cardiometabolic risk scores and PAL in children with obesity., Methods: Maturation status (Tanner stages), anthropometric (height, weight, body mass index, waist circumference, body adiposity index) and cardiometabolic characteristics (systolic and diastolic blood pressure, lipid and glycemic profiles) were assessed in 83 obese children (mean±SD, age: 10.7±2.7years). PAL and SDB were investigated with a step test and interviews, and an overnight sleep monitor, respectively. The presence or absence of metabolic syndrome (MS) was established and continuous cardiometabolic risk scores were calculated (MetScore BMI and MetScore WC )., Results: Obese children with (61.4%) and without (38.6%) MS present similar SDB. SDB severity is associated with increased insulin concentrations, MetScore BMI and MetScore WC (p<0.05) in obese children. There is no association between SDB and PAL., Conclusions: In a context where no consensus exists for SDB diagnosis in children, our results suggest the influence of SDB severity on cardiometabolic risk factors. Further studies are needed to explore the association between PAL and both metabolic and sleep alterations in obese children., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Prader Willi syndrome, resulting from the partial deletion or lack of expression of a region of genes on the paternal chromosome 15, has a number of phenotypic features which predispose affected patients to ventilatory problems. These include generalised hypotonia, abnormal arousal and ventilatory responses to hypoxia and hypercapnia, scoliosis and frequently, obesity. The spectrum of the resulting respiratory complications thus runs from sleep disordered breathing, to aspiration and respiratory functional impairment. While the use of growth hormone, in conjunction with multidisciplinary clinical management, is currently the cornerstone of clinical care of these patients, concerns have been raised following reports of sudden death shortly after growth hormone initiation. This review summarizes the respiratory complications commonly seen and draws together the published literature on the impact of growth hormone in relation to various respiratory parameters, aiming to provide the reader with the necessary information to manage these patients as safely as possible., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Study Objectives: Poor or short sleep and the presence of snoring indicative of sleep-disordered breathing (SDB) have been associated with behavioral problems in school-aged children. We examined the relationship between SDB, sleep duration, obesity risk, and behavioral characteristics in Japanese elementary school students using a large-scale survey., Methods: We conducted a cross-sectional study of children enrolled in all 46 public primary schools in Matsuyama city, Japan. The children's parents or guardians completed a questionnaire that covered sleep habits, presence of SDB risk, and behavioral characteristics., Results: In total, 24 296 responses were received (90% response rate). After excluding incomplete responses, we analyzed complete datasets for 17 769 children. Mean sleep duration decreased with age, as did the prevalence of pediatric SDB. We found an increased risk for the presence of SDB and short sleep among overweight/obese children. With SDB or short sleep, we observed significantly increased odds of restless behaviors, fidgety behaviors, and poor concentration in school., Conclusions: Shorter sleep duration was associated with increased risk of obesity, and in turn, obesity increased SDB risk. Both short sleep duration and SDB risk were significantly associated with behavioral problems in school., (© Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.)

Intensive research is currently being performed into the genetic background of excess body mass compli- cations such as diabetes, cardiovascular disorders, especially atherosclerosis and coronary heart disease. Chronic inflammation is an important process in the pathogenesis of obesity, wherein there is an aberrant ex- pression of genes encoding adipokines. Visceral tissue is characterized by a higher expression and secretion of interleukin-8, interleukin-1ß and plasminogen activator inhibitor 1 in the subcutaneous tissue secretion of leptin prevails. An important complication of obesity is obstructive sleep apnea, often observed in Prader- Willi syndrome. The genetic background of sleep apnea may be a polymorphism of the SREBF1 gene. The consequence of excess body mass is metabolic syndrome, which may be related to the occurrence of the rs926198 variant of gene encoding caveolin-1. The genes of transcription factor TCF7L2 and PPAR-γ2 take part in the pathogenesis of diabetes development. It has been demonstrated that oncogenes FOS, FOSB, and JUN may be co-responsible not only for obesity but also for osteoporosis and colorectal cancer. It has been shown that weight loss causes a modification in the expression of about 100 genes involvedt in the production of substances such as cytokines and other responsible for chronic inflammation in obesity. In future studies on the complications of obesity, such scientific disciplines as proteomics, peptidomics, metabolomics and transcriptomics should be used. The aim of this study is to present the current state of knowledge about the genetic basis of obesity complications.

More women than not are entering pregnancy either overweight or obese. This presents a significant health care burden with respect to maternal morbidities and offspring complications at birth and in later life. In recent years it has also become clear that maternal obesity is an even greater global health problem than anticipated, because the effects are not limited to the mother but are also programmed in the fetus, known as the 'intergenerational cycle of obestiy'. Despite a large body of epidemiological evidence reporting outcomes of obese pregnancies, including offspring respiratory complications, much less is known about the molecular effects of maternal obesity on fetal lung development. This review focuses on the influence of altered substrate supply associated with the obesogenic intrauterine environment on fetal lung development. Understanding the molecular mechanisms contributing to altered fetal lung development will lead to improved respiratory outcomes for offspring at birth and in later life., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: The objective of this study was to evaluate associations between obesity measures and sleep-disordered breathing severity among White, Black, Hispanic, and Chinese Americans., Methods: The method used in this study was a community-based cross-sectional study of 2053 racially/ethnically diverse adults in the Multi-Ethnic Study of Atherosclerosis. Anthropometry and polysomnography were used to measure obesity and apnea-hypopnea index (AHI). Linear regression models were fitted to investigate associations of body mass index (BMI) and waist circumference with AHI (log transformed) with adjustment for sociodemographics, lifestyle factors, and comorbidities., Results: The mean participant age was 68.4 (range: 54-93) years; 53.6% of participants were women. The median AHI was 9.1 events/h. There were significant associations of BMI and waist circumference with AHI in the overall cohort and within each racial/ethnic group. A significant interaction was observed between race/ethnicity and BMI (P interaction  = 0.017). Models predicted that for each unit increase in BMI (kg/m 2 ), the mean AHI increased by 19.7% for Chinese, 11.6% for Whites and Blacks, and 10.5% for Hispanics. Similarly, incremental changes in waist circumference were associated with larger increases in AHI among Chinese than among other groups., Conclusions: Associations of BMI and waist circumference with AHI were stronger among Chinese than among other racial/ethnic groups. These findings highlight a potential emergence of elevated sleep-disordered breathing prevalence occurring in association with increasing obesity in Asian populations., Competing Interests: All authors have no conflict of interest in relation to the work described., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: Polycystic ovary syndrome (PCOS) is one of the most common endocrinological disorders in women of reproductive age, and is characterized by hyperandrogenism. It is associated with long-term metabolic dysfunctions including sleep-disordered breathing (SDB). We hypothesized that the increased prevalence of SDB in PCOS results from raised testosterone levels., Methods: This was a prospective, cross-sectional, case-control study in which 50 case patients with untreated PCOS and 100 control subjects were included. All the case patients and control subjects went through a detailed clinical, biochemical, and hormonal evaluation. Overnight polysomnography was performed in all case patients and the snorers (16 of 100) in the control group., Results: SDB was seen in 66% of the case patients and in 4% of control group with (odds ratio [OR] = 46.5, 95% confidence interval [CI] = 14.6-148.4; p <0.001). After adjustment for body mass index (BMI) and waist circumference (WC), the difference was not significant (p = 0.993 and p = 0.931, respectively). The SDB patients with PCOS showed significantly higher respiratory distress index (RDI) values than SDB patients in the control group (22.5 ± 21.5 vs 9.0 ± 5.6, p = 0.01). On the Epworth Sleepiness Scale the PCOS case patients reported feeling more sleepy than did the control subjects (12.5 ± 3.2 vs 9.32 ± 1.7, p <0.001). Free testosterone levels were also significantly higher in the PCOS group than in the control subjects (2.95 ± 3.44 vs 1.5 ± 1.0, p <0.001). There was a significant correlation between free testosterone level and RDI values (r = 0.377; p = 0.007), WC (r = 0.315; p = 0.026), and BMI (r = 0.398; p = 0.004). A significant correlation of WC (r = 0.551; p <0.001) and BMI (r = 0.572; p <0.001) was observed with RDI., Conclusion: Testosterone-induced obesity is probably the common pathway for the development of SDB in PCOS., (Copyright © 2016. Published by Elsevier B.V.)

Background: Obesity is a predisposing factor for obstructive sleep apnoea (OSA). Conversely, OSA increases the risk of developing hypertension and diabetes mellitus. Whether the presence of metabolic syndrome increases the risk of sleep-disordered breathing (SDB) independent of obesity remains unclear., Methods: Consecutive 25 non-obese and 25 obese adult patients with metabolic syndrome and Epworth Sleepiness Scale (ESS) score 10 underwent full night attended polysomnography. Baseline clinical and demographic parameters were recorded for all the patients. Obesity was defined as body mass index (BMI) 25kg/m2. Occurrence of SDB (central sleep apnoea and/or OSA), sleep efficiency, and time spent in each sleep stage were noted in both the study groups., Results: The study subjects were predominantly nen (n=41, 82%) with a mean age of 47.1 years. A total of 38 (76%) subjects were diagnosed to have OSA. There was no difference in the prevalence of OSA between the study groups (non-obese versus obese, 20 [80%] versus 18 [72%]; p=0.508). Patients in both the groups had low median sleep efficiency (non-obese versus obese, 47% versus 48.7%; p=0.764), and an equal number of awakenings per hour of sleep (non-obese versus obese, median interquartile range [IQR], 21 [7.5-26.5] versus 18 [13-22.5]; p=0.763). None of the patients in either group had central sleep apnoea., Conclusion: Obstructive sleep apnoea is highly prevalent in patients with metabolic syndrome and excessive daytime sleepiness (ESS 10), and the prevalence of OSA in this population is independent of BMI.

Objective: To assess the prevalence of obesity and associated health outcomes among US service members and veterans., Methods: Data from three survey cycles (2001-2008) of the Millennium Cohort Study were used to examine the prevalence of obesity and associated health outcomes., Results: Of the 42,200 individuals, 25% were of normal weight in 2007/2008. Rates of obesity were significantly higher among veterans (32%) compared with service members (20%). Over a 7-year period, obesity rates doubled among both service members (10%-20%) and veterans (14%-32%). Participants with obesity were significantly more likely to be male, older, less educated, in the Army or Navy, and separated/retired from the military. Hypertension, diabetes, and sleep apnea were significantly more common among individuals with obesity compared with participants with normal weight (all P < 0.05). Individuals with obesity also had significantly higher rates of depression and post-traumatic stress disorder than individuals with normal weight and had lower mental and physical functional scores (all P < 0.05)., Conclusions: These findings indicate an urgent need to enhance strategies for preventing and reducing excess weight gain within the military and veteran populations. Such strategies should aim to ensure a fit military force and promote health after military service., (© 2016 The Obesity Society.)

Liraglutide is an analogue of Glucagon-Like Peptide-1 (GLP-1) already indicated under the trade name of Victoza for the treatment of type 2 diabetes, at usual doses of 1.2 or 1.8 mg as once daily subcutaneous injection. It is henceforth indicated at a dose of 3.0 mg, also as once daily subcutaneous injection, for the treatment of obesity or overweight with comorbidities under the trade name of Saxenda, in combination with diet and exercise. Besides a specific action on the endocrine pancreas, mainly responsible for the antihyperglycaemic effect, liraglutide helps controlling appetite at the hypothamalic level. A specific programme of controlled trials (especially SCALE studies) demonstrated both efficacy and safety of the 3.0 mg dose of liraglutide in obese or overweight patients with various comorbidities.

Background: Prevalence and potential risk contributors of sleep-disordered breathing (SDB) in adolescents and younger adults remain unclear. We hypothesized that SDB prevalence in younger Hispanic adults is higher than the limited evidence indicates., Methods: This is a population-based study of Hispanic subjects surveyed as part of the Chilean National Health Survey database. For this study, only subjects aged 15 to 40 years were included. Sleep and demographic questionnaires were used to assess SDB prevalence and its risk factors. Anthropometric measurements were performed in each subject. Prevalence was calculated for each SDB-related symptom. A regression model was constructed to investigate demographic risk factors of SDB., Results: A total of 2,147 subjects were included. Mean age (± SD) was 27.2 ± 7.2 years, n = 899 (42%) were men. Habitual snoring was highly prevalent, with an average of 53.8% in men and 38.3% in women. Snoring, witnessed apneas, and daytime somnolence increased continuously with age, with an abnormal SDB questionnaire score detected in 2.5%. Reported sleep duration was 7.61 ± 1.67 hours during weekdays and 8.27 ± 2.11 hours during weekends. Snoring frequency was significantly higher in men than women at nearly all age groups, and an adjusted regression model (OR [95% CI]) identified male sex (2 [1.6-2.5]; P < .001) and BMI (1.08 [1.03-1.12]; P < .001) as independent risk factors for snoring., Conclusion: The risk of SDB is highly prevalent in younger adults, even in females, and increases with age and BMI. The high prevalence and low awareness justify active screening and treatment of SDB in this population., (Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Purpose: Pediatric brain tumor survivors have increased risk of sleep problems, particularly excessive daytime sleepiness (EDS). Few studies have examined sleep disturbances in this population., Methods: 153 children and adolescents ages 8-18 and their parents completed questionnaires (Modified Epworth Sleepiness Scale, Kosair Children's Hospital Sleep Questionnaire, Children's Report of Sleep Patterns, Children's Sleep Hygiene Scale) during clinic visits. Participants were at least 5 years from diagnosis and 2 years post-treatment. Group differences in age at diagnosis, body mass index, type of treatment received, and tumor location were examined., Results: One-third of adolescents and one-fifth of children reported EDS. Children and parents had fair concordance (kappa coefficient = .64) in their report of EDS, while adolescents and parents had poor concordance (kappa coefficient = .37). Per parents, most children slept 8 to 9 h per night. Poor bedtime routines were reported for children, while adolescents endorsed poor sleep stability. Extended weekend sleep was reported across age groups. A BMI in the obese range was related to higher parent-reported EDS in children. Sleep-disordered breathing was associated with elevated BMI in adolescents., Conclusions: While survivors reported achieving recommended amounts of sleep each night, 20 to 30% reported EDS. Poor concordance among parent and adolescent report highlights the importance of obtaining self-report when assessing sleep concerns. Obesity is a modifiable factor in reducing symptoms of EDS in this population. Finally, the lack of association between EDS and brain tumor location, BMI, or treatment received was unexpected and warrants further investigation.

Study Objective: To investigate the influence of sleep disordered breathing (SDB) on weight loss in overweight/obese veterans enrolled in MOVE!, a nationally implemented behavioral weight management program delivered by the National Veterans Health Administration health system., Methods: This observational study evaluated weight loss by SDB status in overweight/obese veterans enrolled in MOVE! from May 2008-February 2012 who had at least two MOVE! visits, baseline weight, and at least one follow-up weight (n = 84,770). SDB was defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was weight change (lb) from MOVE! enrollment to 6- and 12-mo assessments. Weight change over time was modeled with repeated-measures analyses., Results: SDB was diagnosed in one-third of the cohort (n = 28,269). At baseline, veterans with SDB weighed 29 [48] lb more than those without SDB (P < 0.001). On average, veterans attended eight MOVE! visits. Weight loss patterns over time were statistically different between veterans with and without SDB (P < 0.001); veterans with SDB lost less weight (-2.5 [0.1] lb) compared to those without SDB (-3.3 [0.1] lb; P = 0.001) at 6 months. At 12 mo, veterans with SDB continued to lose weight whereas veterans without SDB started to re-gain weight., Conclusions: Veterans with sleep disordered breathing (SDB) had significantly less weight loss over time than veterans without SDB. SDB should be considered in the development and implementation of weight loss programs due to its high prevalence and negative effect on health., (© 2016 Associated Professional Sleep Societies, LLC.)

Objective: Sleep apnea is associated with hyperuricemia owing to hypoxia-induced nucleotide turnover. We undertook this study to assess the relationship between incident sleep apnea and the risk of incident gout., Methods: Using data from The Health Improvement Network in the UK, we identified individuals with a first-ever physician diagnosis of sleep apnea. For each patient with sleep apnea, up to 5 individuals without sleep apnea were matched by sex, age, birth year, and body mass index (within ±0.5 kg/m(2) ). We estimated the incidence rates of gout and examined the relationship between sleep apnea and the risk of incident gout using a Cox proportional hazards model, adjusting for potential confounders. In addition, we assessed the rate difference in gout due to sleep apnea using an additive hazard model., Results: Among 9,865 patients with newly diagnosed sleep apnea and 43,598 matched individuals without sleep apnea, we identified 270 incident cases of gout over 1 year of followup, resulting in incidence rates of 8.4 per 1,000 person-years and 4.8 per 1,000 person-years, respectively. The crude and multivariable rate ratios of incident gout in patients with sleep apnea were 1.7 (95% confidence interval [95% CI] 1.3, 2.2) and 1.5 (95% CI 1.1, 2.1), respectively. The corresponding rate differences between patients with sleep apnea and the comparison cohort were 3.6 (95% CI 1.6, 5.6) and 2.8 (95% CI 0.7, 4.9) per 1,000 person-years. The effect of sleep apnea persisted across subgroups., Conclusion: This general population-based study indicates that sleep apnea is independently associated with an increased risk of incident gout. Future research should examine the potential benefits of correcting sleep apnea-induced hypoxia on the risk of hyperuricemia and gout flares., (© 2015, American College of Rheumatology.)

Rationale: Hypoxemia in obese patients is likely to be associated with a high prevalence of sleep-disordered breathing. Supplemental oxygen is commonly used to treat chronic hypoxemia but carries some risk in obese individuals due to unrecognized comorbid obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS)., Objectives: The first step in the estimation of this risk is to determine the prevalence of OSA and OHS in obese individuals with chronic, awake hypoxemia., Methods: A single-center retrospective cohort study was performed to assess the prevalence and severity of OSA and OHS among obese individuals with hypoxemia. One hundred eighty-four individuals underwent arterial blood gas testing and polysomnography. One hundred fifty-eight of these individuals also had spirometry., Measurements and Main Results: The prevalence of OSA was 80%, and the prevalence of OHS was 51%. Chronic obstructive pulmonary disease (COPD) was confirmed by spirometry in 49% of the cohort, and OSA was found in 69% of those individuals. The severity of hypoxemia in this cohort was not statistically related to COPD, OSA, or OHS., Conclusions: OSA and OHS are highly prevalent in obese patients with chronic awake hypoxemia, and OSA frequently coexists with COPD. Evaluation of chronic, awake hypoxemia solely based on arterial blood gas measurements and pulmonary function testing is not sufficient to identify OSA and OHS. Further diagnostic sleep testing should be performed to identify those who could benefit from alternative therapies and to avoid potential harm from treatment with supplemental oxygen alone.

Objective: Rapid eye movement (REM)-related sleep disordered breathing (SDB) is an entity in which the cessation or reduction of breathing occurs primarily during the REM period. Most studies have shown that REM-related SDB more frequently affects women, younger people and patients with mild or moderate SDB. The aim of this study was to prospectively investigate the prevalence and features of REM-related SDB in Japanese subjects compared with the findings of previous reports., Methods: A total of 468 patients were evaluated in this study. The diagnosis of SDB was established using polysomnographic monitoring. The patient variables included age, gender, body characteristics, comorbidities, etc., Results: REM-related SDB was more prevalent in women than non-REM-related SDB (male ratio; 66.3% vs. 79.5%, p=0.03). Moreover, the patients with REM-related SDB had lower body mass indexes (25.9 ± 6.9 vs. 28.5 ± 7.7; p=0.003), arousal indexes (31.8 ± 10.7 vs. 61.0 ± 29.1; p<0.001), apnea hypopnea indexes (15.0 ± 8.0 vs. 54.9 ± 35.9) and glycosylated hemoglobin (HbA1c) levels (5.5 ± 0.9 vs. 5.9 ± 2.6; p=0.02) than the patients with non-REM-related SDB. However, the overall and female gender prevalence of REM-related SDB among the Japanese subjects was lower than that shown in previous reports. The finding that REM-related SDB was not prevalent in younger individuals or severely obese patients was not consistent with the results of previous studies., Conclusion: The present findings suggest that REM-related SDB may have different clinical characteristics in the Japanese population than that observed in previous reports.

Introduction: Snoring is the major symptom of sleep disordered breathing (SDB) which is of immense public health importance. It is associated with some morbidities and mortality in the elderly. Few studies have addressed this problem in the elderly Nigerians., Methods: Cross-sectional study of 843 elderly patients at the Geriatric Centre, University College Hospital, Ibadan, Nigeria. Data were collected on the following candidate variables which may be associated with snoring such as socio-demographic characteristics, morbidities, lifestyle habits and functional disability using Katz index. Anthropometric measurements such as body mass index and neck, waist and hip circumferences were taken. Statistical analysis was done with SPSS 17., Results: The point prevalence of reported snoring was 31.2%. Habitual snoring was reported by 24.8%. Snoring was significantly associated with obesity, moderate to severe oropharyngeal crowding, wide neck and waist circumferences in both sexes. Logistic regression analysis showed wide neck circumference (OR = 6.005; 95%CI= 2.150-16.770) among the males and obesity (OR = 2.028; 95%CI= 1.344-3.061) and moderate to severe oropharyngeal crowding (OR = 1.639; 95%CI= 1.057-2.543) in the females to be the most significant factors associated with snoring., Conclusion: The high prevalence of snoring among elderly patients in Nigeria calls for concerted effort by healthcare workers to educate the elderly.

Background: Overweight and obesity are common in the Netherlands: in 2006 51% of adult men and 42% of adult women were overweight; 10% of men and 12% of women were obese. Patients with overweight or obesity in the Netherlands are often referred to dietitians in primary care for weight loss treatment. We followed a prospective observational cohort to study the effectiveness of this treatment and present the baseline results in this article., Methods: We invited dietitians throughout the country, who completed at baseline a questionnaire for each patient including weight, stature, waist circumference, age, gender, morbidities, medication, education level, ethnicity, referral, treatment expectations, history of previous weight loss attempts, and exercise., Results: At baseline data from 1546 patients were obtained from 158 dietitians working in 26 practices. The majority (73%) of patients were obese (BMI ≥ 30 kg/m2); and 10% had a BMI of 40 kg/m2 or more. The majority of patients (94%) had a high to extremely high weight related health risk (WRHR): (BMI 25-30 kg/m2 with comorbidities, or BMI 30-35 kg/m2 without comorbidities, up to BMI ≥35 with comorbidities and BMI ≥40 with or without comorbidities). More than half (57%) had comorbidities and a long history of weight loss attempts. An extremely high WRHR was seen in 24.5% of the sample. Patients with very high to extremely high WRHR often had type 2 diabetes mellitus; hypertension; dyslipidaemia; osteo arthritis; and sleep apnoea. Patients of middle and old age had a higher risk for very high and extremely high WRHR. Those with other comorbidities and those who asked for referral themselves had a lower risk., Conclusion: The study was effective in recruiting dietitians to participate. The sample is representative for dietitians working in primary care. The majority of patients (94%) had a high to extremely high weight related health risk (WRHR).

Background: Weight loss by means of an intragastric balloon is an advantageous procedure, as usage of such a balloon is minimally invasive and of minimal operational risk. Nevertheless, despite the encouraging results referred in to large population studies, its success rate as a treatment option is still questionable. The aim of this study was to classify and analyze all parameters recorded in a database of a treatment protocol concerning obese individuals handled by an intragastric balloon, in an attempt to delineate the comparable profile of those who succeeded to lose weight and those who failed., Subjects and Methods: Retrospective data collection, including demographic and anthropometric data, social and psychological factors, educational status, and attendance at sessions and the exercise program, was conducted. Using as a criterion for grouping the percentage of excess weight loss (%EWL), the successful (%EWL ≥50%) and the poor (%EWL ≤20%) responders were identified., Results: In total, 583 patients were assessed. Initial and ideal body weight (BW), initial body mass index (BMI), and excess weight were significantly lower in the %EWL ≥50% group (P<.001). Upon balloon removal, both groups exhibited a significant difference regarding BW, BW lost, BMI, and %EWL (P<.001). Advanced age (odds ratio [OR]=1.06; P<.001), female gender (OR=3.31; P<.001), basic educational level (OR=3.12; P<.001), and single or divorced marital status (OR=6.00; P<.001) were identified as the most powerful determinants of %EWL ≥50%. Moreover, attendance at more than four monthly interviews and strict exercise program commitment contributed significantly to a favorable outcome., Conclusions: Our findings could serve as an initial step for further research into factors possibly contributing to the early identification of those individuals who will notably benefit from usage of an intragastric balloon regarding BW loss.

Aims: Obesity is associated with the development of atrial fibrillation (AF), and both obesity and AF are independently associated with the development of heart failure with preserved ejection fraction. We tested the hypothesis that sleep apnea (SA) would have a body mass index (BMI) independent association with adverse left ventricular (LV) remodeling and clinical outcomes in patients with AF and preserved LV function., Methods and Results: From 720 consecutive patients with AF, 403 patients without myocardial disease (preserved LV function) were identified and followed up for 3.3 ± 1.5 years. The primary outcome was a combination of all-cause mortality/heart failure hospitalization. Left ventricular mass and LV mass-to-volume ratio were higher in patients with SA and obesity (P < .0001 for all). Body mass index (β per log = .47; P < .0001) and SA (β = .05; P = .045) were independently associated with LV mass index. Patients with treated SA had a lower LV mass index (but not LV mass-to-volume ratio) compared with untreated (P = .002). In a best overall multivariable model, SA therapy (β = -.129; P = .001) and BMI (β per log = .373; P = .0007) had opposing associations with LV mass index. Sleep apnea (hazard ratio [HR] = 2.94; P = .0004) and BMI (HR per 1 kg/m(2) = 1.08; P = .004) were associated with clinical outcome in unadjusted analysis. Only SA was associated with clinical outcome in a best overall multivariable model (HR = 2.14; P = .02)., Conclusion: Sleep apnea and obesity are independently associated with adverse LV remodeling and clinical outcomes in patients with preserved LV function, whereas continuous positive airway pressure therapy is associated with a beneficial effect on LV remodeling. Research investigating SA therapies in patients at high risk for LV remodeling and heart failure is warranted., (Copyright © 2014 Mosby, Inc. All rights reserved.)

The association between body mass index (BMI) in young adulthood and long-term risk of atrial fibrillation (AF) has not yet been examined for men. We conducted a population-based 36-year cohort study to examine the BMI-associated risk of AF in 12,850 young men who had BMI measured at their examination of fitness for military service. AF was identified from the Danish National Registry of Patients, covering all Danish hospitals since 1977. We began follow-up on the twenty-second birthday of each subject and continued until the occurrence of AF, emigration, death, or December 31, 2012. We used Cox regression to compute hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for education and height. The cohort contributed a total of 375,888 person-years of follow-up and the median follow-up time was 26 years (mean 29 years). The incidence of AF per 100,000 person-years was 53 for men of normal weight (BMI: 18.5 to 24.9 kg/m(2)), 54 for underweight men (BMI <18.5 kg/m(2)), 106 for overweight men (BMI: 25.0 to 24.9 kg/m(2)), and 144 for obese men (BMI ≥30 kg/m(2)). With normal weight as the reference group, the adjusted HR for AF was 0.99 (95% CI 0.52 to 1.87) for underweight men, 2.08 (95% CI 1.48 to 2.92) for overweight men, and 2.87 (95% CI 1.46 to 5.62) for obese men. The adjusted HR associating 1 unit increase in BMI with AF was 1.12 (95% CI 1.07 to 1.16). In conclusion, overweight and obese young men had more than twice the risk of AF compared with young men of normal weight., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Childhood high body mass index (BMI) and sleep disordered breathing (SDB) are increasingly prevalent and both are associated with perioperative respiratory complications. Laryngospasm is one of the more serious respiratory complications with potentially devastating consequences. It is presently unclear whether high BMI and incident SDB in children significantly amplifies the risks of perioperative laryngospasm. This study examined the hypothesis that compared to controls; children with high BMI and SDB at the time of surgery have higher rates of perioperative laryngospasm., Methods: Children (6-18 yr) who underwent elective, non-cardiac operations at a tertiary care center were the subjects of this cross-sectional study. Rates of perioperative laryngospasm were compared between normal controls and children who were overweight/obese and had clinical history of SDB at the time of surgery. Stepwise logistic regression analysis was performed to identify independent predictors of perioperative laryngospasm (dependent variable) using high BMI/SDB as the primary predictor variable., Results: Among 642 children, those who were overweight/obese and had incident SDB (N = 197) were younger, and had higher indexes of central adiposity. Children with high BMI and SDB had 3.8 times higher unadjusted odds of developing intraoperative laryngospasm (OR = 3.8; 95% CI = 2.1-6.9, p < 0.001). After adjusting for several relevant covariates, the following factors were found to be independent predictors of perioperative laryngospasm: high BMI + SDB, male sex and increasing neck circumference., Conclusion: High BMI and incident SDB in children is associated with increased rates of perioperative laryngospasm. The mechanism(s) underlying this propensity to laryngospasm deserve further elucidation., (Published by Elsevier Ireland Ltd.)

Sleep apnea headache is a recurrent universal pressing headache without accompanying symptoms at awakening that resolves within 4 h. The diagnosis requires polysomnography-verified apnea hypopnea index≥5, that is, obstructive sleep apnea (OSA). Morning headache has similar symptomatology without OSA. The prevalence of sleep apnea headache is 10-15% in people with OSA, whereas morning headache occurs in 5%. The severity of OSA only slightly affects the prevalence of sleep apnea headache. The pathophysiology of sleep apnea headache remains an enigma, since average oxygen desaturation and lowest oxygen saturation are similar in OSA people without sleep apnea headache. Migraine and tension-type headache are unrelated to OSA. Thus, growing concern of sleep apnea headache in an increasingly obese population is unfounded with our current knowledge.

Objective: To evaluate otolaryngologic findings in obese prepubertal children with sleep-disordered breathing., Methods: We prospectively evaluated 29 obese children referred by pediatric endocrinologist, complaining of snoring and without a history of nasal surgery or removal of the palatine tonsils and/or adenoids. Patients underwent ear, nose and throat (ENT) examination, endoscopy, measurements of weight, height, calculation of body mass index (BMI), assessment of BMI z-score and polysomnography, from which were divided into two groups: those with obstructive sleep apnea syndrome (nine children) and those with primary snoring (20 children). Then we proceeded to the statistical analysis of the data collected., Results: The groups did not differ in age, gender, weight, height, BMI and BMI z-score. Among the findings of the ENT examination, the adenoid size was the only one that differed between the groups (p = 0.01)., Conclusion: The evaluation of the adenoid size is an important in obese children with symptoms of sleep-disordered breathing and is related to the presence of obstructive sleep apnea syndrome., (Published by Elsevier Ireland Ltd.)

Objectives: Obesity has been associated with a lesser degree of asthma control that may be biased by other comorbidities. The objectives of this cross-sectional study were to describe resting and activity-related dyspnea complaints according to the presence of obesity-related comorbidities (asymptomatic airway hyperresponsiveness (AHR), asthma, gastroesophageal reflux disease (GERD) and sleep-disordered breathing (SDB)). We hypothesized that obese women can exhibit both resting and activity-related dyspnea, independently of the presence of asthma., Methods: Severely obese (body mass index (BMI) > 35 kg m(-2)) women prospectively underwent description of resting and activity-related dyspnea (verbal descriptors and Medical Research Council (MRC) scale), pulmonary function testing (spirometry, absolute lung volumes, and methacholine challenge test), oesogastro-duodenal fibroscopy, and overnight polygraphy. Thirty healthy lean women without airway hyperresponsiveness were enrolled., Results: Resting dyspnea complaints were significantly more prevalent in obesity (prevalence 41%) than in healthy lean women (prevalence 3%). Chest tightness and the need for deep inspirations were independently associated with both asthma and GERD while wheezing and cough were related to asthma only in obese women. Activity-related dyspnea was very prevalent (MRC score > 1, 75%), associated with obesity, with the exception of wheezing on exertion due to asthma. Asymptomatic AHR and SDB did not affect dyspneic complaints., Conclusions: In severely obese women referred for bariatric surgery, resting dyspnea complaints are observed in association with asthma or GERD, while activity-related dyspnea was mainly related to obesity only. Consequently, asthma does not explain all respiratory complaints of obese women.

Objectives: To assess whether sleep apnea severity has an independent relationship with leptin levels in blood after adjusting for different measures of obesity and whether the relationship between obstructive sleep apnea (OSA) severity and leptin levels differs depending on obesity level., Methods: Cross-sectional study of 452 untreated OSA patients (377 males and 75 females), in the Icelandic Sleep Apnea Cohort (ISAC), age 54.3±10.6 (mean±s.d.), body mass index (BMI) 32.7±5.3 kg m(-2) and apnea-hypopnea index 40.2±16.1 events per h. A sleep study and magnetic resonance imaging of abdominal visceral and subcutaneous fat volume were performed, as well as fasting serum morning leptin levels were measured., Results: Leptin levels were more highly correlated with BMI, total abdominal and subcutaneous fat volume than visceral fat volume per se. No relationship was found between sleep apnea severity and leptin levels, assessed within three BMI groups (BMI <30, BMI 30-35 and BMI > or =35 kg m(-2)). In a multiple linear regression model, adjusted for gender, BMI explained 38.7% of the variance in leptin levels, gender explained 21.2% but OSA severity did not have a significant role and no interaction was found between OSA severity and BMI on leptin levels. However, hypertension had a significant effect on the interaction between OSA severity and obesity (P=0.04). In post-hoc analysis for nonhypertensive OSA subjects (n=249), the association between leptin levels and OSA severity explained a minor but significant variance (3.2%) in leptin levels. This relationship was greatest for nonobese nonhypertensive subjects (significant interaction with obesity level). No relationship of OSA severity and leptin levels was found for hypertensive subjects (n=199)., Conclusion: Obesity and gender are the dominant determinants of leptin levels. OSA severity is not related to leptin levels except to a minor degree in nonhypertensive nonobese OSA subjects.