Cut-off points of neck and waist circumference as predictors of obstructive sleep apnea in the Colombian population: a comparison with polysomnography

ABSTRACT BACKGROUND: Neck circumference (NC) is a useful anthropometric measure for predicting obstructive sleep apnea (OSA). Ethnicity and sex also influence obesity phenotypes. NC cut-offs for defining OSA have not been established for the Latin American population. OBJECTIVES: To evaluate NC, waist circumference (WC), and body mass index (BMI) as predictors of OSA in the Colombian population and to determine optimal cut-off points. DESIGN AND SETTING: Diagnostic tests were conducted at the Javeriana University, Bogota. METHODS: Adults from three cities in Colombia were included. NC, WC, and BMI were measured, and a polysomnogram provided the reference standard. The discrimination capacity and best cut-off points for diagnosing OSA were calculated. RESULTS: 964 patients were included (57.7% men; median age, 58 years) and 43.4% had OSA. The discrimination capacity of NC was similar for men and women (area under curve, AUC 0.63 versus 0.66, P = 0.39) but better for women under 60 years old (AUC 0.69 versus 0.57, P < 0.05). WC had better discrimination capacity for women (AUC 0.69 versus 0.57, P < 0.001). There were no significant differences in BMI. Optimal NC cut-off points were 36.5 cm for women (sensitivity [S]: 71.7%, specificity [E]: 55.3%) and 41 cm for men (S: 56%, E: 62%); and for WC, 97 cm for women (S: 65%, E: 69%) and 99 cm for men (S: 53%, E: 58%). CONCLUSIONS: NC and WC have moderate discrimination capacities for diagnosing OSA. The cut-off values suggest differences between Latin- and North American as well as Asian populations.

Cut-off points of neck and waist circumference as predictors of obstructive sleep apnea in the Colombian population: a comparison with polysomnography.

BACKGROUND: Neck circumference (NC) is a useful anthropometric measure for predicting obstructive sleep apnea (OSA). Ethnicity and sex also influence obesity phenotypes. NC cut-offs for defining OSA have not been established for the Latin American population. OBJECTIVES: To evaluate NC, waist circumference (WC), and body mass index (BMI) as predictors of OSA in the Colombian population and to determine optimal cut-off points. DESIGN AND SETTING: Diagnostic tests were conducted at the Javeriana University, Bogota. METHODS: Adults from three cities in Colombia were included. NC, WC, and BMI were measured, and a polysomnogram provided the reference standard. The discrimination capacity and best cut-off points for diagnosing OSA were calculated. RESULTS: 964 patients were included (57.7% men; median age, 58 years) and 43.4% had OSA. The discrimination capacity of NC was similar for men and women (area under curve, AUC 0.63 versus 0.66, P = 0.39) but better for women under 60 years old (AUC 0.69 versus 0.57, P < 0.05). WC had better discrimination capacity for women (AUC 0.69 versus 0.57, P < 0.001). There were no significant differences in BMI. Optimal NC cut-off points were 36.5 cm for women (sensitivity [S]: 71.7%, specificity [E]: 55.3%) and 41 cm for men (S: 56%, E: 62%); and for WC, 97 cm for women (S: 65%, E: 69%) and 99 cm for men (S: 53%, E: 58%). CONCLUSIONS: NC and WC have moderate discrimination capacities for diagnosing OSA. The cut-off values suggest differences between Latin- and North American as well as Asian populations.

Biomarkers for the severity of periodontal disease in patients with obstructive sleep apnea:IL-1 ß, IL-6, IL-17A, and IL-33.

Objective: This study aims to compare the salivary and gingival crevicular fluid (GCF) concentrations of five cytokines: IL-1ß, IL-6, IL-17A, IL-33, and Tumor Necrosis Factor-alpha (TNF-α) in patients with OSA and their association with periodontitis. Methods: Samples of saliva and GCF were obtained from 84 patients classified into four groups according to periodontal and OSA diagnosis: G1(H) healthy patients, G2(P) periodontitis and non-OSA patients, G3(OSA) OSA and non-periodontitis patients, and G4(P-OSA) periodontitis and OSA patients. The cytokines in the samples were quantified using multiplexed bead immunoassays. Data were analyzed with the Kruskal-Wallis test, Dunn's multiple comparisons test, and the Spearman correlation test. Results: Stage III periodontitis was the highest in patients with severe OSA (69%; p=0.0142). Similar levels of IL-1ß and IL-6 in saliva were noted in G2(P) and G4(P-OSA). The IL-6, IL-17A and IL-33 levels were higher in the GCF of G4(P-OSA). There was a significant positive correlation between IL-33 in saliva and stage IV periodontitis in G4(P-OSA) (r s  = 0.531). The cytokine profile of the patients in G4(P-OSA) with Candida spp. had an increase of the cytokine's levels compared to patients who did not have the yeast. Conclusions: OSA may increase the risk of developing periodontitis due to increase of IL-1ß and IL-6 in saliva and IL-6, IL-17A and IL-33 in GCF that share the activation of the osteoclastogenesis. Those cytokines may be considered as biomarkers of OSA and periodontitis.

Prevalence of sleep complaints in Colombia at different altitudes.

STUDY OBJECTIVES: To determine the prevalence of sleep complaints in adults in Colombia at different altitudes. DESIGN: Cross-sectional, population-based and observational study. SETTING: Urban areas in three cities (Bogotá, Bucaramanga, Santa Marta) located between 15 and 2640 masl. Subjects Over 18 years old. INTERVENTIONS: Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), Berlin questionnaire, STOP-Bang questionnaire and diagnostic criteria for restless leg syndrome (IRLSSG). MEASUREMENTS AND RESULTS: The overall prevalence of sleep complaints was 59.6% (CI 95%: 57.3; 61.8%). According to the Pittsburgh scale, 45.3% (CI 95%: 43.0; 47.5) required medical assistance. The Berlin questionnaire indicated that 19.0% (CI 95%: 17.3; 20.8%) had a high risk of sleep apnea (OSA) compared to 26.9% (CI 95%: 24.9; 29.0%) according to STOP-Bang. Among the subjects, 13.7% (CI 95%: 12.3; 15.3%) had excessive daytime sleepiness and 37.7% (CI 95%: 35.5; 39.8%) had a restless leg syndrome. When comparing cities, significant differences in the overall frequency of subjects requiring care were found between Santa Marta (higher frequency) and the other two cities. Differences in sleep problem frequency (Pittsburgh) were observed between Bogota (higher frequency) and Bucaramanga and also between Santa Marta (higher frequency) and the other two cities. The high risk of OSA (STOP-Bang) was different between Bogota (higher frequency) and Bucaramanga and also between Santa Marta (high frequency) and Bucaramanga. CONCLUSIONS: We observed a high prevalence of sleep complaints with significant differences among the cities, indicating a need to pay a greater attention to these problems.