Association between obstructive sleep apnea and comorbidities in adult patients

Govind Narayan Srivastava, Deepanjali Sharma, Mrityunjay Sharma, Aiyush Jain


Background: With the emergence of lifestyle diseases in epidemic proportions in developing nations like India, Obstructive sleep apnea syndrome (OSAS) is increasing consistently. OSA brings many adverse consequences, such as systemic hypertension, cardiovascular diseases, obesity, diabetes mellitus, behavioral changes and many other comorbid conditions.  

Methods: This is a prospective study of 46 polysomnography proven patients with OSA apnea hypopnea index (AHI) ≥5/h. The study period was from 1st October, 2017 to 31st March, 2019. Subjects were divided into three subgroups according to AHI: mild OSAS: 5<AHI<15, moderate OSAS: 15<AHI<30 and severe OSAS: AHI >30. The patients were thoroughly examined and evaluated for associated comorbidities.  

Results: We evaluated 25 men and 21 women with OSA, mean age of 57.7 years (range 30–86). Average weight and body mass index (BMI) of the patients were 86.1 kg (range 65-132) and 33.1 kg/m2 (range 25-46.9) respectively. On evaluation of comorbidities hypertension was on the top 30 (65%) followed by obesity 28 (61%), left ventricular hypertrophy 23 (50%), diabetes mellitus 21 (46%), dyslipidemia and chronic obstructive pulmonary disease in 12 (26%) each. Total no. of comorbidities and multiple comorbidities in a single patient were highest in severe OSA group.

Conclusions: OSA predominantly affects middle-aged (>55 years) individuals who are overweight with many having high neck circumference. There is statistically significant positive correlation between AHI and BMI and between number of comorbidities and severity of OSAS. Awareness regarding OSA among the general population and clinicians, wider availability of PSG studies will help in identifying and treating these patients.


Obstructive sleep apnea, Apnea hypopnea index, Comorbidities, Obese

Full Text:



Kapur V, Strohl KP, Redline S, Iber C, O’Connor G, Nieto J. Underdiagnosis of sleep apnea syndrome in U.S. communities. Sle Brea. 2002;6:49-54.

Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20:705-6.

Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. J Am Med Assoc. 2004;291:2013-6.

Singh A, Prasad R, Garg R, Kant S, Hosmane GB, Dubey A, et al. A study to estimate prevalence and risk factors of obstructive sleep apnoea syndrome in a semi-urban Indian population. Monaldi Arch Chest Dis. 2017;87:773.

George CF. Sleep apnea, alertness, and motor vehicle crashes. Am J Respir Crit Care Med. 2007; 176:954–6.

Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnoea syndrome in a population of Delhi, India. Chest 2006;130:149:56.

Carter R 3rd, D.E. Watenpaugh, Obesity and obstructive sleep apnea: or is it OSA and obesity? Pathophysiology. 2008;15(2):71–7.

Wickramasinghe H. Obstructive Sleep Apnea (OSA) Differential Diagnoses– Diagnostic Considerations.

Veloro LV, Sarte MA, Castañeda SS. Collar size as predictor of obstructive sleep apnea. Philip J Otolaryngol Head Neck Surg. 2008;23(2):14-6.

Punjabi NM, Bandeen-Roche K, Young T. Predictors of objective sleep tendency in the general population. Sleep. 2003;26(6):678-83.

Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012:108(5):768-75.

Kapsimalis F, Varouchakis G, Manousaki A, Daskas S, Nikita D, Kryger M, et al. Association of sleep apnea severity and obesity with insulin resistance, C-reactive protein, and leptin levels in male patients with obstructive sleep apnea. Lung. 2008;186(4):209-17.

Punjabi NM et al. Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study. PLo Med. 2009;6:e1000132.

Hla KM, Young TB, Bidwell T, Palta M, Skatrud JB, Dempsey J. Sleep apnea and hypertension. A population-based study. Ann Intern Med. 1994;120(5):382-8.

Nieto FJ, Young TB, Lind BK et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. J Am Med Assoc. 2000;283(14):1829–36.

Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378-84.

Millman RP, Redline S, Carlisle CC, Assaf AR, Levinson PD. Daytime hypertension in obstructive sleep apnea. Prevalence and contributing risk factors. Chest. 1991;99(4):861-6

Wang H, Parker JD, Newton GE, Floras JS, Mak S, Chiu KL, et al. Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol. 2007;49(15):1625-31.

Al-Delaimy W. Snoring as a risk factor for type II diabetes mellitus: a prospective study. Am J Epidemiol. 2002;155:387-93.

Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160(6):521-30.

Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Slee-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med. 2002;165(5):677-82.

Foster GD, Sanders MH, Millman R, et al; Sleep AHEAD Research Group. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009;32(6):1017–9.

Elmasry A, Lindberg E, Berne C, et al. Sleep-disordered breathing and glucose metabolismin hypertensive men: a population-based study. J Intern Med. 2001;249(2):153–61

Newman AB, Nieto FJ, Guidry U, et al; Sleep Heart Health Study Research Group. Relation of sleep-disordered breathing to cardiovascular disease risk factors: The sleep Heart Health Study. Am J Epidemiol. 2001;154(1):50–9.

Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur. Heart J. 2004;25(9):735–41.

Roche F, Sforza E, Pichot V, et al; PROOF Study Group. Obstructive sleep apnoea/hypopnea influences high-density lipoprotein cholesterol in the elderly. Sleep Med. 2009;10(8):882–6.

Tan KC, Chow WS, Lam JC etal.HDL dysfunction in obstructive s sleep apnea. Atherosclerosis. 2006;184(2):377–82.

Baumeister H, Harter M. Mental disorders in patients with obesity in comparison with healthy probands. Int J Obes. 2007;31:1155-65.

Onyike C, Crum R, Lee H, Lyketsos C, Eaton W. Is obesity associated with major depression? Results from the third National Health and Nutrition Examination Survey. Am J Epidemiol. 2003;158:1139-47.

Simon G, Von Korff M, Saunders K, Miglioretti D, et al. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiat. 2006;63:824-30.

Sharafkhaneh A, Giray N, Richardson P, Young T, Hirshowitz M. Association of psychiatric disorders and sleep apnea in a large cohort. Sllep. 2005;28(11):1405-11.

Salles C, Terse-Ramos R, Souza-Machado A, Cruz ÁA. Obstructive sleep apnea and asthma. J Bras Pneumol. 2013;39(5):604-12

Guilleminault C, Quera-Salva MA, Powell N. Nocturnal asthma: snoring, small pharynx and nasal CPAP. Eur Respir J. 1988;1(10):902-7

Suganuma N, Shigedo Y, Adachi H, Watanabe T, Kumano‐Go T, Terashima K, Mikami A, et al. Association of gastroesophageal reflux disease with weight gain and apnea, and their disturbance on sleep. Psychiat Clinic Neurosci. 2001;55(3):255-6.

Lurie A. Inflammation, oxidative stress, and procoagulant and thrombotic activity in adults with obstructive sleep apnea. Adv Cardiol. 2011;46:43-66.

Sharma D, Shah DK, Bharti A, Mishra J. Study to Evaluate the Role of Inflammatory Biomarker- IL-6 in Obstructive Sleep Apnea in Correlation with Apnea-Hypopnea Index. Journal of Clinical and Diagnostic Research. 2020;14(1):EC11-4.