Prevalence of obstructive sleep apnoea in metabolic syndrome


  • A. P. Dubey Department of Medicine and Medical Oncology, Army Hospital (R and R), Delhi Cantt-110010, New Delhi, India
  • Ashok K. Rajput Department of Medicine, Venkateswara Hospital, Dwarka, New Delhi-110075, India
  • Virender Suhag Department of Radiation Oncology, Army Hospital (R and R), Delhi Cantt-110010, New Delhi, India
  • Durgesh Sharma Department of Medicine, Army Hospital (R and R), Delhi Cantt-110010, New Delhi, India
  • Ajay Kandpal Department of Medicine, Army Hospital (R and R), Delhi Cantt-110010, New Delhi, India
  • Roshlin Keisham Department of Medicine, Army Hospital (R and R), Delhi Cantt-110010, New Delhi, India



AHI, Metabolic syndrome, Obstructive sleep apnoea, Polymsomnography


Background: The prevalence of both OSA and metabolic syndrome is increasing worldwide, in part linked to the epidemic of obesity. Beyond their epidemiologic relationship, growing evidence suggests that OSA may be causally related to metabolic syndrome. We are only beginning to understand the potential mechanisms underlying the OSA-metabolic syndrome interaction. Objectives were to study the clinical prevalence of obstructive sleep apnoea in metabolic syndrome; and to find risk factors associated with obstructive sleep apnoea (OSA).

Methods: 50 patients attending various OPDs of a tertiary care research and referral hospital and found to have metabolic syndrome on the basis of NCEP criteria were selected. These patients were subjected to overnight polysomnography. Parameters such as apnea-hypopnoea index (AHI), respiratory efforts related arousals (RERA), minimum SpO2, pulse rate, blood pressure, and ECG were monitored throughout the study.

Results: Central obesity was found in 34 patients, xanthelasmas in 12 patients and xanthomas in 08 patients. Pitting type of pedal oedema was noted in 14 patients. Epworth sleepiness score (ESS) was calculated in all the patients by interviewing them before the polysomnography. Most of the patients have ESS Score more than 11.03 out of 50 patients were found to have AHI<5.20 patients were found to have moderate AHI (AHI 15-30) whereas 22 were found to have severe AHI.

Conclusions: Polysomnography provides a valuable tool to access non symptomatic sleep disordered breathing at an early stage in patients with metabolic syndrome.


Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14.

Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217-39.

Goldbart AD. Sleep medicine. Curr Opin Pediatr. 2015;27(3):329-33.

Young T, Javaheri S. Cardiovascular disorders: systemic and pulmonary hypertension in obstructive sleep apnea. In: Kryger MH, Roth T, Dement WC, eds. Principles and practice of sleep medicine. 4. ed. Philadelphia, PA: Elsevier/Saunders; 2005:1192-1202.

AASM (2001). The International Classification of Sleep Disorders, Revised. Westchester, Illinois: American Academy of Sleep Medicine. 2001:52-8. Retrieved 2010-09-11.

Somers VK. White DP. Amin R. Sleep apnea and cardiovascular disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). J Amn Coll Cardiol. 2008;52:686-717.

Schwab RJ. Pasirstein M. Pierson R. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med. 2003;168:522-30.

Fogel RB. Malhotra A. Pillar G. Genioglossal activation in patients with obstructive sleep apnea versus control subjects. Mechanisms of muscle control. Am J Respir Crit Care Med. 2001;164:2025-30.

Calvin AD, Albuquerque FN, Jimenez FL, Somers VK. Obstructive sleep apnea, inflammation, and the metabolic syndrome. Metab Syndr Relat Disord. 2009;7(4):271-7.

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

Sharma SK, Reddy EV, Sharma A. Prevalence and risk factors of syndrome Z in urban Indians. Sleep Med. 2010;11:562-8.

Nieto FJ, Young TB, Lind BK. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study. JAMA. 2000;283:1829-36.

Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165:670-6.

Sharma SK, Sreenivas V. Are metabolic syndrome, obstructive sleep apnoea and syndrome Z sequential? a hypothesis. Indian J Med Res. 2010;131:455-8.

Sreedharan SE, Agrawal P, Rajith RS, Nair S, Sarma SP, Radhakrishnan A. Clinical and polysomnographic predictors of severe obstructive sleep apnea in the South Indian population. Ann Indian Acad Neurol. 2016;19(2):216-20.

Vgontzas AN, Kales A. Sleep and its disorders. Annu Rev Med. 1999;50:387-400.

Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep- disordered breathing among middle-age adults. N Engl J Med. 1993;328:1230-5.

Bassiri AG, Guilleminault C. Clinical features and evaluation of obstructive sleep apnea-hypopnea syndrome. In: Kryger MH, Roth T, Dement WC, eds. Sleep Medicine. Philadelphia: W.B. Saunders, 2000;869-878.

Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med. 1998;157:144-8.

Zhang W, Si LY. Obstructive sleep apnea syndrome (OSAS) and hypertension: pathogenic mechanisms and possible therapeutic approaches. Upsala J Med Sci. 2012;117(4):370-82.

Phillips CL, Cistulli PA. Obstructive sleep apnea and hypertension: epidemiology, mechanisms and treatment effects. Minerva Med. 2006;97(4):299-312.

Parikh RM, Mohan V. Changing definitions of metabolic syndrome. Indian J Endocrinol Metab. 2012;16(1):7-12.

Hwu CM, Hsiung CA, Wu KD, Lee WJ, Shih KC, Grove J, et al. Diagnosis of insulin resistance in hypertensive patients by the metabolic syndrome: AHA vs. IDF definitions. Int J Clin Pract. 2008;62:1441-6.

Deepa M, Farooq S, Datta M, Deepa R, Mohan V. Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES-34). Dia Metab Res Rev. 2007;23:127-34.

National Institutes of Health: Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Executive Summary. Bethesda, MD, National Institutes of Health, National Heart, Lung and Blood Institute. 2001 (NIH publ. no. 01-3670)

Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499-521.

Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine. 2007;3(7):737-47.

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.

Gruber A, Horwood F, Sithole J, Ali NJ, Idris I. Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state. Cardiovasc Diabetol. 2006;5:22.






Original Research Articles