Abstract
Background:
Obstructive sleep apnea (OSA) affects nearly one billion adults globally, but data on its prevalence in the Middle East is very limited. While obesity and age are major risk factors, recent studies suggest that non-obese individuals may have a distinct OSA phenotype with varying prevalence and characteristics. This study investigates factors associated with OSA and its severity in young, non-obese Middle Eastern adults, emphasizing the importance of understanding it in this population.
Methods:
A retrospective case-control study was conducted on individuals aged 18-55 who underwent sleep studies between 2021 and 2022. The case group included individuals with OSA (apnea-hypopnea index [AHI] ≥ 5 events/h), while the control group had normal AHI (< 5 events/h). Data collected included age, gender, BMI, neck circumference, hypertension (HTN), COPD, alcohol usage, and lowest SpO2 levels. The t-test was used for comparison within groups, and multiple regression was used to assess the relationship between AHI and independent variables. A P-value of <0.05 was accepted to be significant.
Results:
Out of 2,517 records reviewed, 555 patients met the inclusion criteria. OSA was diagnosed in 67.2% of participants. The OSA group had a higher male/female ratio (80.4% vs 49.5%, P < .005) and were older (40.7 ± 8.9 vs. 35.3 ± 8.9 y, P < .005) (Table 1). OSA patients also had higher BMI (26.7 ± 2.8 vs. 25.3 ± 2.8 kg/m2, P < .005) and larger neck circumference (38.3 ± 4.0 vs. 35.7 ± 4.0 cm, P < .005). Hypertension and COPD were more prevalent in the OSA group (P = .003 and P = .03, respectively). Alcohol usage was significantly higher in the OSA group (13.3% vs. 8.7%, P = .005). Multiple linear regression identified age (β = 0.170, P = .005), neck circumference (β = 0.597, P < .001), hypertension (β = 6.495, P < .001), and lowest SpO2 (β = -0.907, P < .001) as significant predictors of OSA severity (Table 2).
Conclusions:
Males with larger neck circumference were at higher risk of OSA in this cohort. Despite being non-obese, OSA patients had higher BMI than controls. Hypertension and alcohol intake were also more common in OSA patients. Age, neck circumference, and hypertension were significant predictors of OSA severity.
Baseline characteristics and results
Characteristics
Total n (%)
OSA
non-OSA
p-value
Total
555
Male
390 (70)
300
90
<0.005
Female
165 (30)
72
93
Sleep study
Type 1
375 (67)
265
110
Type 3
180 (33)
108
72
Comorbidities
DM
35 (6.3)
23
11
0.808
HTN
106 (19.1)
84
22
0.003
CAD
7 (1.3)
6
1
0.207
COPD
5 (0.9)
5
0
0.025
PHTN
7 (1.3)
6
1
0.208
Arrythmia
1 (0.2)
1
0
0.318
Rhinosinusitis
3 (0.5)
3
0
0.083
Polyps (NASAL)
16 (2.9)
11
5
0.868
Septal deviation
141 (25.4)
98
43
0.566
Sedative use
169 (30.4)
98
71
0.162
Anti-depressant
54 (9.7)
32
22
0.397
Alcohol
74 (13.3)
58
16
0.005
Mallampati score
2.3 (1)
2.4
2.2
0.314
Mean (std dev)
Age
38.9 (8.9)
40.7
35.3
<0.005
BMI
26.2 (2.8)
26.7
25.3
<0.005
Neck Circum (cm)
37.3 (4)
38.3
35.7
<0.005
ODI
10.9 (16)
13.8
5.2
<0.005
Lowest Spo2 %
86.8 (6.7)
84.9
90.5
<0.005
Mean SpO2 %
86.8 (6.7)
84.9
90.5
<0.005
Mean SpO2 %
94.9 (1.9)
94.4
95.4
<0.005
Results of the regression model
Variables
Coefficients
std error
t- statistic
p-value
Lower 95%
Upper 95%
Intercept
38.911
32.483
1.198
0.231
-24.897
102.718
Age
0.170
0.060
2.845
0.005
0.05
0.29
Neck Circum (cm)
0.597
0.158
3.785
0.000
0.29
0.91
HTN
6.495
1.620
4.008
0.000
9.68
3.31
BMI
-0.205
0.185
-1.105
0.269
-0.57
0.16
Hypoxemia (mins)
-0.007
0.017
-0.431
0.666
-0.04
0.03
Lowest Spo2 %
-0.907
0.089
-10.150
0.000
-1.08
-0.73
Mean SpO2 %
0.317
0.340
0.930
0.353
-0.35
0.99
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