Obstructive Sleep Apnea and Metabolic Health
| Status: | Completed |
|---|---|
| Conditions: | Insomnia Sleep Studies, Endocrine, Pulmonary |
| Therapuetic Areas: | Endocrinology, Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 21 - 88 |
| Updated: | 6/8/2017 |
| Start Date: | April 2015 |
| End Date: | January 15, 2017 |
Obstrutive Sleep Apnea: is it a Biomarker of Metabolically Healthy vs. Unhealthy Obese
This is an observational study involving chart review of patients seen in the bariatric
clinic since 2012 at The Ohio State University (OSU). Obese patients will be divided into
two groups according to their metabolic profile (healthy vs unhealthy). The assignment to
each group will be determined by the presence of diagnosis of hypertension, diabetes
mellitus and/or dyslipidemia. The presence of at least 2 diagnoses will be defined as
metabolically unhealthy. Then, each group will be divided based on the presence of
Obstructive Sleep Apnea diagnosis. All data will be collected through a review of the
patient's electronic medical record from the bariatric clinic database (the investigators
will collect variables as age, gender, race, BMI, smoking status, the presence of diagnosis
as Obstructive sleep apnea, hypertension, diabetes, hyperlipidemia). The investigators will
analyze that data and establish if there is any correlation between sleep apnea and the
subjects' metabolic profile.
clinic since 2012 at The Ohio State University (OSU). Obese patients will be divided into
two groups according to their metabolic profile (healthy vs unhealthy). The assignment to
each group will be determined by the presence of diagnosis of hypertension, diabetes
mellitus and/or dyslipidemia. The presence of at least 2 diagnoses will be defined as
metabolically unhealthy. Then, each group will be divided based on the presence of
Obstructive Sleep Apnea diagnosis. All data will be collected through a review of the
patient's electronic medical record from the bariatric clinic database (the investigators
will collect variables as age, gender, race, BMI, smoking status, the presence of diagnosis
as Obstructive sleep apnea, hypertension, diabetes, hyperlipidemia). The investigators will
analyze that data and establish if there is any correlation between sleep apnea and the
subjects' metabolic profile.
Obesity is associated with numerous metabolic complications including Type 2 diabetes
mellitus, hypertension, dyslipidemia, cardiovascular disease (CVD) and several forms of
cancer. However, the presence of these obesity-related metabolic abnormalities varies among
obese individuals. The phenotype of a metabolically healthy obese (MHO) individual was
initially described in 1980 and includes a subset of obese patients (as defined by BMI) who
do not manifest the typical metabolic abnormalities associated with obesity. Although
results are conflicting and highly dependent on patient population and diagnostic criteria
for metabolic health, these individuals tend to have a preserved level of insulin
sensitivity, absence of hypertension, and a more favorable lipid, inflammatory, hormonal,
hepatic, and immunologic profile compared to the majority of metabolically abnormal obese
(MAO) patients. This seeming paradox underscores that excess body the weight is not the sole
determinant of obesity-related complications and allows for novel pathogenic investigation.
The postulated mechanism(s) underlying the differential metabolic profile in these
individuals is not well known and the physiologic and molecular basis for 'healthy' obesity
remains relatively undiscovered. In addition, a recent meta-analysis demonstrated that
although MHO patients have a comparable metabolic profile to normal the weight individuals,
their risk of adverse, long-term CV and mortality outcomes remains higher, calling into
question the clinical importance of the healthy obese categorization. Despite these
knowledge gaps, a limited number of studies have recently attempted to elucidate the
processes that lead to the MHO profile, including characterization of lifestyle factors,
adipocyte size, amount and location of ectopic fat, inflammatory mediators, and immune
cells, and differences in gene expression.
The prevalence of obstructive sleep apnea (OSA) increases with increasing BMI and has also
been linked to various cardiometabolic abnormalities. Patients with OSA experience
repetitive episodes of hypoxia and reoxygenation during transient cessation of breathing
that may provoke adverse systemic effects. These effects are reflected in increased levels
of biomarkers linked to endocrine-metabolic and cardiovascular disease. OSA may exert
negative effects on the cardiovascular system through multiple mechanisms including
hypoxemia, sleep disruption, activation of the sympathetic nervous system, and inflammatory
activation. In spite of this connection, the contribution of these deleterious effects in
determining the phenotype of an obese patient (MHO vs. MAO) is unknown. Furthermore, the
prevalence of OSA in these two subsets is not the well established.
In this study, the investigators hypothesize the prevalence of OSA is higher in MAO compared
to BMI-matched MAO patients
Aim 1:
Define the prevalence of OSA in metabolically-healthy obese and metabolically abnormal obese
(MHO and MAO) patients.
Aim 2:
Elucidate the association of OSA disease severity parameters with markers of clinically
available abnormal metabolic profile (elevated cholesterol, blood pressure, fasting
glucose/hemoglobin A1c, inflammatory markers, and insulin resistance if available).
mellitus, hypertension, dyslipidemia, cardiovascular disease (CVD) and several forms of
cancer. However, the presence of these obesity-related metabolic abnormalities varies among
obese individuals. The phenotype of a metabolically healthy obese (MHO) individual was
initially described in 1980 and includes a subset of obese patients (as defined by BMI) who
do not manifest the typical metabolic abnormalities associated with obesity. Although
results are conflicting and highly dependent on patient population and diagnostic criteria
for metabolic health, these individuals tend to have a preserved level of insulin
sensitivity, absence of hypertension, and a more favorable lipid, inflammatory, hormonal,
hepatic, and immunologic profile compared to the majority of metabolically abnormal obese
(MAO) patients. This seeming paradox underscores that excess body the weight is not the sole
determinant of obesity-related complications and allows for novel pathogenic investigation.
The postulated mechanism(s) underlying the differential metabolic profile in these
individuals is not well known and the physiologic and molecular basis for 'healthy' obesity
remains relatively undiscovered. In addition, a recent meta-analysis demonstrated that
although MHO patients have a comparable metabolic profile to normal the weight individuals,
their risk of adverse, long-term CV and mortality outcomes remains higher, calling into
question the clinical importance of the healthy obese categorization. Despite these
knowledge gaps, a limited number of studies have recently attempted to elucidate the
processes that lead to the MHO profile, including characterization of lifestyle factors,
adipocyte size, amount and location of ectopic fat, inflammatory mediators, and immune
cells, and differences in gene expression.
The prevalence of obstructive sleep apnea (OSA) increases with increasing BMI and has also
been linked to various cardiometabolic abnormalities. Patients with OSA experience
repetitive episodes of hypoxia and reoxygenation during transient cessation of breathing
that may provoke adverse systemic effects. These effects are reflected in increased levels
of biomarkers linked to endocrine-metabolic and cardiovascular disease. OSA may exert
negative effects on the cardiovascular system through multiple mechanisms including
hypoxemia, sleep disruption, activation of the sympathetic nervous system, and inflammatory
activation. In spite of this connection, the contribution of these deleterious effects in
determining the phenotype of an obese patient (MHO vs. MAO) is unknown. Furthermore, the
prevalence of OSA in these two subsets is not the well established.
In this study, the investigators hypothesize the prevalence of OSA is higher in MAO compared
to BMI-matched MAO patients
Aim 1:
Define the prevalence of OSA in metabolically-healthy obese and metabolically abnormal obese
(MHO and MAO) patients.
Aim 2:
Elucidate the association of OSA disease severity parameters with markers of clinically
available abnormal metabolic profile (elevated cholesterol, blood pressure, fasting
glucose/hemoglobin A1c, inflammatory markers, and insulin resistance if available).
Inclusion Criteria:
- Age 21 - 88 year old
- BMI ≥ 30 kg/m2
Exclusion Criteria:
◦ Lack of pertinent clinical data to include in the study.
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