Indian Journal of Sleep Medicine

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VOLUME 17 , ISSUE 1 ( January-March, 2022 ) > List of Articles

Original Article

Anthropometric Indices and Obstructive Sleep Apnea Severity in Syndrome Z

Govind N Srivastava, Aiyush Jain, Aparna Suresh, Deepanjali Sharma, Kanchi Sravani, Soumya S Dash, B Gowthami

Keywords : Apnea–hypopnea index, Metabolic syndrome, Obstructive sleep apnea, Syndrome Z

Citation Information : Srivastava GN, Jain A, Suresh A, Sharma D, Sravani K, Dash SS, Gowthami B. Anthropometric Indices and Obstructive Sleep Apnea Severity in Syndrome Z. Indian Sleep Med 2022; 17 (1):10-14.

DOI: 10.5005/jp-journals-10069-0093

License: CC BY-NC 4.0

Published Online: 30-04-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Syndrome Z is the coexistence of two chronic diseases, obstructive sleep apnea (OSA) and metabolic syndrome. It is one of the under-recognized public health issues in the Indian subcontinent. Syndrome Z is associated with multiple risk factors and cardiometabolic abnormality, which increases its severity. In this study, we assess anthropometric indices and OSA severity in patients with syndrome Z. Materials and methods: We evaluated 100 patients aged more than 50 years in chest outpatient department (OPD), who met the screening criteria for OSA using the Snoring, Tiredness, Observed apnea, Blood pressure, Body mass index (BMI), Age, Neck size, and Gender (STOPBANG) Questionnaire and the Epworth Sleepiness Scale (ESS). All patients underwent overnight level 1 polysomnography (PSG) using Alice 6 PDx Philips Sleep System. Parameters of metabolic syndrome and OSA were noted using National Cholesterol Education Program—Third Adult Treatment Panel (NCEP ATP III) and American Academy of Sleep Medicine (AASM) guidelines. We did a comparative study using baseline anthropometric indices, metabolic syndrome parameters, and apnea–hypopnea index (AHI) level in PSG in patients with syndrome Z and OSA using various correlations. Results: Syndrome Z was present in 60% of patients with OSA. Among syndrome Z patients, male subjects were 60% and female subjects were 40%. OSA was severer in patients with syndrome Z, i.e., AHI levels in the PSG were higher in patients having both OSA and metabolic syndrome (p <0.001). Other parameters that were found to be associated in patients with syndrome Z were higher BMI, larger waist circumference (p <0.003), deranged lipid profile, hyperglycemia (p <0.001), and hypertension (p <0.001). Conclusion: Anthropometric indices, obesity (BMI), parameters of metabolic syndrome, and AHI level should be a part of routine checkups in follow-ups of patients with syndrome Z, which will help in better management. Treating each factor individually can increase the quality of life and decrease the morbidity associated with syndrome Z.

  1. Wilcox I, McNamara SG, Collins FL, et al. “Syndrome Z”: the interaction of sleep apnoea, vascular risk factors and heart disease. Thorax 1998;53(Suppl 3):S25–S28. PMID: 10193357.
  2. Venkateswaran S, Shankar P. The prevalence of syndrome Z (the interaction of obstructive sleep apnoea with the Metabolic syndrome) in a teaching hospital in Singapore. Postgrad Med J 2007;83(979):329–331. DOI: 10.1136/pgmj.2006.051805.
  3. American Academy of Sleep Medicine ICSD-2. The international classification of sleep disorders. Diagnostic and coding manual. 2nd ed. 2005.
  4. Engleman HM, Wild MR. Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev 2003;7(1):81–99. DOI: 10.1053/smrv.2001.0197.
  5. Expert Panel on Detection. Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). Journal of the American Medical Association 2001;285(19):2486–2497. DOI: 10.1001/jama.285.19.2486.
  6. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 2002;106(25):3143–3421. PMID: 12485966.
  7. Coughlin SR, Mawdsley L, Mugarza JA, et al. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004;25(9):735–741. DOI: 10.1016/j.ehj.2004.02.021.
  8. Agrawal S, Sharma SK, Sreenivas V, et al. Prevalence of metabolic syndrome in a north Indian hospital-based population with obstructive sleep apnoea. Indian J Med Res 2011;134(5):639–644. DOI: 10.4103/0971-5916.90988.
  9. Sharma SK, Reddy EV, Sharma A, et al. Prevalence and risk factors of syndrome Z in urban Indians. Sleep Med 2010;11(6):562–568. DOI: 10.1016/j.sleep.2010.02.008.
  10. Lam JC, Lam B, Lam CL, et al. Obstructive sleep apnea and the metabolic syndrome in community-based Chinese adults in Hong Kong. Respir Med 2006;100(6):980–987. DOI: 10.1016/j.rmed.2005.10.003.
  11. Agrawal S, Sharma SK, Sreenivas V, et al. Stepped approach for prediction of syndrome Z in patients attending sleep clinic: a north Indian hospital-based study. Sleep Breath 2012;16(3):621–627. DOI: 10.1007/s11325-011-0548-3.
  12. Sureja B, Bhambhani GD. The prevalence of syndrome Z (the interaction of obstructive sleep apnoea with the metabolic syndrome) in a tertiary care center, Gujarat, India. Int J Adv Med 2019;5(6):1476–1480. DOI: 10.18203/2349-3933.ijam20184760.
  13. Schwartz AR, Patil SP, Laffan AM, et al. Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc 2008;5(2):185–192. DOI:10.1513/pats.200708-137MG.
  14. Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab 2008;93(11_supplement_1):S9–S30. DOI: 10.1210/jc.2008-1595.
  15. Tażbirek M, Potoczny J, Strójwąs K, et al. Anthropometric factors in the assessment of obstructive sleep apnea risk in patients with metabolic syndrome. In: Pokorski M, editor. Advances in pulmonary medicine: research and innovations. Advances in experimental medicine and biology. vol. 1160. Springer, Cham; 2019.
  16. Cizza G, de Jonge L, Piaggi P, et al. Neck circumference is a predictor of metabolic syndrome and obstructive sleep apnea in short-sleeping obese men and women. Metab Syndr Relat Disord 2014;12(4):231–241. DOI: 10.1089/met.2013.0093.
  17. Drager LF, Togeiro SM, Polotsky VY, et al. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol 2013;62(7):569–576. DOI: 10.1016/j.jacc.2013.05.045.
  18. Wolk R, Somers VK. Sleep and the metabolic syndrome. Exp Physiol 2007;92(1):67–78. DOI: 10.1113/expphysiol.2006.033787.
  19. Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342(19):1378–1384. DOI: 10.1056/NEJM200005113421901.
  20. Hasan A, Uzma N, Santhosh Kumar B. Obstructive sleep apnea and the metabolic syndrome. In: Modulation of sleep by obesity, diabetes, age, and diet. 2015. p. 139–153. DOI: 10.1016/B978-0-12-420168-2.00016-8.
  21. Nock NL, Li L, Larkin EK, et al. Empirical evidence for “syndrome Z”: a hierarchical 5-factor model of the metabolic syndrome incorporating sleep disturbance measures. Sleep 2009;32(5):615–622. DOI: 10.1093/sleep/32.5.615.
  22. Shiina K, Tomiyama H, Takata Y, et al. Concurrent presence of metabolic syndrome in obstructive sleep apnea syndrome exacerbates the cardiovascular risk: a sleep clinic cohort study. Hypertension Res 2006;29(6):433. DOI: 10.1291/hypres.29.433.
  23. Ming X, Yang M, Chen X. Metabolic bariatric surgery as a treatment for obstructive sleep apnea hypopnea syndrome: review of the literature and potential mechanisms. Surg Obes Relat Dis 2021;17(1):215–220. DOI: 10.1016/j.soard.2020.09.019.
  24. Perez EA, Oliveira LV, Freitas WR, et al. Prevalence and severity of syndrome Z in women with metabolic syndrome on waiting list for bariatric surgery: a cross-sectional study. Diabetol Metab Syndrome 2017;9(1):72. DOI: 10.1186/s13098-017-0269-2.
  25. Coughlin SR, Mawdsley L, Mugarza JA, et al. Cardiovascular and metabolic effects of CPAP in obese males with OSA. Eur Respir J 2007;29(4):720–727. DOI: 10.1183/09031936.00043306.
  26. Mansukhani MP, Olson EJ, Caples SM. Upper airway surgery for obstructive sleep apnea. Journal of the American Medical Association 2020;324(12):1161–1162. DOI:10.1001/jama.2020.9332.
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