Predictive factors of sleep apnea syndrome in obesity.


Sonia Maalej
Samira Aouadi
Hatem Ben Moussa
Meherzia Bourguiba
Ali Ben Kheder
Ikram Drira


Background: Obstructive sleep apnea (OSA) syndrome is frequent, and misdiagnosed.
The aim: of this study is to assess the prevalence of OSA syndrome in a Tunisian population of obese (body mass index > or = 30 Kg/m2) and to determine its predictive factors.
Methods :It’s a transversal study. One hundred patients (63 females, 37 males) were inculded. All patients underwent nocturnal polysomnography or respiratory polygraphy.
Results: Sixty-five patients had an OSA syndrome: mild (24.6 %), moderate ( 30.7%) and severe (44.6 %).
We compared, by a statistical analysis, the group with OSA syndrome and the group without OSA syndrome. There was a predominance of men (81 % of men vs 55.5 of women had OSA). Age was higher in the group with OSA syndrome (56.8 years +/- 10 vs 48.1 +/- 12, P = 0.04). Clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses were more frequent in the group with OSA syndrome. Morphological abnormalities such as retrognathy and/or short neck were significantly more frequent in the group with OSA syndrome (p = 0.05 and 0.02 respectively). Cardiopathies and diabetes were more frequent in obese with OSA syndrome.
Conclusion : in obese persons, male gender, comorbidities and /or clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses, retrognathy and/or short neck are predictive of OSA syndrome. So, we propose a nocturnal recording in obese presenting at least one of these predictive factors.


Obstructive sleep apnea syndrome, Obesity, Polysomnography, Respiratory polygraphy



  1. Laaban JP. Epidémiologie croisée de l'obésité et des troubles respiratoires du sommeil. Médecine du Sommeil 2004,1 :13-16
  2. Durieux P, Neukirich F. Epidémiologie du syndrome d'apnées du sommeil de l'adulte. Rev Mal Resp 1990 ; 7 : 441-49
  3. Ayoub A, Barkia A, Kammoun S. Le syndrome des apnées du sommeil. Tunis Med 2000 ; 78 :685-9
  4. Labban JP, Cassuto D, Orvoen-Frija E et al. Cardiorespiratory consequences of sleep apnoea syndrome in patients with massive obesity. Eur Respir J 1998 ; 11 : 20-27
  5. Resta O, Foschino-Barbaro MP, Legari G, et al. Sleep related breathing disorders, loud snoring and excessive daytime spleepness in obese subjects. In J Obes 2000 ; 25 : 669-675
  6. Broussolle C, Piperon D, Gormand F et al. Syndrome d'apnée du sommeil chez les obèses : existent-il des facteurs prédictifs ? Rev Med Interne 1994 ; 15 : 161
  7. Weitzenblum E, Racineux JL. Syndrome d'apnées obstructives du sommeil. Rev Mal Respir 1997 ;6 :322-7
  8. Krieger J. Les syndromes d'apnée du sommeil de l'adulte. Bull Eur Physiopat Resp 1986 ; 22 : 147-86
  9. Alexandors N, Vgontzas A, Edward O, Bixler A, George P, Chrousos B. Sleep apnea is a manifestation of the metabolic syndrome. Sleep Med Rev 2005; 9: 211-224
  10. Fletcher EC, De Behnke RD, Lovoi MS, Gorin AB. Undiagnosed Sleep apnea in patients with essential hypertension. Ann intern Med 1985 ; 103 : 190-5
  11. Arlette F. Conséquences cardiovasculaires des apnées du sommeil. EMC ; Néphrologie et thérapeutique 2007 : 463-473
  12. Lavie P, Herer P, Hoffstein V: Obstructive Sleep apnoea syndrome as a risk factor for hypertension : population study. BMJ 2000 ; 320 : 479-82
  13. Schmidt-Nowara WW, Coultas DB, Wiggins C, et al. Snoring in Hispanic-American population. Risk Factors and association with hypertension and other morbidity. Arc Intern Med 1990 ; 150 : 597 - 601
  14. Punjabi NM, Sorkin JD, Katzel LI et al. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002 ; 165 : 677-682
  15. Viner S, Szlai JP, HoffsteinV. Are history and physical examination a good screening test for sleep apnea ? Ann Intern Med Med 1991 ; 115 : 365-359
  16. Crocker BD, Olson LG, Saunders NA et al. Estimation of the probability of disturbed breathing during sleep before a sleep study. Am Rev Resp Dis 1990 ; 142 : 14-8
  17. American Thoracic Society. Medical Section of the American Lung Association. Indications and standards for cardiopulmonary sleep studies. Am Rev Respir Dis;1989;139 : 559-68
  18. Newman AB, Nieto FJ, Guidry U, et al. Relation of sleepdisordered breathing to cardiovascular disease risk factors. The Sleep Heart Dtudy : Am J Epidemiolol 2001 ; 154 : 50-59
  19. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D'Agostino RB, Newaman AB, Lebowitz MD, Pickering TG : Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep heart health study. JAMA 2000 ; 283 : 1829-36
  20. Orvoean-Frija E, Cassuto D, Pascal S et al. Mechanisms of diurnal hypercapnia in sleep apnea syndromes in morbidity obese subjects. Press Med 1996; 25 : 12-16.
  21. Cooper BG, Veale D, Griffithis CJ, Gibson GJ. Values of nocturnal oxygen saturation as a screening test for sleep apnea ?. Thorax 1991 ; 115 : 356-9