DOI QR코드

DOI QR Code

Association between the Risk of Obstructive Sleep Apnea and Lung Function: Korea National Health and Nutrition Examination Survey

  • Jinwoo Seok (Division of Pulmonology and Allergy, Department of Internal Medicine, Soonchunhyang University Seoul Hospital) ;
  • Hee-Young Yoon (Division of Pulmonology and Allergy, Department of Internal Medicine, Soonchunhyang University Seoul Hospital)
  • Received : 2023.11.15
  • Accepted : 2024.03.17
  • Published : 2024.07.31

Abstract

Background: Obstructive sleep apnea (OSA) is a prevalent sleep disorder associated with various health issues. Although some studies have suggested an association between reduced lung function and OSA, this association remains unclear. Our study aimed to explore this relationship using data from a nationally representative population-based survey. Methods: We performed an analysis of data from the 2019 Korea National Health and Nutrition Examination Survey. Our study encompassed 3,675 participants aged 40 years and older. Risk of OSA was assessed using the STOP-Bang (Snoring, Tiredness during daytime, Observed apnea, and high blood Pressure-Body mass index, Age, Neck circumference, Gender) questionnaire and lung function tests were performed using a portable spirometer. Logistic regression analysis was applied to identify the risk factors associated with a high-risk of OSA, defined as a STOP-Bang score of ≥3. Results: Of 3,675 participants, 600 (16.3%) were classified into high-risk OSA group. Participants in the high-risk OSA group were older, had a higher body mass index, and a higher proportion of males and ever-smokers. They also reported lower lung function and quality of life index in various domains along with increased respiratory symptoms. Univariate logistic regression analysis indicated a significant association between impaired lung function and a high-risk of OSA. However, in the multivariable analysis, only chronic cough (odds ratio [OR], 2.413; 95% confidence interval [CI], 1.383 to 4.213) and sputum production (OR, 1.868; 95% CI, 1.166 to 2.992) remained significantly associated with a high OSA risk. Conclusion: Our study suggested that, rather than baseline lung function, chronic cough, and sputum production are more significantly associated with OSA risk.

Keywords

Acknowledgement

This study was supported by the Soonchunhyang University Research Fund.

References

  1. Sankri-Tarbichi AG. Obstructive sleep apnea-hypopnea syndrome: etiology and diagnosis. Avicenna J Med 2012;2:3-8. https://doi.org/10.4103/2231-0770.94803
  2. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet 2014;383:736-47. https://doi.org/10.1016/S0140-6736(13)60734-5
  3. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 2017;34:70-81. https://doi.org/10.1016/j.smrv.2016.07.002
  4. Sunwoo JS, Hwangbo Y, Kim WJ, Chu MK, Yun CH, Yang KI. Prevalence, sleep characteristics, and comorbidities in a population at high risk for obstructive sleep apnea: a nationwide questionnaire study in South Korea. PLoS One 2018;13:e0193549.
  5. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MS, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019;7:687-98. https://doi.org/10.1016/S2213-2600(19)30198-5
  6. Bonsignore MR, Baiamonte P, Mazzuca E, Castrogiovanni A, Marrone O. Obstructive sleep apnea and comorbidities: a dangerous liaison. Multidiscip Respir Med 2019;14:8.
  7. Shawon MS, Perret JL, Senaratna CV, Lodge C, Hamilton GS, Dharmage SC. Current evidence on prevalence and clinical outcomes of co-morbid obstructive sleep apnea and chronic obstructive pulmonary disease: a systematic review. Sleep Med Rev 2017;32:58-68. https://doi.org/10.1016/j.smrv.2016.02.007
  8. Kong DL, Qin Z, Shen H, Jin HY, Wang W, Wang ZF. Association of obstructive sleep apnea with asthma: a meta-analysis. Sci Rep 2017;7:4088.
  9. Reis R, Antunes A. Lung volumes in the pathogenesis of obstructive sleep apnea. Rev Port Pneumol 2014;20:173-4. https://doi.org/10.1016/j.rppneu.2014.01.005
  10. Appelberg J, Nordahl G, Janson C. Lung volume and its correlation to nocturnal apnoea and desaturation. Respir Med 2000;94:233-9. https://doi.org/10.1053/rmed.1999.0730
  11. Emilsson OI, Sundbom F, Ljunggren M, Benediktsdottir B, Garcia-Aymerich J, Bui DS, et al. Association between lung function decline and obstructive sleep apnoea: the ALEC study. Sleep Breath 2021;25:587-96. https://doi.org/10.1007/s11325-020-02086-1
  12. Hoffstein V, Oliver Z. Pulmonary function and sleep apnea. Sleep Breath 2003;7:159-65. https://doi.org/10.1007/s11325-003-0159-8
  13. Wang JF, Zhang Q, Xie YP, Chu YY, Ma W. Analysis of the overweight and obesity effects on pulmonary function in OSA patients. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019;33:611-4.
  14. Sharma B, Feinsilver S, Owens RL, Malhotra A, McSharry D, Karbowitz S. Obstructive airway disease and obstructive sleep apnea: effect of pulmonary function. Lung 2011;189:37-41. https://doi.org/10.1007/s00408-010-9270-3
  15. Kim JS, Azarbarzin A, Podolanczuk AJ, Anderson MR, Cade BE, Kawut SM, et al. Obstructive sleep apnea and longitudinal changes in interstitial lung imaging and lung function: the MESA study. Ann Am Thorac Soc 2023;20:728-37. https://doi.org/10.1513/AnnalsATS.202208-719OC
  16. Wang TY, Lo YL, Lin SM, Huang CD, Chung FT, Lin HC, et al. Obstructive sleep apnoea accelerates FEV1 decline in asthmatic patients. BMC Pulm Med 2017;17:55.
  17. Oh K, Kim Y, Kweon S, Kim S, Yun S, Park S, et al. Korea National Health and Nutrition Examination Survey, 20th anniversary: accomplishments and future directions. Epidemiol Health 2021;43:e2021025.
  18. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 2014;43:69-77. https://doi.org/10.1093/ije/dyt228
  19. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008;108:812-21. https://doi.org/10.1097/ALN.0b013e31816d83e4
  20. Jeon HJ, Bang YR, Yoon IY. A validation study on three screening questionnaires for obstructive sleep apnea in a Korean community sample. Sleep Breath 2019;23:969-77. https://doi.org/10.1007/s11325-018-1748-x
  21. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. An official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med 2019;200:e70-88. https://doi.org/10.1164/rccm.201908-1590ST
  22. Park HJ, Rhee CK, Yoo KH, Park YB. Reliability of portable spirometry performed in the Korea National Health and Nutrition Examination Survey compared to conventional spirometry. Tuberc Respir Dis (Seoul) 2021;84:274-81. https://doi.org/10.4046/trd.2021.0016
  23. Choi JK, Paek D, Lee JO. Normal predictive values of spirometry in Korean population. Tuberc Respir Dis 2005;58:230-42. https://doi.org/10.4046/trd.2005.58.3.230
  24. Lee YK, Nam HS, Chuang LH, Kim KY, Yang HK, Kwon IS, et al. South Korean time trade-off values for EQ-5D health states: modeling with observed values for 101 health states. Value Health 2009;12:1187-93. https://doi.org/10.1111/j.1524-4733.2009.00579.x
  25. Huh G, Han KD, Park YM, Park CS, Lee KN, Lee EY, et al. Comorbidities associated with high-risk obstructive sleep apnea based on the STOP-BANG questionnaire: a nationwide population-based study. Korean J Intern Med 2022;38:80-92. https://doi.org/10.3904/kjim.2022.198
  26. Wetter DW, Young TB, Bidwell TR, Badr MS, Palta M. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 1994;154:2219-24. https://doi.org/10.1001/archinte.1994.00420190121014
  27. Kim TH, Heo IR, Kim HC. Impact of high-risk of obstructive sleep apnea on chronic cough: data from the Korea National Health and Nutrition Examination Survey. BMC Pulm Med 2022;22:419.
  28. Chan KK, Ing AJ, Laks L, Cossa G, Rogers P, Birring SS. Chronic cough in patients with sleep-disordered breathing. Eur Respir J 2010;35:368-72. https://doi.org/10.1183/09031936.00110409
  29. Birring SS, Ing AJ, Chan K, Cossa G, Matos S, Morgan MD, et al. Obstructive sleep apnoea: a cause of chronic cough. Cough 2007;3:7.
  30. Wang TY, Lo YL, Liu WT, Lin SM, Lin TY, Kuo CH, et al. Chronic cough and obstructive sleep apnoea in a sleep laboratory-based pulmonary practice. Cough 2013;9:24.
  31. Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest 2007;132:325-37. https://doi.org/10.1378/chest.07-0040
  32. Sundar KM, Daly SE, Pearce MJ, Alward WT. Chronic cough and obstructive sleep apnea in a community-based pulmonary practice. Cough 2010;6:2.
  33. Banerjee J, Roy A, Singhamahapatra A, Dey PK, Ghosal A, Das A. Association of body mass index (BMI) with lung function parameters in non-asthmatics identified by spirometric protocols. J Clin Diagn Res 2014;8:12-4. https://doi.org/10.7860/JCDR/2014/7306.3993
  34. Zerah-Lancner F, Lofaso F, Coste A, Ricolfi F, Goldenberg F, Harf A. Pulmonary function in obese snorers with or without sleep apnea syndrome. Am J Respir Crit Care Med 1997;156(2 Pt 1):522-7. https://doi.org/10.1164/ajrccm.156.2.9609015
  35. Ijaz A, Bashir I, Ikhlaq A, Ijaz F, Aftab RK, Zia R. Correlation between peak expiratory flow rate, markers of adiposity, and anthropometric measures in medical students in Pakistan. Cureus 2020;12:e12408.
  36. Ali R, Shaikh S, Siddiqui N, Fahad M, Jawed S, Masood N. Impacts of adiposity parameters on peak expiratory flow rate in healthy young adults of Bahria University Medical and Dental College Karachi: cross-sectional study. J Pak Med Assoc 2022;72:1513-7. https://doi.org/10.47391/JPMA.3306
  37. Joshi V, Shah S. Effect of body mass index (BMI) on peak expiratory flow rate in young adults. Int Arch Integr Med 2016;3:85-8.
  38. Al Ghobain M. The effect of obesity on spirometry tests among healthy non-smoking adults. BMC Pulm Med 2012;12:10.
  39. Gundogdu Z, Eryilmaz N. Correlation between peak flow and body mass index in obese and non-obese children in Kocaeli, Turkey. Prim Care Respir J 2011;20:403-6. https://doi.org/10.4104/pcrj.2011.00061
  40. Bhardwaj P, Poonam K, Jha K, Bano M. Effects of age and body mass index on peak-expiratory flow rate in Indian population. Indian J Physiol Pharmacol 2014;58:166-9.