The influence of gender, weight, and age on OSA progression in REM and NREM sleep Open Access

Abstract

Abstract

The influence of gender, weight, and age on OSA progression in REM and NREM sleep

By Alan Michael Jones

Background

           In the United States, it is estimated that obstructive sleep apnea (OSA), which greatly increases the risk of many adverse health conditions, affects over 25 million adults with prevalence rates that have drastically increased over the last two decades, likely due to the obesity epidemic. Research has identified several explanatory variables of OSA, but studies have indicated that OSA incidence and severity is mainly determined by three variables: gender, weight and age.

Purpose

The purpose of this study is to investigate the effects and importance of gender, weight, and age on OSA levels (as measured by respiratory disturbance index (RDI) values) by using a large, community-based sample with equal amounts of men and women. This study will also investigate these variables’ impact on OSA in the whole-night, rapid eye movement (REM), and non-rapid eye movement (NREM) stages of sleep.

Sample/Design

A retrospective, secondary analysis of the Sleep Heart Health Study (SHHS) will be used. SHHS is a multi-center cohort study that was implemented in an effort to determine what the cardiovascular and other consequences were of sleep-disordered breathing. Participants were recruited from 9 existing epidemiological studies (“parent cohorts”), and two time points of data collection were performed (labeled SHHS1 and SHHS2). The total number of subjects at SHHS1 is 5804, and 4080 subjects were present at SHHS2.

Results

Overall, RDI values were significantly higher (indicating higher OSA levels) for men in all sleep

 stages. Gender, body mass index (BMI), and age

were the main explanatory variables for RDI values. Overall, BMI was the main variable influencing RDI values in all sleep stages. For men and women, BMI is significantly lowerdifferent in those who, over time, stay at either a normal or mild OSA level versus those who, over time, progress to moderate or severe levels.

Conclusion

           Gender age, and BMI were influential on OSA and its progression or improvement. BMI was the main variable of influence in all sleep stages, and BMI median value was significantly different lower in those who maintained a normal or mild OSA level over time compared to those with a more severe OSA level.

Table of Contents

Table of Contents

Chapter 1: Dissertation Introduction

Figure 1           Conceptual Model for the Dissertation

Chapter 2: Dissertation Manuscript 1

Manuscript Title: RDI value difference in men and women during whole-night, REM, and NREM

sleep

Table 1            Participant Age, BMI, Race/Ethnicity and Prior Diagnosis of OSA

Table 2            T-test results and descriptive statistics for RDI means

Table 3            Group statistics and p-values for RDI means

Table 4            Differences between group means for RDI means

Chapter 3: Dissertation Manuscript 2

Manuscript Title: The significance of BMI in varying OSA levels for men and women

Table 1            Participant Age, BMI, Race/Ethnicity, and Prior Diagnosis of OSA

Table 2            Men - Group number reference

Table 3            Men - Sample Distribution

Table 4            Men – Mean Baseline BMI

Table 5            Men - Median Baseline BMI

Figure 1           Men – Pairwise Comparison results

Table 6            Women - Group number reference

Table 7            Women - Sample Distribution

Table 8            Women – Mean Baseline BMI

Table 9            Women - Median Baseline BMI

Figure 2           Women – Pairwise Comparison results

Figure 3           Men – Pairwise Comparisons results narrative

Figure 4           Women – Pairwise Comparisons results narrative

Chapter 4: Dissertation Manuscript 3

Manuscript Title: Examining the significant factors contributing to RDI in whole-night, REM,

and NREM sleep

Table 1            Participant Age, BMI, Race/Ethnicity, and Prior Diagnosis of OSA

Table 2            Multiple linear regression results for Whole-Night RDIsleep

Table 3            Multiple linear regression results for REM RDIsleep

Table 4            Multiple linear regression results for NREM RDIsleep

Table 5            Multiple linear regression results for REM RDIsleep (modified with REM > 15 minutes)

Table 6            Causal mediation analysis results

Table 7            Relative Variable Importance in 3 sleep stages

Chapter 5: Dissertation Summary

Figure 1           Next Steps

About this Dissertation

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Nursing
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Health Sciences, Nursing
Keyword	Obstructive sleep apnea
Committee Chair / Thesis Advisor	Ann Rogers, Emory University
Committee Members	Donald Bliwise, Emory University Tene Lewis, Emory University Vicki Hertzberg, Emory University

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