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OBSTRUCTIVE SLEEP APNEA SYNDROME: ARE WE MISSING AN AT-RISK POPULATION?

Walter Reed Army Medical Center, Washington DC, DC

PURPOSE: While age and body-mass index (BMI) are well-established risk factors for obstructive sleep apnea syndrome (OSAS), this disorder occurs across a wide spectrum of ages and weights. Preconceptions regarding "classic" patients with OSAS may lead to an under diagnosis in at-risk populations, particularly women or younger, non-overweight individuals. We hypothesized that disease severity is independent of age and BMI. We compared military service members to civilians to determine if disease severity was equivalent in a younger, less obese population.

METHODS: Prospective study of consecutive patients diagnosed with OSAS. Active duty military, National Guardsmen and civilians were compared to determine if age and BMI correlated with disease severity.

RESULTS: 270 subjects (120 active duty military, 80 National Guardsmen and 70 civilians) were included. Active duty military were significantly younger and less overweight than National Guardsmen and civilians. 64.3% of civilians and 48.8% of National Guardsmen were obese, while only 19.2% of active-duty had BMI 30 Kg/m2 (p<0.001 for both). However, prevalence of severe disease did not differ between groups. 37.5% of active duty had severe disease, compared with 42.5% of National Guard and 45.7% of civilians (p=0.18 and 0.09, respectively). BMI did not differ between active duty with severe disease and those with mild or moderate OSAS (26.7 Kg/m2 versus 26.9 Kg/m2, p=0.40) and disease severity did not correlate with BMI (R=0.09, p=0.33). There was a low correlation between age and AHI (R=0.21, p=0.02).

CONCLUSION: OSAS occurs in young, non-obese individuals. While obesity and age are risk factors for OSAS, they did not correlate with disease severity. Obesity is not a diagnostic criterion for OSAS and should not be required for evaluation.

CLINICAL IMPLICATIONS: OSAS should be considered in symptomatic patients regardless of age or BMI. Failing to consider this diagnosis in individuals who do not fit into the stereotypical image of OSAS patients may under diagnose an at-risk population.

DISCLOSURE: Christopher Lettieri, None.