Diet as a Risk Factor in Obstructive Sleep Apnea

Rationale: Obstructive sleep apnea (OSA) is a common disease affecting approximately 2% of women and 4% of men. It is independently associated with cardiovascular disease and metabolic syndrome. Established risk factors for OSA include obesity, male gender, post-menopausal state, smoking and increased neck circumference. Sleep deprivation, a common occurrence in OSA, is associated with weight gain and cravings for carbohydrates. Preference for fatty foods has been documented in sleep deprivation. Studies using mouse models have suggested that high fats diets increase the severity of sleep apnea independent of BMI (body mass index). We hypothesized that dietary habits, especially increased fatty food intake, are independently associated with severity of OSA. Methods: 104 patients, diagnosed with obstructive sleep apnea and presenting to the George Washington-Medical Faculty Associates Center for Sleep Disorders, completed a validated diet survey, Rapid Eating Assessment for Patients (REAP). Apnea-hypopnea index (AHI) was used as a measure of the severity of OSA. Subjects were divided using BMI in to obese (BMI \u3e 30 kg/m2) and overweight (BMI \u3e 25 but \u3c 30 kg/m2) categories. Regression analysis was performed to predict severity of OSA from gender, BMI, age, % energy from fat, and the individual dietary components of REAP. Results: Subjects with a BMI(\u3e35% of their total diet) had twice the severity of sleep apnea (AHI 18.2 ± 10.1 vs. 36.6 ± 27.5; p = 0.001). There was a statistically significant difference (p= 0.04) in OSA severity between subjects eating processed meats “often” [AHI 42.5 ± 30.7] versus those eating “rarely/never” [AHI 28.9 ± 22.7], even after adjusting for BMI. Conversely, eating greater than 2 servings of dairy per day conferred protection against sleep apnea [AHI 26.2 ± 15.6 vs. 39.7 ± 31; p = 0.04]. Conclusions: Dietary components may confer increased risk for worsening severity of OSA. Based on these find¬ings, unhealthy dietary patterns warrant further study of their role in OSA associated cardiovascular diseases and metabolic syndrome development