Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome

Osler Chest Unit, Churchill Hospital, Oxford.
Thorax (Impact Factor: 8.56). 03/1992; 47(2):101-5. DOI: 10.1136/thx.47.2.101
Source: PubMed

ABSTRACT Neck circumference has been suggested to be more predictive of obstructive sleep apnoea than general obesity, but the statistical validity of this conclusion has been questioned. Combining neck circumference with other signs and symptoms may allow the clinical diagnosis or exclusion of sleep apnoea to be made with reasonable confidence. This study examines these issues.
One hundred and fifty patients referred to a sleep clinic for investigation of sleep related breathing disorders completed a questionnaire covering daytime sleepiness, snoring, driving, and nasal disease. Body mass index and neck circumference corrected for height were measured and obstructive sleep apnoea severity was quantified as number of dips in arterial oxygen saturation (SaO2) of more than 4% per hour of polysomnography. Multiple linear regression was used retrospectively to identify independent predictors of SaO2 dip rate, and the model derived was then prospectively tested in a further 85 subjects.
The retrospective analysis showed that the question "Do you fall asleep during the day, particularly when not busy?" was the best questionnaire predictor of variance in the SaO2 dip rate (r2 = 0.13); no other question improved this correlation. This analysis also showed that neither body mass index nor any of the questionnaire variables improved the amount of variance explained by height corrected neck circumference alone (r2 = 0.35). A statistically similar prospective analysis confirmed this relationship (r2 = 0.38).
Prospective study of these patients referred to a sleep clinic with symptoms suggesting sleep apnoea shows that neck circumference corrected for height is more useful as a predictor of obstructive sleep apnoea than general obesity. None of the questionnaire variables examined add to its predictive power, but alone it is inadequate to avoid the need for sleep studies to diagnose this disease.

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Available from: John R Stradling, Jul 30, 2015
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    • "The link between these consequences of OSA and vascular disease are probably multifactorial, most likely augmented sympathetic activity, with less evidence for oxidative stress, systemic inflammation, and vibration damage to the carotid arteries. However, because of the close association between central obesity and both OSA (Davies et al. 1992) and vascular disease (Yusuf et al. 2005), it has been very difficult to disentangle the inter-relations and demonstrate that OSA is a truly independent risk factor for vascular disease. Although laboratory studies may support plausible hypotheses, this does not prove their relevance to clinical medicine, a painful lesson learnt in other areas of vascular risk (e.g. "
    The Journal of Physiology 06/2012; 590(Pt 12):2813-5; discussion 2823. DOI:10.1113/jphysiol.2012.229633 · 4.54 Impact Factor
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    • "These include upper airway alterations such as an increased collapsibility of the peripharyngeal tissues . The accumulation of adipose tissue in the neck and also in the pharyngeal structures induces an airway restriction and collapse during inspiration [19] [27]. Abnormalities in the chest wall dynamics, a reduced respiratory compliance, and an impaired respiratory muscle function contribute to the pulmonary dysfunction of severely obese patients [28]. "
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    • "In older men and postmenopausal women, increased fat in the neck and craniofacial areas may increase sleep apnea prevalence [18] [19]. Differences in pharyngeal anatomy (i.e., length) and ventilatory stability (dilator muscle activation) may explain some of the gender differences , but it is likely complex and multifactorial [14] [20]. In children, however, a link between pharyngeal fat and structure and OSA is not supported by the results of a recent study [21]. "
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