Abdominal Obesity Is More Strongly Correlated with Obstructive Sleep Apnea than General Obesity in China: Results from Two Separated Observational and Longitudinal Studies

  • Xiaolong Zhao
  • Huajun Xu
  • Yingjun Qian
  • Yupu Liu
  • Juanjuan Zou
  • Hongliang Yi
  • Jian GuanEmail author
  • Shankai YinEmail author
Original Contributions



Previous studies have reported that obesity can result in or worsen obstructive sleep apnea (OSA). However, whether abdominal or general obesity indices or visceral adiposity indicators have a stronger association with OSA remains unclear.


This cross-sectional study included 4344 patients who underwent polysomnography (PSG) due to suspicion of OSA. We also performed a longitudinal study on 86 patients who underwent bariatric surgery to confirm the relationship between OSA and obesity. Data on overnight PSG parameters, biochemical biomarkers, and multiple anthropometric obesity indices were collected.


In the cross-sectional study, waist circumference (WC) and body mass index (BMI) were independently associated with the apnea-hypopnea index (AHI) after adjusting for potential confounding factors (additional R2 = 0.232, standardized beta coefficient [Beta] = 0.210; and additional R2 = 0.015, Beta = 0.183, respectively). Logistic regression analysis showed similar results, as did stratified analysis of adult males aged ≤ 55 years. Restricted cubic spline (RCS) analysis revealed a linear dose-response relationship between OSA and obesity. In the longitudinal study, no significant relationship was found between remission of OSA and improvement in WC and BMI (r = 0.252, p = 0.098; and r = 0.132, p = 0.395, respectively), whereas the change in the visceral adiposity indicator (lipid accumulation calculated according to WC and fasting triglycerides) was significantly correlated with ΔAHI (r = 0.322, p = 0.033).


Abdominal obesity, rather than general obesity, appears to play a more important role in OSA.


Abdominal obesity Bariatric surgery Obesity Obstructive sleep apnea Visceral adiposity indicator 


Authors’ Contributions

Prof. Shankai Yin, Jian Guan, and Hongliang Yi had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Study design: Xiaolong Zhao, Jian Guan, Hongliang Yi, and Shankai Yin; data collection: Huajun Xu, Yupu Liu, Yingjun Qian; statistical analysis: Huajun Xu; manuscript draft: Xiaolong Zhao, Jian Guan, Hongliang Yi, and Shankai Yin.

Funding Information

This study was supported by grants-in-aid from National Key R&D Program of China (2017YFC0112500); National Natural Science Foundation of China (81770987, 81700896, 81701306, 81770988); Innovation Program of Shanghai Municipal Education Commission (2017-01-07-00-02-E00047); multi-center clinical research project from school of medicine, Shanghai Jiao Tong University (DLY201502); and Shanghai Shen-Kang Hospital Management Center Project (SHDC12015101).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Ethical Approval

This study was approved by the Internal Review Board of the Institutional Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth Hospital and was conducted in accordance with the Declaration of Helsinki.

Informed Consent

Informed consent was obtained from all participants included in the study

Supplementary material

11695_2019_3870_MOESM1_ESM.tif (99 kb)
Supplementary Figure 1 The flow diagram of recruitment of participants in longitudinal study. T2DM, type 2 diabetes mellitus; PSG polysomnography, OSA obstructive sleep apnea, RYGB, Roux-en-Y gastric bypass (TIF 99 kb)
11695_2019_3870_Fig2_ESM.png (580 kb)

High resolution image (PNG 579 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology Head and Neck Surgery & Center of Sleep MedicineShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina
  2. 2.Otolaryngological InstituteShanghai Jiao Tong UniversityShanghaiChina
  3. 3.Clinical Research CenterShanghai Jiao Tong University School of MedicineShanghaiChina
  4. 4.Shanghai Key Laboratory of Sleep Disordered BreathingShanghaiChina

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