The Impact of Obesity and Its Associated Sleep Disorders Either Alone or in Combination towards Systemic Diseases in Turkey

Aims: Both obesity and sleep disorders represent an important public health problem. In this study, the prevalence and consequences of obesity and associated sleep disorders were investigated in the Turkish adult population.

Methodology: Data were analyzed in 5019 subjects who had available body mass index (BMI) data from a population-based study interviewer-administered questionnaire (Turkish Adult Population Epidemiology of Sleep Disorders study: TAPES, original sample: 5521). Obesity was defined and classified by BMI into four groups as underweight (BMI<18 kg/m2), normal (18≤BMI<25 kg/m2), overweight (25≤BMI<30 kg/m2), and obese (BMI >30 kg/m2). Insomnia was defined according to the DSM-IV criteria, habitual snoring and risk for sleep-related breathing disorders (SDB) using the Berlin questionnaire, excessive daytime sleepiness with the Epworth sleepiness scale score, and restless legs syndrome (RLS) according to symptoms as per the International Restless Legs Syndrome Study Group criteria.

Results: The underweight, normal, overweight, and obesity rates were 2.9%, 40.5%, 34.3%, and 22.3%, respectively. Obesity was more common in women, and in the middle age, divorced/widow, lower education status, ex-smoker, low-income, and no regular exercise groups After the adjustment for age, gender, smoking status, educational status and income levels obesity was associated with the increased risk of SDB (OR: 13.03, 95%CI: 9.91-17.14), RLS (OR: 1.43, 95%CI: 1.01-2.02). The risk of heart disease, hypertension, diabetes mellitus, and hospitalization in the last year was higher in the obese population even after adjusting for age, sex, smoking status, educational status, and income levels [OR=2.06 (1.50-2.82), OR=3.45 (2.64-4.51), OR=2.93 (2.05-4.16), and OR=1.55 (1.22-1.98) respectively]. The risk of heart disease increased in subjects who were overweight and obese who had a high risk of SDB, and subjects with obesity who had RLS. The diabetes mellitus risk increased in subjects with obese who had a high risk of SDB or RLS.

Conclusion: Obesity was associated with a high risk of systemic diseases and obesity together with sleep disorders was associated with a higher risk of systemic diseases such as heart disease and diabetes. If confirmed with prospective longitudinal studies with objective measurements, screening for sleep-related symptoms could help to identify adults with obesity at high risk for heart disease and diabetes, and implementation of preventive measures and the proper management of these populations.