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INVITED REVIEW
HIGHLIGHTED TOPICS
Physiology and Pathophysiology of Sleep Apnea
1Department of Population Health Sciences, University of Wisconsin-Madison, Madison Wisconsin; and 2Henry Wellcome Laboratories for Integrated Neuroscience and Endocrinology (LINE), University of Bristol, Bristol, United Kingdom
Excess weight is a well-established predictor of sleep-disordered breathing (SDB). Clinical observations and population studies throughout the United States, Europe, Asia, and Australia have consistently shown a graded increase in the prevalence of SDB as body mass index, neck girth, or other measures of body habitus increases. Clinical studies of weight loss and longitudinal population studies provide strong support for a causal association. The role of excess body weight, a modifiable risk factor, with SDB raises many questions relevant to clinical practice and public health. The topic takes on added importance with the alarming rate of weight gain in children as well as adults in industrialized nations. Among adults ages 30–69 yr, averaging over the estimated United States 2003 age, sex, and BMI distributions, we estimate that 
17% of adults have mild or worse SDB (apnea-hypopnea index 
5) and that 41% of those adults have SDB "attributable" to having a body mass index of 25 kg/m2. Similarly, we estimate that 5.7% of adults have moderate or worse SDB (apnea-hypopnea index 15) and that 58% of those adults have SDB attributable to excess weight. Clearly, if the expanding epidemic of obesity seen in the United States continues, the prevalence of SDB will almost certainly increase, along with the proportion of SDB attributable to obesity.
apnea-hypopnea index; body mass index
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