Relationship between obstructive sleep apnea and obesity in sarcopenia and presarcopenia among elderly people

Relationship between obstructive sleep apnea and obesity in sarcopenia and presarcopenia among elderly people | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relationship between obstructive sleep apnea and obesity in sarcopenia and presarcopenia among elderly people Shih-Wei Huang, Wen-Jui Chang, Pi-Hung Tung, Ting-Wei Liao, Geng-Hao Liu, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4370108/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Obstructive sleep apnea (OSA), obesity and sarcopenia are issues have been attracting increasing attention. The associations between OSA, obesity and sarcopenia have rarely been investigated in previous studies. Methods We invited healthy adults aged 60 years or older who lived in Chang Gung Health and Culture Village in Taoyuan or Songshan District in Taipei city between September 2019 and October 2020 to participate in this study. Demographics were collected from the electronic medical records of our hospital or statements of the participants. Full-channel home polysomnography (PSG), handgrip strength, the 4-meter walk test, and bioelectrical impedance analysis (BIA) were used to evaluate OSA and sarcopenia. Results A total of 96 participants were included. Considering the small number of sarcopenia participants and the pathophysiology of OSA, we included presarcopenia participants in the sarcopenia group. The severity of OSA and BMI increased with age, and the peak values were observed between 70 and 80 years of age. A delayed increase in the severity of OSA in females was observed. Males were more likely to be obese than females. The prevalence of sarcopenia increased with age and was greater in females. In those without sarcopenia, a positive correlation was observed between the severity of OSA and obesity ( p = 0.043). Conclusions Sarcopenia and low muscle mass may be confounding factors when evaluating the relationship between OSA and obesity in elderly individuals. obstructive sleep apnea obesity sarcopenia muscle mass elderly Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Obstructive sleep apnea (OSA) is a disorder of repeated upper airway collapse during sleep that causes apnea or hypopnea to varying degrees. Intermittent oxygen desaturation, hypercapnia and sleep fragmentation contribute to excessive daytime sleepiness, which leads to reduced quality of life, impaired work performance, and increased risk of traffic accidents( 1 – 3 ). OSA is also associated with the development of several clinical comorbidities, including hypertension, cardiovascular disease, cardiac arrhythmia, pulmonary hypertension, stroke, cognitive impairment, and metabolic syndrome( 4 – 9 ). Advanced age, male sex, obesity, and smoking have been proposed as risk factors for OSA( 1 , 2 , 10 ). The prevalence of OSA increases with age. Although a greater proportion of OSA was found in people aged 65 years and older, the trend of OSA incidence was not only a simple positive correlation with age in elderly people( 11 ). The etiology of OSA in the aged population might be different from that in the middle-aged population( 11 ). Sarcopenia is a skeletal muscle disorder characterized by low muscle strength, low muscle mass and low physical performance, which contribute to recurrent falls, fractures and mortality( 12 – 14 ). Muscle weakness may lead to increased hospitalization and health care costs( 15 , 16 ). Changes in lifestyle, physical activity, nutritional conditions, hormonal status and chronic metabolic disease with age lead to the development of sarcopenia( 17 ). The prevalence and severity of both OSA and sarcopenia increase with increasing age( 12 , 18 ). One of the pathogenic mechanisms associated with OSA, sarcopenia and sarcopenia is poor upper airway muscle function, which may induce upper airway collapse( 19 , 20 ). However, few studies have evaluated the interaction between age, OSA and sarcopenia. Our study aimed to investigate the relationships among OSA, obesity and sarcopenia in an aged population. Methods Study population We invited healthy adults aged more than or equal to 60 years old to join the Integrated Systematic Data of Geriatric Medicine to Explore the Solution for Healthy Aging (ISD-HA) study between September 2019 and October 2020 during their general medical examination at Chang Gung Health and Culture Village in Taoyuan city or Songshan District in Taipei city. The inclusion criteria were as follows: ( 1 ) aged ≥ 60 years; ( 2 ) visited Chang Gung Memorial Hospital at least once within 1 year before recruitment; and ( 3 ) stayed in Taiwan for more than 180 days within 1 year before recruitment. The exclusion criteria were as follows: ( 1 ) had clinical evidence of severe abnormalities in any major organ system; ( 2 ) had a medical history of severe autoimmune disease; ( 3 ) were receiving cancer therapy at the time of recruitment; ( 4 ) had active infection with antibiotic treatment within one month of recruitment; ( 5 ) were diagnosed with dementia or major depressive disorder; and ( 6 ) were too frail to stand or walk. Data collection Demographics were collected from the electronic medical records of our hospital or statements of the participants. We obtained demographic information, including age, sex, body height, body weight, body mass index (BMI), and medical history (including hypertension, hyperlipidemia, diabetes mellitus, osteoporosis, osteoarthritis, chronic obstructive pulmonary disease, chronic kidney disease and malignancy). The study was approved by the Institutional Review Board of Chang Gung Medical Foundation, Taiwan (IRB approval number: 201900702A3). The study procedures followed the Declaration of Helsinki. All participants provided written informed consent. All personal information was encrypted in a database and anonymized, so there was no breach of privacy. Sleep assessments Objective sleep assessment was performed with a single night of standardized in-home polysomnography (PSG) using a portable monitoring system (Philips Alice 6 lDe; Philips Health care, Andover, MD, USA). Sleep stages were scored by a certificated sleep technologist and an experienced sleep specialist according to the established criteria( 21 ). The time spent in each sleep stage, total sleep time, total awake time, sleep efficiency and sleep onset latency were recorded. OSA severity is quantified according to the apnea–hypopnea index (AHI), the number of apnea or hypopnea events recorded per hour of sleep( 22 ). An AHI score of 5 to 15 events per hour was defined as mild OSA, 15 to 30 events per hour was defined as moderate OSA, and ≥ 30 events per hour was defined as severe OSA( 22 ). Assessment of sarcopenia Handgrip strength (kg) was measured by a hand dynamometer (Jamar® Plus + Digital Hand Dynamometer) to evaluate muscle strength. Gait speed was measured by the 4-meter walk test and is presented as the distance (m) per second. Appendicular skeletal muscle mass (ASM) was measured by bioelectrical impedance analysis (BIA), and the ASM index was calculated as the ASM divided by the square of the height. The Asian Working Group for Sarcopenia (AWGS) proposed that the cutoff value for low muscle strength was defined as a handgrip strength < 28 kg for men and < 18 kg for women. Low physical performance was defined as a gait speed < 1.0 m/s. Loss of muscle mass was defined as an ASM index < 7.0 kg/m 2 in men and < 5.7 kg/m 2 in women( 23 ). The European Working Group on Sarcopenia in Older People (EWGSOP) and the AWGS both proposed that sarcopenia is characterized by a loss of skeletal muscle mass plus a loss of muscle strength and/or reduced physical performance( 23 , 24 ). The EWGSOP also proposed the concept of presarcopenia, which is characterized by a loss of skeletal muscle mass without an impact on muscle strength or physical performance( 24 ). Statistical analysis Our study aimed to evaluate whether there is a positive correlation between OSA and sarcopenia in people aged ≥ 60 years. We also investigated the associations between OSA, age, sex and obesity. All the statistical analyses were performed using the statistics program IBM SPSS version 21.0 (SPSS, Inc., Chicago, IL, USA). A t test was used to compare the means between two groups. Linear regression was used to test the relationship between BMI and the AHI to determine the changes in BMI with the severity of OSA. A p value of 0.05 or less was considered to indicate statistical significance, and all the data are expressed as the mean ± SEM. Results A total of 112 participants were initially included, 16 of whom were excluded because they were too frail to complete the assessment of sarcopenia. The demographic data of the 96 final participants are summarized in Table 1. Considering the small number of sarcopenia participants and the pathophysiology of OSA, we included presarcopenia participants in the sarcopenia group. Body weight, BMI, incidence of OSA, ASM index and handgrip strength were significantly different between the participants with and without sarcopenia ( p < 0.001, p < 0.001, p = 0.018, p < 0.001, p = 0.004, respectively; Table 1). The relationship between the severity of OSA and age in different sex groups. The relationship between the AHI and age in elderly individuals is shown in Fig. 1 . The mean AHI increased with age, and the peak AHI was observed among the participants aged between 70 and 80 years. However, it decreased among those aged above 80 years (Fig. 1 A). The trend of correlation between the AHI and age in the female participants was similar to that in the whole participants; nonetheless, the AHI decreased with age in the male participants. Among those aged between 60 and 70 years, the male participants had a greater AHI than did the female participants ( p = 0.049, Fig. 1 B). The relationship between obesity and age in different sex groups The relationship between BMI and age is presented in Fig. 2 . BMI increased with age among the participants aged between 60 and 70 years and between 70 and 80 years but decreased among those aged older than 80 years (Fig. 2 A). Among those aged between 60 and 70 years, male participants had a higher BMI ( p = 0.046, Fig. 2 B). The relationship between the incidence of sarcopenia and age in elderly individuals. The proportion of patients with sarcopenia increased with age ( p = 0.036, Fig. 3 A). Among those aged between 60 and 70 years and between 70 and 80 years, the proportion of patients with sarcopenia was greater among the female participants ( p = 0.029 and p = 0.048, respectively; Fig. 3 B). Among those aged above 80 years, the proportion of females with sarcopenia was close to that of males. Correlations between the AHI and BMI in elderly individuals with or without sarcopenia The AHI was not correlated with BMI in any of the participants ( p = 0.63, Fig. 4 A). Taking sarcopenia into account, the correlation between the AHI and BMI was also unremarkable (Fig. 4 B). Nevertheless, in those without sarcopenia, a positive correlation was observed between the AHI and BMI (Fig. 4 C, p = 0.043). Therefore, sarcopenia is a confounding factor when exploring the relationship between OSA and obesity. Discussion In the present study, both the severity of OSA and obesity increased with age; moreover, the peak values were both in the group aged 70–80 years. The AHI increased later in the female participants. The prevalence of sarcopenia increased with increasing age in both males and females. Obesity is not positively correlated with the severity of OSA. However, in the group without sarcopenia, the severity of OSA increased with increasing obesity. In our study, there was no significant correlation between the severity of OSA and BMI. This result is different from previous studies suggesting that obesity is an important risk factor for OSA( 25 , 26 ). However, in the group without sarcopenia, there was a positive correlation between the severity of OSA and BMI. This could be explained by the likelihood of sarcopenia being inversely associated with BMI in elderly individuals( 27 ). A British cohort study demonstrated that greater gains in BMI are associated with greater muscle mass( 28 ). The phenomenon of increased lean muscle along with fat mass probably contributed to this result( 29 ). Another cross-sectional study revealed that in nonobese individuals, upper body obesity significantly increased the frequency of OSA( 26 ). In our study, we did not investigate the impact of upper body obesity on OSA, which may influence the relationship between OSA and obesity. One study in Brazil revealed that a high risk of OSA was associated with low muscle mass and low muscle strength among obese participants( 30 ). In our study, the number of individuals with low muscle strength was too low to investigate the correlation with OSA. Some previous studies have demonstrated that the prevalence of sarcopenia increases with age( 31 ), while others have shown the opposite results( 32 ). The prevalence of sarcopenia varies when different definitions and cutoff values are used( 33 ). In Japan, a study with 1882 participants revealed a positive correlation between sarcopenia and advanced age( 34 ). Another study in China also reported similar results( 27 , 35 ). Considering the small number of sarcopenia participants who met the criteria of the AWGS and the pathophysiology of OSA, which is correlated with changes in the muscle and fat proportions of the upper airway and muscle tone, we included presarcopenia participants in the sarcopenia group( 1 , 2 , 23 , 24 ). In our study, the proportion of sarcopenia increased with age; moreover, the prevalence in women was greater than that in men. These results are consistent with other studies in Japan and China( 27 , 34 , 35 ). The close living environment and similar lifestyles likely contributed to this result. A previous study showed that the severity of OSA increased with increasing age( 36 , 37 ). Fietze et al. demonstrated that the AHI is significantly greater for participants aged 60 years or older than for participants under 60 years old( 18 ). These findings are consistent with our study. Nonetheless, in our study, the severity of OSA did not follow this trend in participants aged above 80 years. Gabbay et al. conducted a retrospective study with 23806 participants between 2000 and 2009( 38 ). A plateau in the AHI was found for participants aged between 70 and 75 years, especially males. This demonstration was similar to our results. Moderate-to-severe OSA is associated with an increased risk of all-cause mortality with increasing age, which may lead to a healthy survival effect( 39 ). According to our study design, we excluded people with severe major organ dysfunction and poor performance status. The above factors may contribute to selection bias. Moreover, few studies have investigated adults aged above 80 years independently( 18 , 36 – 38 , 40 ). However, further studies are needed to confirm our results. The severity of OSA is greater in males than in females; moreover, Fietze et al. and Gabbay et al. both demonstrated that the AHI increases significantly in females aged greater than 50–59 years( 18 , 38 ). In our study, the AHI was also greater in the male group than in the female group and increased significantly with increasing age between the females aged 60 and 70 years and between the females aged 70 and 80 years. The phenomenon of a delayed increase in the severity of OSA in the female group is consistent with the findings of a previous study, which might be due to the diminished protective effect of gonadal hormones on OSA( 41 ). Changes in serum gonadal hormone levels may contribute to the redistribution of body fat to central regions and the loss of lean muscle mass with a proportional increase in fat mass( 1 ). Globally, the incidence of obesity increases with increasing age from 20 years of age, reaches a peak between the ages of 50 and 65 years of age, and then declines thereafter( 42 ). The prevalence of obesity in females was greater than that in males in all age groups. Haslam et al. investigated the prevalence of obesity by age and sex in subregions of the world and demonstrated that the proportion of obese individuals increases after 15 to 29 years of age and reaches a peak between 60 and 69 years of age in China and Vietnam( 43 ). The incidence of obesity is slightly greater in females than in males; however, the trend of the curve is similar in both males and females( 43 ). In our study, the prevalence of obesity was greater in males than in females, which is in contrast with the findings of previous studies( 42 , 43 ). However, a cross-sectional study demonstrated a slightly greater BMI in males than in females in southern China( 44 ). This phenomenon is likely related to their similar lifestyles and ethnicities. There were several inherent limitations in our study. First, the number of participants with sarcopenia was small. Therefore, we included participants with presarcopenia in the sarcopenia group. The different definitions led to different results compared with those of previous studies. Second, we did not record data on upper body obesity, which likely influenced the severity of OSA. Third, the exclusion criteria of our study may have contributed to selection bias. Considering that people with severe major organ dysfunction and poor performance status may have different results when investigating the relationships among age, OSA, obesity and sarcopenia. Conclusions In conclusion, the severity of OSA and obesity and the prevalence of sarcopenia increased with increasing age. The severity of OSA increased later in females, which is likely correlated with postmenopause. Sarcopenia and low muscle mass are confounding factors when evaluating the relationship between OSA and obesity. Abbreviations OSA obstructive sleep apnea BMI body mass index PSG polysomnography AHI apnea-hypopnea index ASM appendicular skeletal muscle mass BIA bioelectrical impedance analysis AWGS Asian Working Group for Sarcopenia EWGSOP European Working Group on Sarcopenia in Older People Declarations Ethics approval and consent to participate This study was carried out in accordance with the principles of the Declaration of Helsinki and was approved by the Ethics Review Committee of Chang Gung Medical Foundation (approval number: 201900702A3). Informed consent was obtained from all participants. Consent for publication Not applicable. Availability of data and materials The data sets analysed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was supported by grant CORPG3J0371 & CMRPG3J1931 from Chang Gung Memorial Hospital. The sponsors only provided financial support. Author’s contributions Li-Pang Chuang, Ning-Hung Chen and Ji-Tseng Fang contributed to the conception and design of the study. Shih-Wei Huang, Wen-Jui Chang, and Pi-Hung Tung analysed and interpreted the data. Shih-Wei Huang and Li-Pang Chuang drafted the manuscript. Ting-Wei Liao and Geng-Hao Liu provided the study materials and selected patients. Shih-Wei Lin and Han-Chung Hu collected and assembled the data. All authors read and approved the final manuscript and have agreed to be personally accountable for the author's own contributions, and to ensure that questions related to the accuracy or integrity of any part of the work are addressed. 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Demographics of the participants Demographics Total, n = 96 Sarcopenia, n = 25 Nonsarcopenia, n = 71 p value Gender Male, n(%) 42(43.8%) 7(28%) 35(49.3%) Female, n(%) 54(56.2%) 18(72%) 36(50.7%) 0.065 Age, years, mean ± SD 73.3 ± 7.0 75.3 ± 7.99 72.7 ± 6.6 0.103 Height, cm, mean ± SD 160.2 ± 7.6 158 ± 7.7 160.1 ± 7.5 0.097 Weight, kg, mean ± SD 60.9 ± 10.9 51.9 ± 7.6 64.1 ± 10.1 <0.001 BMI, kg/m 2 , mean ± SD 23.6 ± 3.4 20.7 ± 2.07 24.7 ± 3.19 <0.001 Medical history Hypertension, n(%) 33(34.4%) 7(28%) 26(36.6%) 0.435 Hyperlipidemia, n(%) 33(34.4%) 11(44%) 22(31%) 0.239 Diabetes mellitus, n(%) 15(15.6%) 2(8%) 13(18.3%) 0.222 Osteoporosis, n(%) 7(7.3%) 4(16%) 3(4.2%) 0.051 Osteoarthritis, n(%) 8(8.3%) 1(4%) 7(9.9%) 0.362 Chronic obstructive pulmonary disease, n(%) 6(6.3%) 3(12%) 3(4.2%) 0.167 Chronic kidney disease, n(%) 2(2.1%) 0(0%) 2(2.8%) 0.396 Malignancy, n(%) 5(5.2%) 1(4%) 4(5.6%) 0.752 Obstructive sleep apnea, n(%) 77(80.2%) 16(64%) 61(85.9%) 0.018 AHI, events/hour, mean ± SD 20.1 ± 14.4 16.4 ± 11.9 21.2 ± 15.0 0.186 Mild, n(%) 28(29.2%) 5(20%) 23(32.4%) 0.241 Moderate, n(%) 25(26%) 7(28%) 18(25.4%) 0.795 Severe, n(%) 24(25%) 4(16%) 20(28.2%) 0.227 ASM index, kg/m 2 , mean ± SD 6.8 ± 1.2 5.8 ± 0.6 7.2 ± 1.2 <0.001 Handgrip strength, kg, mean ± SD 28.2 ± 8.2 24.1 ± 7.5 29.6 ± 8.0 0.004 Gait speed, m/s, mean ± SD 1.1 ± 0.3 1.1 ± 0.3 1.2 ± 0.3 0.353 BMI, Body Mass Index; AHI, Apnea-Hypopnea Index; ASM index, appendicular skeletal muscle mass index Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4370108","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":302462881,"identity":"a1ae2af4-e052-4988-8fb7-66ed4f5f857d","order_by":0,"name":"Shih-Wei Huang","email":"","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shih-Wei","middleName":"","lastName":"Huang","suffix":""},{"id":302462883,"identity":"878cdb99-c521-4253-875f-6acdae1721ed","order_by":1,"name":"Wen-Jui Chang","email":"","orcid":"","institution":"New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wen-Jui","middleName":"","lastName":"Chang","suffix":""},{"id":302462886,"identity":"b0123dff-2800-49f8-a01c-0a0411ef7dda","order_by":2,"name":"Pi-Hung Tung","email":"","orcid":"","institution":"Saint Paul’s Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Pi-Hung","middleName":"","lastName":"Tung","suffix":""},{"id":302462889,"identity":"c1e947f5-ab78-4beb-937b-3cc177d43d93","order_by":3,"name":"Ting-Wei Liao","email":"","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ting-Wei","middleName":"","lastName":"Liao","suffix":""},{"id":302462890,"identity":"8b0523ac-0c07-48b4-8cbe-ded6cb5e05c1","order_by":4,"name":"Geng-Hao Liu","email":"","orcid":"","institution":"Chang Gung University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Geng-Hao","middleName":"","lastName":"Liu","suffix":""},{"id":302462891,"identity":"117bc0f1-be3b-4a0e-843d-1bda216c7db9","order_by":5,"name":"Shih-Wei Lin","email":"","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shih-Wei","middleName":"","lastName":"Lin","suffix":""},{"id":302462892,"identity":"e532436f-6fb5-4dca-a3c7-412f03bf69dd","order_by":6,"name":"Han-Chung Hu","email":"","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Han-Chung","middleName":"","lastName":"Hu","suffix":""},{"id":302462893,"identity":"4dbabf30-9fa8-4f22-b5ea-31b30cb9fd9d","order_by":7,"name":"Ning-Hung Chen","email":"","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ning-Hung","middleName":"","lastName":"Chen","suffix":""},{"id":302462894,"identity":"a998cd5f-042d-4fe2-9ec5-538d06dfa8b1","order_by":8,"name":"Ji-Tseng Fang","email":"","orcid":"","institution":"Chang Gung Memorial Hospital, Chang Gung University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ji-Tseng","middleName":"","lastName":"Fang","suffix":""},{"id":302462895,"identity":"0e0e3cd3-8cc3-43df-94cc-1a8eda65c794","order_by":9,"name":"Li-Pang Chuang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYBACPgYGNjCDH0QkFBChhQ2mRbIBpMWAFC0GB8AkMVqkm5895qm5Y7f5/OrEDw8MGOT5xQ4Q0CJzzNyY59iz5G033m6WADrMcObsBAJaJHLYpHnYDieb3Ti7AaQlweA2UVr+HU42nnF28w/itfC2HbYz4O/dRqQtMsfMJOf2HU6QuMG7zSLBQIKwX/iBISbx5tthe/7+s5tv/qiwkeeXJqCFQQJCJTZIJCBxidFiz8B/gAjVo2AUjIJRMCIBAErWP/N3mn4YAAAAAElFTkSuQmCC","orcid":"","institution":"Linkou Chang Gung Memorial Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Li-Pang","middleName":"","lastName":"Chuang","suffix":""}],"badges":[],"createdAt":"2024-05-05 03:08:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4370108/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4370108/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56620899,"identity":"68ac85ce-53db-4ace-b9b3-f5dfe1ed2582","added_by":"auto","created_at":"2024-05-16 18:01:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":331836,"visible":true,"origin":"","legend":"\u003cp\u003eThe relationship between the severity of OSA and age in different sex groups. (A) All participants. The mean AHI increased with age, and the peak was observed at ages between 70 and 80 years. (B) Males and females. The mean AHI was significantly greater in males than in females aged between 60 and 70 years (\u003cem\u003ep\u003c/em\u003e = 0.049). A delayed increase in the AHI was observed in the female group. OSA, obstructive sleep apnea; AHI, apnea‒hypopnea index.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4370108/v1/cedbf098a7109aa42ae2b802.png"},{"id":56620901,"identity":"09f3db73-990e-49c7-a1d4-a62acf27eb8b","added_by":"auto","created_at":"2024-05-16 18:01:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":342440,"visible":true,"origin":"","legend":"\u003cp\u003eThe relationship between obesity and age in different sex groups. (A) All participants. The mean BMI increased with age, especially in participants younger than 80 years (\u003cem\u003ep\u003c/em\u003e = 0.044); however, it declined slightly in those older than 80 years. (B) Males and females. Overall, the mean BMI was greater for males, especially those aged between 60 and 70 years (\u003cem\u003ep\u003c/em\u003e = 0.046). BMI, body mass index.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4370108/v1/44a7e242c87cbe0379272f8a.png"},{"id":56620902,"identity":"1b1879e7-e20c-4696-b611-bda95fc05219","added_by":"auto","created_at":"2024-05-16 18:01:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":344354,"visible":true,"origin":"","legend":"\u003cp\u003eThe relationship between the incidence of sarcopenia and age in elderly individuals. (A) All participants. The proportion of sarcopenia increased significantly with age (\u003cem\u003ep \u003c/em\u003e= 0.036). (B) Males and females. The proportion of sarcopenia increased with age in both male and female participants, and it was greater in females, especially in the 60- to 70-year-old group and the 70- to 80-year-old group (\u003cem\u003ep\u003c/em\u003e = 0.029, \u003cem\u003ep\u003c/em\u003e= 0.048, respectively).\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4370108/v1/ab81afe27a5bf16ea776b6fd.png"},{"id":56620903,"identity":"1f16e2ef-2fca-4977-a343-972d4a32d991","added_by":"auto","created_at":"2024-05-16 18:01:51","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":397320,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelations between the AHI and BMI in elderly individuals with or without sarcopenia. (A) All participants. There was no significant correlation between the AHI and BMI in any of the participants (\u003cem\u003ep\u003c/em\u003e = 0.63). (B) Participants with sarcopenia. In the group of participants with sarcopenia, there was no significant correlation between the AHI and BMI (\u003cem\u003ep\u003c/em\u003e = 0.469). (C) Participants without sarcopenia. In the group of participants without sarcopenia, there was a positive correlation between the AHI and BMI (\u003cem\u003ep\u003c/em\u003e = 0.043). AHI, apnea‒hypopnea index; BMI, body mass index.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-4370108/v1/e8a2941cf4ee2ccadd230b9a.png"},{"id":57825049,"identity":"39336c15-ccb2-490a-9eda-f63c9e777d5d","added_by":"auto","created_at":"2024-06-06 06:50:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2124208,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4370108/v1/8cbc0a26-64a0-468d-9969-5483eaad8b04.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship between obstructive sleep apnea and obesity in sarcopenia and presarcopenia among elderly people","fulltext":[{"header":"Background","content":"\u003cp\u003eObstructive sleep apnea (OSA) is a disorder of repeated upper airway collapse during sleep that causes apnea or hypopnea to varying degrees. Intermittent oxygen desaturation, hypercapnia and sleep fragmentation contribute to excessive daytime sleepiness, which leads to reduced quality of life, impaired work performance, and increased risk of traffic accidents(\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). OSA is also associated with the development of several clinical comorbidities, including hypertension, cardiovascular disease, cardiac arrhythmia, pulmonary hypertension, stroke, cognitive impairment, and metabolic syndrome(\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdvanced age, male sex, obesity, and smoking have been proposed as risk factors for OSA(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The prevalence of OSA increases with age. Although a greater proportion of OSA was found in people aged 65 years and older, the trend of OSA incidence was not only a simple positive correlation with age in elderly people(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The etiology of OSA in the aged population might be different from that in the middle-aged population(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSarcopenia is a skeletal muscle disorder characterized by low muscle strength, low muscle mass and low physical performance, which contribute to recurrent falls, fractures and mortality(\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Muscle weakness may lead to increased hospitalization and health care costs(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Changes in lifestyle, physical activity, nutritional conditions, hormonal status and chronic metabolic disease with age lead to the development of sarcopenia(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence and severity of both OSA and sarcopenia increase with increasing age(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). One of the pathogenic mechanisms associated with OSA, sarcopenia and sarcopenia is poor upper airway muscle function, which may induce upper airway collapse(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). However, few studies have evaluated the interaction between age, OSA and sarcopenia. Our study aimed to investigate the relationships among OSA, obesity and sarcopenia in an aged population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eWe invited healthy adults aged more than or equal to 60 years old to join the Integrated Systematic Data of Geriatric Medicine to Explore the Solution for Healthy Aging (ISD-HA) study between September 2019 and October 2020 during their general medical examination at Chang Gung Health and Culture Village in Taoyuan city or Songshan District in Taipei city. The inclusion criteria were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) visited Chang Gung Memorial Hospital at least once within 1 year before recruitment; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) stayed in Taiwan for more than 180 days within 1 year before recruitment. The exclusion criteria were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) had clinical evidence of severe abnormalities in any major organ system; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) had a medical history of severe autoimmune disease; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) were receiving cancer therapy at the time of recruitment; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) had active infection with antibiotic treatment within one month of recruitment; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) were diagnosed with dementia or major depressive disorder; and (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) were too frail to stand or walk.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eDemographics were collected from the electronic medical records of our hospital or statements of the participants. We obtained demographic information, including age, sex, body height, body weight, body mass index (BMI), and medical history (including hypertension, hyperlipidemia, diabetes mellitus, osteoporosis, osteoarthritis, chronic obstructive pulmonary disease, chronic kidney disease and malignancy). The study was approved by the Institutional Review Board of Chang Gung Medical Foundation, Taiwan (IRB approval number: 201900702A3). The study procedures followed the Declaration of Helsinki. All participants provided written informed consent. All personal information was encrypted in a database and anonymized, so there was no breach of privacy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSleep assessments\u003c/h2\u003e \u003cp\u003eObjective sleep assessment was performed with a single night of standardized in-home polysomnography (PSG) using a portable monitoring system (Philips Alice 6 lDe; Philips Health care, Andover, MD, USA). Sleep stages were scored by a certificated sleep technologist and an experienced sleep specialist according to the established criteria(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The time spent in each sleep stage, total sleep time, total awake time, sleep efficiency and sleep onset latency were recorded. OSA severity is quantified according to the apnea\u0026ndash;hypopnea index (AHI), the number of apnea or hypopnea events recorded per hour of sleep(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). An AHI score of 5 to 15 events per hour was defined as mild OSA, 15 to 30 events per hour was defined as moderate OSA, and \u0026ge;\u0026thinsp;30 events per hour was defined as severe OSA(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of sarcopenia\u003c/h2\u003e \u003cp\u003eHandgrip strength (kg) was measured by a hand dynamometer (Jamar\u0026reg; Plus\u0026thinsp;+\u0026thinsp;Digital Hand Dynamometer) to evaluate muscle strength. Gait speed was measured by the 4-meter walk test and is presented as the distance (m) per second. Appendicular skeletal muscle mass (ASM) was measured by bioelectrical impedance analysis (BIA), and the ASM index was calculated as the ASM divided by the square of the height. The Asian Working Group for Sarcopenia (AWGS) proposed that the cutoff value for low muscle strength was defined as a handgrip strength\u0026thinsp;\u0026lt;\u0026thinsp;28 kg for men and \u0026lt;\u0026thinsp;18 kg for women. Low physical performance was defined as a gait speed\u0026thinsp;\u0026lt;\u0026thinsp;1.0 m/s. Loss of muscle mass was defined as an ASM index\u0026thinsp;\u0026lt;\u0026thinsp;7.0 kg/m\u003csup\u003e2\u003c/sup\u003e in men and \u0026lt;\u0026thinsp;5.7 kg/m\u003csup\u003e2\u003c/sup\u003e in women(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The European Working Group on Sarcopenia in Older People (EWGSOP) and the AWGS both proposed that sarcopenia is characterized by a loss of skeletal muscle mass plus a loss of muscle strength and/or reduced physical performance(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The EWGSOP also proposed the concept of presarcopenia, which is characterized by a loss of skeletal muscle mass without an impact on muscle strength or physical performance(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eOur study aimed to evaluate whether there is a positive correlation between OSA and sarcopenia in people aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years. We also investigated the associations between OSA, age, sex and obesity. All the statistical analyses were performed using the statistics program IBM SPSS version 21.0 (SPSS, Inc., Chicago, IL, USA). A t test was used to compare the means between two groups. Linear regression was used to test the relationship between BMI and the AHI to determine the changes in BMI with the severity of OSA. A \u003cem\u003ep\u003c/em\u003e value of 0.05 or less was considered to indicate statistical significance, and all the data are expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SEM.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 112 participants were initially included, 16 of whom were excluded because they were too frail to complete the assessment of sarcopenia. The demographic data of the 96 final participants are summarized in Table\u0026nbsp;1. Considering the small number of sarcopenia participants and the pathophysiology of OSA, we included presarcopenia participants in the sarcopenia group. Body weight, BMI, incidence of OSA, ASM index and handgrip strength were significantly different between the participants with and without sarcopenia (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004, respectively; Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe relationship between the severity of OSA and age in different sex groups.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe relationship between the AHI and age in elderly individuals is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean AHI increased with age, and the peak AHI was observed among the participants aged between 70 and 80 years. However, it decreased among those aged above 80 years (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). The trend of correlation between the AHI and age in the female participants was similar to that in the whole participants; nonetheless, the AHI decreased with age in the male participants. Among those aged between 60 and 70 years, the male participants had a greater AHI than did the female participants (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.049, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eThe relationship between obesity and age in different sex groups\u003c/h2\u003e \u003cp\u003eThe relationship between BMI and age is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. BMI increased with age among the participants aged between 60 and 70 years and between 70 and 80 years but decreased among those aged older than 80 years (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Among those aged between 60 and 70 years, male participants had a higher BMI (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eThe relationship between the incidence of sarcopenia and age in elderly individuals.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe proportion of patients with sarcopenia increased with age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). Among those aged between 60 and 70 years and between 70 and 80 years, the proportion of patients with sarcopenia was greater among the female participants (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048, respectively; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB). Among those aged above 80 years, the proportion of females with sarcopenia was close to that of males.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCorrelations between the AHI and BMI in elderly individuals with or without sarcopenia\u003c/h2\u003e \u003cp\u003eThe AHI was not correlated with BMI in any of the participants (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.63, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA). Taking sarcopenia into account, the correlation between the AHI and BMI was also unremarkable (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB). Nevertheless, in those without sarcopenia, a positive correlation was observed between the AHI and BMI (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC, p\u0026thinsp;=\u0026thinsp;0.043). Therefore, sarcopenia is a confounding factor when exploring the relationship between OSA and obesity.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, both the severity of OSA and obesity increased with age; moreover, the peak values were both in the group aged 70\u0026ndash;80 years. The AHI increased later in the female participants. The prevalence of sarcopenia increased with increasing age in both males and females. Obesity is not positively correlated with the severity of OSA. However, in the group without sarcopenia, the severity of OSA increased with increasing obesity.\u003c/p\u003e \u003cp\u003eIn our study, there was no significant correlation between the severity of OSA and BMI. This result is different from previous studies suggesting that obesity is an important risk factor for OSA(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). However, in the group without sarcopenia, there was a positive correlation between the severity of OSA and BMI. This could be explained by the likelihood of sarcopenia being inversely associated with BMI in elderly individuals(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). A British cohort study demonstrated that greater gains in BMI are associated with greater muscle mass(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The phenomenon of increased lean muscle along with fat mass probably contributed to this result(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Another cross-sectional study revealed that in nonobese individuals, upper body obesity significantly increased the frequency of OSA(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In our study, we did not investigate the impact of upper body obesity on OSA, which may influence the relationship between OSA and obesity. One study in Brazil revealed that a high risk of OSA was associated with low muscle mass and low muscle strength among obese participants(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In our study, the number of individuals with low muscle strength was too low to investigate the correlation with OSA.\u003c/p\u003e \u003cp\u003eSome previous studies have demonstrated that the prevalence of sarcopenia increases with age(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), while others have shown the opposite results(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The prevalence of sarcopenia varies when different definitions and cutoff values are used(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In Japan, a study with 1882 participants revealed a positive correlation between sarcopenia and advanced age(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Another study in China also reported similar results(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Considering the small number of sarcopenia participants who met the criteria of the AWGS and the pathophysiology of OSA, which is correlated with changes in the muscle and fat proportions of the upper airway and muscle tone, we included presarcopenia participants in the sarcopenia group(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In our study, the proportion of sarcopenia increased with age; moreover, the prevalence in women was greater than that in men. These results are consistent with other studies in Japan and China(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The close living environment and similar lifestyles likely contributed to this result.\u003c/p\u003e \u003cp\u003eA previous study showed that the severity of OSA increased with increasing age(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Fietze et al. demonstrated that the AHI is significantly greater for participants aged 60 years or older than for participants under 60 years old(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). These findings are consistent with our study. Nonetheless, in our study, the severity of OSA did not follow this trend in participants aged above 80 years. Gabbay et al. conducted a retrospective study with 23806 participants between 2000 and 2009(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). A plateau in the AHI was found for participants aged between 70 and 75 years, especially males. This demonstration was similar to our results. Moderate-to-severe OSA is associated with an increased risk of all-cause mortality with increasing age, which may lead to a healthy survival effect(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). According to our study design, we excluded people with severe major organ dysfunction and poor performance status. The above factors may contribute to selection bias. Moreover, few studies have investigated adults aged above 80 years independently(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). However, further studies are needed to confirm our results.\u003c/p\u003e \u003cp\u003eThe severity of OSA is greater in males than in females; moreover, Fietze et al. and Gabbay et al. both demonstrated that the AHI increases significantly in females aged greater than 50\u0026ndash;59 years(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). In our study, the AHI was also greater in the male group than in the female group and increased significantly with increasing age between the females aged 60 and 70 years and between the females aged 70 and 80 years. The phenomenon of a delayed increase in the severity of OSA in the female group is consistent with the findings of a previous study, which might be due to the diminished protective effect of gonadal hormones on OSA(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Changes in serum gonadal hormone levels may contribute to the redistribution of body fat to central regions and the loss of lean muscle mass with a proportional increase in fat mass(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, the incidence of obesity increases with increasing age from 20 years of age, reaches a peak between the ages of 50 and 65 years of age, and then declines thereafter(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). The prevalence of obesity in females was greater than that in males in all age groups. Haslam et al. investigated the prevalence of obesity by age and sex in subregions of the world and demonstrated that the proportion of obese individuals increases after 15 to 29 years of age and reaches a peak between 60 and 69 years of age in China and Vietnam(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). The incidence of obesity is slightly greater in females than in males; however, the trend of the curve is similar in both males and females(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). In our study, the prevalence of obesity was greater in males than in females, which is in contrast with the findings of previous studies(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). However, a cross-sectional study demonstrated a slightly greater BMI in males than in females in southern China(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). This phenomenon is likely related to their similar lifestyles and ethnicities.\u003c/p\u003e \u003cp\u003eThere were several inherent limitations in our study. First, the number of participants with sarcopenia was small. Therefore, we included participants with presarcopenia in the sarcopenia group. The different definitions led to different results compared with those of previous studies. Second, we did not record data on upper body obesity, which likely influenced the severity of OSA. Third, the exclusion criteria of our study may have contributed to selection bias. Considering that people with severe major organ dysfunction and poor performance status may have different results when investigating the relationships among age, OSA, obesity and sarcopenia.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, the severity of OSA and obesity and the prevalence of sarcopenia increased with increasing age. The severity of OSA increased later in females, which is likely correlated with postmenopause. Sarcopenia and low muscle mass are confounding factors when evaluating the relationship between OSA and obesity.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eobstructive sleep apnea\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePSG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epolysomnography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAHI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eapnea-hypopnea index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eappendicular skeletal muscle mass\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBIA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebioelectrical impedance analysis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAWGS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAsian Working Group for Sarcopenia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEWGSOP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEuropean Working Group on Sarcopenia in Older People\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out in accordance with the principles of the Declaration of Helsinki and was approved by the Ethics Review Committee of Chang Gung Medical Foundation (approval number: 201900702A3). Informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by grant CORPG3J0371 \u0026amp; CMRPG3J1931 from Chang Gung Memorial Hospital. The sponsors only provided financial support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLi-Pang Chuang, Ning-Hung Chen and Ji-Tseng Fang contributed to the conception and design of the study. Shih-Wei Huang, Wen-Jui Chang, and Pi-Hung Tung analysed and interpreted the data. Shih-Wei Huang and Li-Pang Chuang drafted the manuscript. Ting-Wei Liao and Geng-Hao Liu provided the study materials and selected patients. Shih-Wei Lin and Han-Chung Hu collected and assembled the data. All authors read and approved the final manuscript and have agreed to be personally accountable for the author\u0026apos;s own contributions, and to ensure that questions related to the accuracy or integrity of any part of the work are addressed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the investigators and members of the Integrating Systematic Data\u003c/p\u003e\n\u003cp\u003eof Geriatric Medicine to Explore the Solution for Health Aging Study from Formosa Biomedical Technology Corporation and Chang Gung Medical Foundation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGottlieb DJ, Punjabi NM. Diagnosis and Management of Obstructive Sleep Apnea: A Review. 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Am J Med. 2006;119(1):e729\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSleep-related breathing. disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22(5):667\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020;21(3):300\u0026ndash;e72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMirrakhimov AE, Sooronbaev T, Mirrakhimov EM. Prevalence of obstructive sleep apnea in Asian adults: a systematic review of the literature. BMC Pulm Med. 2013;13:10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFernandes JFR, Barreto Silva MI, Loivos CP, Menna Barreto APM, Meira VDS, Kaiser SE, et al. Obstructive sleep apnea in non-dialyzed chronic kidney disease patients: Association with body adiposity and sarcopenia. Nutrition. 2019;57:282\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan P, Kang L, Guo Q, Wang J, Zhang W, Shen S, et al. Prevalence and Factors Associated With Sarcopenia in Suburb-dwelling Older Chinese Using the Asian Working Group for Sarcopenia Definition. J Gerontol Biol Sci Med Sci. 2016;71(4):529\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCooper R, Hardy R, Bann D, Aihie Sayer A, Ward KA, Adams JE, et al. Body mass index from age 15 years onwards and muscle mass, strength, and quality in early old age: findings from the MRC National Survey of Health and Development. J Gerontol Biol Sci Med Sci. 2014;69(10):1253\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang X, Bi P, Kuang S. Fighting obesity: When muscle meets fat. Adipocyte. 2014;3(4):280\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSzlejf C, Suemoto CK, Drager LF, Griep RH, Fonseca MJM, Diniz M, et al. Association of sleep disturbances with sarcopenia and its defining components: the ELSA-Brasil study. Braz J Med Biol Res. 2021;54(12):e11539.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVolpato S, Bianchi L, Cherubini A, Landi F, Maggio M, Savino E, et al. Prevalence and clinical correlates of sarcopenia in community-dwelling older people: application of the EWGSOP definition and diagnostic algorithm. J Gerontol Biol Sci Med Sci. 2014;69(4):438\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBastiaanse LP, Hilgenkamp TI, Echteld MA, Evenhuis HM. Prevalence and associated factors of sarcopenia in older adults with intellectual disabilities. Res Dev Disabil. 2012;33(6):2004\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetermann-Rocha F, Balntzi V, Gray SR, Lara J, Ho FK, Pell JP, et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2022;13(1):86\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamada M, Nishiguchi S, Fukutani N, Tanigawa T, Yukutake T, Kayama H, et al. Prevalence of sarcopenia in community-dwelling Japanese older adults. J Am Med Dir Assoc. 2013;14(12):911\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu X, Li X, Xu M, Zhang Z, He L, Li Y. Sarcopenia prevalence and associated factors among older Chinese population: Findings from the China Health and Retirement Longitudinal Study. PLoS ONE. 2021;16(3):e0247617.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePinilla L, Santamaria-Martos F, Ben\u0026iacute;tez ID, Zapater A, Targa A, Mediano O, et al. Association of Obstructive Sleep Apnea with the Aging Process. Ann Am Thorac Soc. 2021;18(9):1540\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGabbay IE, Lavie P. Age- and gender-related characteristics of obstructive sleep apnea. Sleep Breath. 2012;16(2):453\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarshall NS, Wong KK, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort. J Clin Sleep Med. 2014;10(4):355\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKapsimalis F, Kryger MH. Gender and obstructive sleep apnea syndrome, part 2: mechanisms. Sleep. 2002;25(5):499\u0026ndash;506.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. 2019;92:6\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaslam DW, James WP. Obes Lancet. 2005;366(9492):1197\u0026ndash;209.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu L, Huang X, You C, Li J, Hong K, Li P, et al. Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in southern China. PLoS ONE. 2017;12(9):e0183934.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"136%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eTable 1. Demographics of the participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eDemographics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003eTotal, n = 96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003eSarcopenia, n = 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003eNonsarcopenia, n = 71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Male, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e42(43.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e7(28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e35(49.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Female, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e54(56.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e18(72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e36(50.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eAge, years, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e73.3 \u0026plusmn; 7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e75.3 \u0026plusmn; 7.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e72.7 \u0026plusmn; 6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eHeight, cm, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e160.2 \u0026plusmn; 7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e158 \u0026plusmn; 7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e160.1 \u0026plusmn; 7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eWeight, kg, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e60.9 \u0026plusmn; 10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e51.9 \u0026plusmn; 7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e64.1 \u0026plusmn; 10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e23.6 \u0026plusmn; 3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e20.7 \u0026plusmn; 2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e24.7 \u0026plusmn; 3.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eMedical history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Hypertension, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e33(34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e7(28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e26(36.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.435\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Hyperlipidemia, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e33(34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e11(44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e22(31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Diabetes mellitus, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e15(15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e2(8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e13(18.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Osteoporosis, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e7(7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e4(16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e3(4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Osteoarthritis, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e8(8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e1(4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e7(9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Chronic obstructive pulmonary disease, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e6(6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e3(12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e3(4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Chronic kidney disease, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e2(2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e2(2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Malignancy, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e5(5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e1(4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e4(5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eObstructive sleep apnea, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e77(80.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e16(64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e61(85.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; AHI, events/hour, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e20.1 \u0026plusmn; 14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e16.4 \u0026plusmn; 11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e21.2 \u0026plusmn; 15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Mild, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e28(29.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e5(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e23(32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Moderate, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e25(26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e7(28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e18(25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Severe, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e24(25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e4(16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e20(28.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eASM index, kg/m\u003csup\u003e2\u003c/sup\u003e, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e6.8 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e5.8 \u0026plusmn; 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e7.2 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eHandgrip strength, kg, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e28.2 \u0026plusmn; 8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e24.1 \u0026plusmn; 7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e29.6 \u0026plusmn; 8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eGait speed, m/s, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e1.1 \u0026plusmn; 0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e1.1 \u0026plusmn; 0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\n \u003cp\u003e1.2 \u0026plusmn; 0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.55555555555556%\" valign=\"top\"\u003e\n \u003cp\u003eBMI, Body Mass Index; AHI, Apnea-Hypopnea Index; ASM index, appendicular skeletal muscle mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.080808080808081%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"obstructive sleep apnea, obesity, sarcopenia, muscle mass, elderly","lastPublishedDoi":"10.21203/rs.3.rs-4370108/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4370108/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eObstructive sleep apnea (OSA), obesity and sarcopenia are issues have been attracting increasing attention. The associations between OSA, obesity and sarcopenia have rarely been investigated in previous studies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e We invited healthy adults aged 60 years or older who lived in Chang Gung Health and Culture Village in Taoyuan or Songshan District in Taipei city between September 2019 and October 2020 to participate in this study. Demographics were collected from the electronic medical records of our hospital or statements of the participants. Full-channel home polysomnography (PSG), handgrip strength, the 4-meter walk test, and bioelectrical impedance analysis (BIA) were used to evaluate OSA and sarcopenia.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 96 participants were included. Considering the small number of sarcopenia participants and the pathophysiology of OSA, we included presarcopenia participants in the sarcopenia group. The severity of OSA and BMI increased with age, and the peak values were observed between 70 and 80 years of age. A delayed increase in the severity of OSA in females was observed. Males were more likely to be obese than females. The prevalence of sarcopenia increased with age and was greater in females. In those without sarcopenia, a positive correlation was observed between the severity of OSA and obesity (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.043).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eSarcopenia and low muscle mass may be confounding factors when evaluating the relationship between OSA and obesity in elderly individuals.\u003c/p\u003e","manuscriptTitle":"Relationship between obstructive sleep apnea and obesity in sarcopenia and presarcopenia among elderly people","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-16 18:01:46","doi":"10.21203/rs.3.rs-4370108/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e63f4143-eccd-4549-b849-9dfbf29633f5","owner":[],"postedDate":"May 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-06T06:41:54+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-16 18:01:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4370108","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4370108","identity":"rs-4370108","version":["v1"]},"buildId":"ApUGefWb6u5IBVtyqm6d5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}