Obstructive Sleep Apnea Risk, Body Fat, and BMI in Pulmonary Tuberculosis Patients
Main Article Content
Abstract
Background: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder significantly associated with body composition abnormalities. Pulmonary tuberculosis (TB) causes structural lung damage that may predispose patients to sleep disturbances, yet the relationship between OSA and body composition in TB populations remains inadequately explored. Aim: This study aimed to investigate the association between OSA severity and body composition measures including total body fat, visceral fat, subcutaneous fat, and body mass index (BMI) among pulmonary TB patients.
Methods: A cross-sectional analytical observational study was conducted at RS Ibnu Sina YW-UMI Makassar from August to November 2025. Eighty-five pulmonary TB patients were selected through purposive sampling. OSA risk was assessed using the STOP-BANG questionnaire, while body composition was measured using bioelectrical impedance analysis. Chi-square tests were performed to examine associations between variables with significance set at p<0.05.
Results: Significant associations were found between OSA severity and all body composition parameters: total body fat (p=0.004), visceral fat (p=0.000), subcutaneous fat (p=0.005), and BMI (p=0.000). Severe OSA showed highest prevalence of very high total body fat (46.4%), elevated visceral fat (60.7%), high subcutaneous fat (57.1%), and obesity grade 1 (35.7%). Moderate OSA occurred predominantly in underweight patients (50.0%), revealing a U-shaped BMI-OSA relationship.
Conclusions: Visceral fat demonstrated the strongest association with OSA severity in pulmonary TB patients. Comprehensive body composition assessment provides superior clinical utility compared to BMI alone for OSA risk stratification.
Implementation. These findings support integrating body composition monitoring into TB management protocols and provide foundation for personalized interventions addressing both infectious disease treatment and metabolic health optimization
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Avishek Layek, & Tejas Menon Suri. (2025). Tuberculosis and sleep – An underexplored association? Indian Journal of Tuberculosis, 27(1), S91–S93.
Cahaya, G., Berawi, K. N., & Mustofa, S. (2019). Obesitas Meningkatkan Risiko Obstructive Sleep Apnea pada Laki-laki Dewasa. Majority, 8(2), 161.
Chuang, Y. M., Liu, W. Te, Tsai, C. Y., Lin, Y. C., Ho, K. F., Chuang, K. J., & Chuang, H. C. (2025). Associations between body composition, hydration status, and sleep architecture in obstructive sleep apnea. Frontiers in Endocrinology, 16. https://doi.org/10.3389/fendo.2025.1666026
Esmaeili, N., Gell, L., Imler, T., Hajipour, M., Taranto-Montemurro, L., Messineo, L., Stone, K. L., Sands, S. A., Ayas, N., Yee, J., Cronin, J., Heinzer, R., Wellman, A., Redline, S., & Azarbarzin, A. (2025). The relationship between obesity and obstructive sleep apnea in four community-based cohorts: an individual participant data meta-analysis of 12,860 adults. EClinicalMedicine, 83. https://doi.org/10.1016/j.eclinm.2025.103221
Fitrah Ahmad, I., Pandu Wiriansya, E., Puspa Ratu, A., & Kasim, S. (2025). Tuberculosis Infection In Women. In International Journal of Health and Pharmaceutical. https://ijhp.net
Gao, L., Wen, Y., Guo, K., Li, R., Mao, M., Feng, S., & Wang, X. (2025). Research trends and hot spots in obesity-induced pain: A bibliometric analysis of the last 20 years. In IBRO Neuroscience Reports (Vol. 18, pp. 311–322). Elsevier B.V. https://doi.org/10.1016/j.ibneur.2025.02.001
Kim, S. H., Sim, J. K., Choi, J. Y., Moon, J. Y., Lee, H., & Min, K. H. (2024). Prevalence of and factors associated with likely obstructive sleep apnea in individuals with airflow limitation. Frontiers in Medicine, 11. https://doi.org/10.3389/fmed.2024.1343372
Kritikou, I., Basta, M., Tappouni, R., Pejovic, S., Fernandez-Mendoza, J., Nazir, R., Shaffer, M. L., Liao, D., Bixler, E. O., Chrousos, G. P., & Vgontzas, A. N. (2013). Sleep apnoea and visceral adiposity in middle-aged male and female subjects. European Respiratory Journal, 41(3), 601–609. https://doi.org/10.1183/09031936.00183411
Kundel, V., Lehane, D., Ramachandran, S., Fayad, Z., Robson, P., Shah, N., & Mani, V. (2021). Measuring visceral adipose tissue metabolic activity in sleep apnea utilizing hybrid18f-fdg pet/mri: A pilot study. Nature and Science of Sleep, 13, 1943–1953. https://doi.org/10.2147/NSS.S327341
Liao, Z., Chen, Y., Wu, L., Huang, Y., Li, S., Liu, J., Zong, X., Tai, J., & Chen, F. (2024). Associations of Obstructive Sleep Apnea Risk with Obesity, Body Composition and Metabolic Abnormalities in School-Aged Children and Adolescents. Nutrients, 16(15). https://doi.org/10.3390/nu16152419
Locke, B. W., Lee, J. J., & Sundar, K. M. (2022). OSA and Chronic Respiratory Disease: Mechanisms and Epidemiology. In International Journal of Environmental Research and Public Health (Vol. 19, Number 9). MDPI. https://doi.org/10.3390/ijerph19095473
Messineo, L., Bakker, J. P., Cronin, J., Yee, J., & White, D. P. (2024). Obstructive sleep apnea and obesity: A review of epidemiology, pathophysiology and the effect of weight-loss treatments. In Sleep Medicine Reviews (Vol. 78). W.B. Saunders Ltd. https://doi.org/10.1016/j.smrv.2024.101996
Molnár, V., Lakner, Z., Molnár, A., Tárnoki, D. L., Tárnoki, Á. D., Kunos, L., & Tamás, L. (2022). The Predictive Role of Subcutaneous Adipose Tissue in the Pathogenesis of Obstructive Sleep Apnoea. Life, 12(10). https://doi.org/10.3390/life12101504
Mukhlis, M., & Bakhtiar, A. (2021). Obstructive Sleep Apneu (OSA), Obesitas Hypoventilation Syndrome (OHS) dan Gagal Napas.
Qian, Y., Perret, J. L., Hamilton, G. S., Abramson, M. J., Lodge, C. J., Bui, D. S., Ali, G. B., De Silva, A. P., Adams, R. J., Thompson, B. R., Erbas, B., Walters, E. H., Senaratna, C. V., & Dharmage, S. C. (2025). Early-to-Midlife Body Mass Index Trajectories and Obstructive Sleep Apnoea Risk 10 Years Later. Respirology, 30(5), 435–445. https://doi.org/10.1111/resp.70002
Sekizuka, H., Ono, Yoshiaki, Saitoh, T., & Ono, Yoshitaka. (2021). Visceral fat area by abdominal bioelectrical impedance analysis as a risk of obstructive sleep apnea a single-clinic retrospective case study. International Heart Journal, 62(5), 1091–1095. https://doi.org/10.1536/ihj.21-219
Shah, N. M., & Kaltsakas, G. (2023). Respiratory complications of obesity: from early changes to respiratory failure. In Breathe (Vol. 19, Number 1). European Respiratory Society. https://doi.org/10.1183/20734735.0263-2022
Xu, X., Xu, J., & Zhang, M. (2024). Association between metabolic score for visceral fat and obstructive sleep apnea: a cross-sectional study. Frontiers in Medicine, 11. https://doi.org/10.3389/fmed.2024.1480717
Yetim, M., Kalçık, M., Bekar, L., Karavelioğlu, Y., & Yılmaz, Y. A. (2025). Body Composition Analysis in Obstructive Sleep Apnea: A Cross-Sectional Study Using Bioelectrical Impedance Analysis. Clinical Respiratory Journal, 19(9). https://doi.org/10.1111/crj.70123
Zaffanello, M., Pietrobelli, A., Piacentini, G., Zoller, T., Nosetti, L., Guzzo, A., & Antoniazzi, F. (2025). Mapping the Fat: How Childhood Obesity and Body Composition Shape Obstructive Sleep Apnoea. In Children (Vol. 12, Number 7). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/children12070912