The Role of Total Body Fluid in Pulmonary Tuberculosis Patients with Risk of Obstructive Sleep Apnea
Main Article Content
Abstract
Background: Pulmonary Tuberculosis (TB) patients are vulnerable to sleep-disordered breathing, particularly Obstructive Sleep Apnea (OSA), due to chronic pulmonary inflammation, structural lung damage, and systemic metabolic disturbances. Alteration of total body fluid, especially extracellular fluid accumulation, may contribute to upper airway collapsibility through rostral fluid shift during sleep. However, evidence regarding the relationship between total body fluid and OSA risk in TB patients remains limited.
Aim: An analytic observational study with a cross-sectional design was conducted on 85 TB patients selected using total sampling. OSA risk was assessed using the STOP-BANG questionnaire and categorized as mild, moderate, and severe. Total body water was measured using Bioelectrical Impedance Analysis (BIA) and classified as low, normal, or high. Data were analyzed using the Chi-Square test with a significance level of p < 0.05.
Results: The prevalence of OSA risk was high, with 34.1% mild, 32.9% moderate, and 32.9% severe. Most respondents had normal body fluid (68.2%), while 23.5% had high fluid levels. A significant association was found between OSA risk and total body fluid (p = 0.000). Patients with severe OSA showed a markedly higher proportion of fluid overload (46.6%) compared to those with mild OSA (10.3%).
Conclusion: There is a significant relationship between OSA risk and total body fluid in TB patients. Higher OSA severity is associated with increased likelihood of fluid overload. Assessment of hydration status should be included in TB management to reduce the risk of respiratory complications and sleep disturbances.
Keywords: Pulmonary Tuberculosis, obstructive sleep apnea, total body fluid, bioelectrical impedance analysis, STOP-BANG.
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
A. Nugraha, M. A. R., and T. P. (2016). Rancang Bangun Alat Pengukur Persentase Lemak Tubuh dengan Metode Whole Body Measurement Bioelectrical Impedance Analysis (BIA) Empat Elektroda Berbasis Mikrokontroler Atmega 32. Transient: Jurnal Ilmiah Teknik Elektro, 5(2), 157–165.
Alatas F, Aniwidyaningsih W, Purnowo A, Nurrasyidah I, Rahmania A, Setiawan H W, S. N. A. (2024). Tata Laksana Tuberkulosis Endobronkial dengan Obstruksi Jalan Napas Sentral. In Pedoman Penatalaksanaan di Indonesia. Perhimpunan Dokter Paru Indonesia (PDPI).
Arnardóttir, E. S., Bjórnsdóttir, E., Ólafsdóttir, K. A., Benediktsdóttir, B., & Gislason, T. (2016). Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms. European Respiratory Journal, 47(1), 194–202. https://doi.org/10.1183/13993003.01148-2015
Azzahra, S. S. (2019). Obstructive Sleep Apnea (OSA) Sebagai Faktor Resiko Hipertensi. Jurnal Ilmiah Kesehatan Sandi Husada, 10(2), 321–324. https://doi.org/10.35816/jiskh.v10i2.180
Bakker, J., Campbell, A., & Neill, A. (2010). Randomized Controlled Trial Comparing Flexible and Continuous Positive Airway Pressure Delivery: Effects on Compliance, Objective and Subjective Sleepiness and Vigilance. In SLEEP (Vol. 33, Issue 4).
Cahyono A, Hermani B, Mangunkusumo E, P. R. (2017). Hubungan Obstructive Sleep Apnea dengan Penyakit Sistem Kardiovaskuler. ORLI, 41(1), 37–45.
Chuang, F.-C., Lin, S.-W., Chuang, C.-H., Lee, C.-S., & Lin, C.-Y. (2025). Investigating the association between obstructive sleep apnea and fluid status by using bioimpedance analysis. Scientific Reports, 15(1)(Article 17435), https://doi.org/10.1038/s41598-025 77411-5. https://doi.org/10.1038/s41598-025%0A77411-5
Ding, N., Lin, W., Zhang, X. L., Ding, W. X., Gu, B., Ni, B. Q., Zhang, W., Zhang, S. J., & Wang, H. (2014). Overnight fluid shifts in subjects with and without obstructive sleep apnea. Journal of Thoracic Disease, 6(12), 1736–1741. https://doi.org/10.3978/j.issn.2072-1439.2014.11.19
Dokter, P., & Indonesia, P. (2021). Pedoman Diagnosis dan Penatalaksanaan TB di Indonesia.
Faverio, P., Zanini, U., Monzani, A., Parati, G., Luppi, F., Lombardi, C., & Perger, E. (2023). Sleep-Disordered Breathing and Chronic Respiratory Infections: A Narrative Review in Adult and Pediatric Populations. In International Journal of Molecular Sciences (Vol. 24, Issue 6). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/ijms24065504
Gottlieb, D. J., & Punjabi, N. M. (2020). Diagnosis and Management of Obstructive Sleep Apnea. JAMA, 323(14), 1389. https://doi.org/10.1001/jama.2020.3514
Houben, R. M. G. J., & Dodd, P. J. (2016). The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling. PLoS Medicine, 13(10). https://doi.org/10.1371/journal.pmed.1002152
I. Danindra, A. A. S. and K. T. (2019). Hubungan Obstructive Sleep Apnea Dengan Profil Lipid Mahasiswa Fk Undip. Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal), 8, 245–254.
Javaheri, S., Barbe, F., Campos-Rodriguez, F., Dempsey, J. A., Khayat, R., Javaheri, S., Malhotra, A., Martinez-Garcia, M. A., Mehra, R., Pack, A. I., Polotsky, V. Y., Redline, S., & Somers, V. K. (2017). Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. In Journal of the American College of Cardiology (Vol. 69, Issue 7, pp. 841–858). Elsevier USA. https://doi.org/10.1016/j.jacc.2016.11.069
Joshua E. Brinkman, Bradley Dorius, & Sandeep Sharma. (2023). Physiology, Body Fluids. Reasure Island (FL): StatPearls Publishing.
Jusak Nugraha, F. R. M. S. P. E. S. S. S. L. A. (2020). Analisis Cairan Tubuh dan Urine. Airlangga University Press. https://books.google.co.id/books?id=smvIDwAAQBAJ&printsec=frontcover&hl=id#v=onepage&q&f=false
Kemenkes. (2024). Cegah dan Obati TB dengan Terapi Pencegahan Tuberkulosis. https://kemkes.go.id/id/rilis-kesehatan/cegah-dan-obati-tb-dengan-terapi-pencegahan-tuberkulosis
Kim, S., Cho, E., Lim, S., & Park, J. (2024). Prevalence of high risk for obstructive sleep apnea in adults with airflow limitation: A nationwide population-based study. Clinical Respiratory Journal, 18(9), 345–353. https://doi.org/10.1111/crj.14487
Layek, A. (2025). A narrative review on challenges faced by patients with active tuberculosis and chronic obstructive pulmonary disease. Journal of Taibah University Medical Sciences, 22(2), 157–165. https://doi.org/10.1016/j.jtumed.2024.11.006
Mannarino, M. R., Di Filippo, F., & Pirro, M. (2012). Obstructive sleep apnea syndrome. In European Journal of Internal Medicine (Vol. 23, Issue 7, pp. 586–593). Elsevier B.V. https://doi.org/10.1016/j.ejim.2012.05.013
Montalvo, R., Bernabe-Ortiz, A., Kirwan, D. E., & Gilman, R. H. (2018). Bioimpedance Markers and Tuberculosis Outcome Among HIV-Infected Patiens. African Journal of Infectious Diseases, 12(2), 47–54. https://doi.org/10.21010/ajid.v12i2.8
Pang, K. P., Kishore, S., Kit, J. C. C., Pang, E. B., Chan, Y. H., Keat, S. J., & Rotenberg, B. (2016). Pang-Rotenberg sign--snoring surgery prognosticator: A prospective clinical trial of 153 patients. The Laryngoscope, 126(1), 260–265. https://doi.org/10.1002/lary.25392
Patel, A. B., & Hinni, M. L. (2013). Tuberculous retropharyngeal abscess presenting with symptoms of obstructive sleep apnea. European Archives of Oto-Rhino-Laryngology, 270(1), 371–374. https://doi.org/10.1007/s00405-012-2227-9
Riha, R. L. (2021). Defining obstructive sleep apnoea syndrome: A failure of semantic rules. In Breathe (Vol. 17, Issue 3). European Respiratory Society. https://doi.org/10.1183/20734735.0082-2021
Sasongko, P. V., Yunika, K., & Andhitara, Y. (2016). Faktor-faktor yang Berhubungan dengan TerjadinyaObstructive Sleep Apnea Syndrome (OSAS) pada PasienStroke Iskemik. In Yovita Andhitara JKD (Vol. 5, Issue 4).
Setiati, S. (Ed.). (2014). Buku Ajar Penyakit Dalam (Edisi Keenam). InternalPublishing.
Setyaningrum, S. D., Yunika, K., & Andhitara, Y. (2017). Hubungan antara Fungsi Kognitif dengan Riwayat Obstructive Sleep Apnea Syndrome (OSAS) pada Pasien Pasca Stroke Iskemik di RSUP dr Kariadi. Yovita Andhitara JKD, 6(2), 1237–1243.
Slowik JM, Sankari A, C. J. (2024). Obstructive Sleep Apnea. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459252/
Tan, A., Yin, J. D. C., Tan, L. W. L., van Dam, R. M., Cheung, Y. Y., & Lee, C.-H. (2016). Predicting obstructive sleep apnea using the STOP-Bang questionnaire in the general population. Sleep Medicine, 27–28, 66–71. https://doi.org/10.1016/j.sleep.2016.06.034
Vadakkan Devassy, T., PS, N., Sharma, D., & Thomas, A. M. (2022). Sleep disorders in elderly population suffering from TB and respiratory diseases. Indian Journal of Tuberculosis, 69, S272–S279. https://doi.org/10.1016/j.ijtb.2022.10.019
White, L. H., & Bradley, T. D. (2013). Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea. In Journal of Physiology (Vol. 591, Issue 5, pp. 1179–1193). https://doi.org/10.1113/jphysiol.2012.245159
WHO. (2024). Global tuberculosis report 2021. World Health Organization. https://www.who.int/publications/i/item/9789240037021
WHO. (2022). Global tuberculosis report 2022. https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2022
World Health Organization. (2017). Guidelines for treatment of drug-susceptible tuberculosis and patient care.
Zhang, W., Wu, D., & Gao, H. (2024). The co-existence of fluid overload and high risk of obstructive sleep apnea is associated with worse clinical outcomes. Medicine (Baltimore), 103(44)(e37538). https://doi.org/10.1097/MD.0000000000037538