30
Assessment/Diagnosis
➤ Diagnostic Criteria
• The diagnosis of OSA is established through objective sleep testing,
with polysomnography serving as the gold standard for measuring
the apnea-hypopnea index. Home sleep apnea testing is suitable for
certain uncomplicated cases. The apnea-hypopnea index defines
OSA severity as mild (5–14.9 events/h), moderate (15–29.9 events/h),
and severe (≥30 events/h). Clinical symptoms, such as excessive
sleepiness and hypertension, are integrated with apnea-hypopnea
index values to inform treatment decisions. Although emerging
biomarkers, such as adipokine profiles, are being studied, they are
not yet part of standard diagnostic practice.
Gastroesophageal Reflux Disease
➤ In the presence of obesity, GERD arises from visceral adiposity-
induced intraabdominal pressure that disrupts lower esophageal
sphincter function and esophagogastric anatomy (often worsened
by hiatal hernia). Hormonal and inflammatory disturbances further
impair mucosal defenses, leading to increased esophageal injury
even in the absence of typical symptoms.
Risk Factors
• Central adiposity, as measured by waist-to-hip ratio, is a stronger
predictor of GERD than BMI, with each 3.5 kg/m² increase in BMI
associated with a 2.7-fold increase in risk. Modif iable contributors
include dietary habits, particularly high intake of ultra-processed
fats and ref ined carbohydrates, which reduce lower esophageal
sphincter pressure and delay gastric emptying; lifestyle factors such
as smoking, alcohol consumption, and late-night eating; the use
of certain medications (e.g., nonsteroidal anti-inflammatory drugs,
nitrates, glucagon-like peptide-1 receptor agonists, and some
calcium channel blockers); and sleeve gastrectomy. Nonmodif iable
risks include male sex and postmenopausal status, attributed
to hormonal changes and central fat distribution, genetic
predisposition, including familial clustering of hiatal hernia and
higher prevalence in White populations, and craniofacial structural
abnormalities like retrognathia, which can impair esophagogastric
junction function.
