Clinical profile of patients with obstructive sleep apnea syndrome in a cardiology hospital

Cover Page

Abstract


Relevance. Obstructive sleep apnea syndrome (OSAS) is an important medical and social problem due to its high prevalence and impact on quality of life. The relationship between OSAS and cardiovascular pathology has been proven by many studies, which confirms the necessity for early diagnosis of OSAS and its treatment for the prevention of fatal and non-fatal events.
Aim: to study epidemiological and clinical profile of the patients referred by a cardiologist to a specialized sleep laboratory to verify the diagnosis of OSAS.
Materials and methods. Object of study – 527 patients aged 56.9±12.5 years who were hospitalized to the Myasnikov Clinical Cardiology Research Institute from 2016–2018 and had OSAS risk factors. Initially, complaints, medical history, anthropometric data were collected. As a screening survey, questionnaires were conducted using questionnaire scales. Verification of the diagnosis of OSAS and determination of the severity was carried out by cardiorespiratory or respiratory monitoring. Subsequently, 4 groups were formed depending on the presence and severity of OSAS.
Results. The prevalence of OSAS among patients in a cardiology hospital referred to a verification study was 88.6%. A comparative analysis of the groups revealed a progressive increase in the values of anthropometric indicators with increasing severity of OSAS. No differences were found between the groups by gender and daytime sleepiness on the Karolinska Sleepiness Scale. The average score on the Epworth sleepiness scale was statistically significantly lower only in the group of patients without OSAS when compared with the group with a severe degree of OSAS, and is comparable with the scores in the groups of mild and moderate degrees of OSAS. In a multivariate model of logistic regression, independent predictors of OSAS were identified as: age over 45 years, indications of loud intermittent snoring, frequent nightly urination, overweight or obesity. According to the results of assessing the incidence of various cardiovascular diseases in patients referred to the sleep laboratory, no significant differences were detected. At the same time, a significant difference was found in the frequency of obesity in patients with severe OSAS compared with other groups, as well as the frequency of type 2 diabetes mellitus or impaired glucose tolerance – when compared with groups without OSAS, and with mild OSAS. In one-factor logistic regression models, it was found that the likelihood of having a severe degree of OSAS increases with increasing both comorbidity and age.
Conclusions. High prevalence of OSAS in patients of a cardiological hospital, referred to a sleep laboratory for verification study, was confirmed. Considering the data that early diagnosis and treatment of OSAS can affect the course of both nosologies, the quality of life and prognosis of these patients, it is advisable to routinely screen and verify the diagnosis of OSAS in patients with cardiovascular diseases.


Full Text

Restricted Access

About the authors

E. M. Elfimova

National Medical Research Center for Cardiology

Email: alelitvin@yandex.ru
ORCID iD: 0000-0002-3140-5030

Russian Federation, Moscow

д.м.н., рук. лаб. апноэ сна, гл.н.с. отд. гипертонии, проф. отд. высшего и дополнительного профессионального образования; проф. каф. поликлинической терапии лечебного фак-та

O. O. Mikhailova

National Medical Research Center for Cardiology

Email: alelitvin@yandex.ru
ORCID iD: 0000-0002-3609-2504

Russian Federation, Moscow

к.м.н., мл.н.с. лаб. апноэ сна отд. гипертонии

N. T. Khachatryan

National Medical Research Center for Cardiology

Email: alelitvin@yandex.ru
ORCID iD: 0000-0002-0945-9665

Russian Federation, Moscow

аспирант отд. гипертонии ИКК им. А.Л. Мясникова

A. Yu. Litvin

National Medical Research Center for Cardiology; Pirogov Russian National Research Medical University

Author for correspondence.
Email: alelitvin@yandex.ru
ORCID iD: 0000-0001-5918-9969

Russian Federation, Moscow

д.м.н., рук. лаб. апноэ сна, гл.н.с. отд. гипертонии, проф. отд. высшего и дополнительного профессионального образования; проф. каф. поликлинической терапии лечебного фак-та

I. E. Сhazova

National Medical Research Center for Cardiology

Email: alelitvin@yandex.ru
ORCID iD: 0000-0002-9822-4357

Russian Federation, Moscow

акад. РАН, д.м.н., проф., директор НИИ клинической кардиологии им. А.Л. Мясникова, руководитель отд. гипертонии НИИ клинической кардиологии им. А.Л. Мясникова

References

  1. Phillipson E. Sleep apnea – a major public health problem. N Engl J Med. 1993;328:1271-3. doi: 10.1056/NEJM199304293281712
  2. Young T, Palta M, Dempsey J, et al. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. Wis- consin Medical J. 2009;108(5):246-9.
  3. Peppard P, Young T, Barnet J, et al. Increased prevalence of sleep-di- sordered breathing in adults. Am J Epidemiol. 2013;177(9):1006. doi: 10.1093/aje/kws342
  4. Jennum P, Soul A. Epidemiology of snoring and obstructive sleep apnoea in the Dannish population age 30–60. J Sleep Res. 1992;1(4):240-4. doi: 10.1111/j.1365-2869.1992.tb00045.x
  5. Lindberg E, Gislason T. Epidemiology of sleep-related obstructive bre- athing. Sleep Med Rev. 2000;4(5):411-433. doi: 10.1053/smrv. 2000.0118
  6. Аксенова А.В., Елфимова Е.М., Галицин П.В. и др. Значение ком- пьютерной пульсоксиметрии в практике врача-кардиолога. Систем- ные гипертензии. 2014;11(4):26-30 [Aksenova AV, Elfimova EM, Galitsin PV, et al. Role of the Pulse Oximetry in the cardiologist's prac- tice. Systemic Hypertension. 2014;11(4):26-30 (In Russ.)]. doi: 10.26442/2075-082X_11.4.26-30
  7. Parati G, Lombardi C, Hedner J, et al. Recommendations for the mana- gement of patients with obstructive sleep apnoea and hypertension. Eur Respir J. 2013;41(3):523-38. doi: 10.1183/09031936.00226711
  8. Teran-Santos J, Jimenez- Gomez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos Santander. N Engl J Med. 1999;340(11):847-51. doi: 10.1056/NEJM199903183401104
  9. Kryger M, Roth T, Dement W. Elsevier. Principles and practices of sleep medicine, sleep and cardiovascular disease: present and future. 6th edi- tion. Philadelphia. 2017.
  10. Drager L, McEvoy R, Barbe F, et al. Sleep Apnea and Cardiovascular Disease Lessons From Recent Trials and Need for Team Science. Cir- culation. 2017;136(19):1840-50. doi: 10.1161/CIRCULATIONAHA. 117.029400
  11. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagno- sed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705-6. doi: 10.1093/sleep/20.9.705
  12. Kryger M, Roth T, Dement W. Elsevier. Principles and practices of sleep medicine. Philadelphia. 2005.
  13. Lin C, Davidson T, Ancoli-Israel S. Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev. 2008;12(6):481- 96. doi: 10.1016/j.smrv.2007.11.003
  14. Tung P, Levitzky Y, Wang R, et al. Obstructive and Central Sleep Apnea and the Risk of Incident Atrial Fibrillation in a Community Cohort of Men and Women. J Am Heart Assoc. 2017;6(7):e004500. doi: 10.1161/JAHA.116.004500
  15. Sands S, Owens R. Congestive Heart Failure and Central Sleep Apnea. Critical Care Clinics. 2015;31(3):473-95. doi: 10.1016/j.ccc. 2015.03.005
  16. Blissitt P. Sleep-disordered breathing after stroke nursing implications.
  17. Stroke. 2017;48(3):e81-e84. doi: 10.1161/STROKEAHA.116.013087
  18. Bartels M. Fatigue in Cardiopulmonary Disease. Phys Med Rehabil Clin N Am. 2009;20(2):389-404. doi: 10.1016/j.pmr.2008.12.002
  19. Newman A, Spiekerman C, Enright P, et al. Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group. J Am Geriatrics Soc. 2000;48(2):115- 23. doi: 10.1111/j.1532-5415.2000.tb03901.x
  20. Bruno R, Palagini L, Gemignani A, et al. Poor sleep quality and resistant hypertension. Sleep Med. 2013;14(11):1157-63. doi: 10.1016/j.sleep.2013.04.020
  21. Spiegelhalder K, Scholtes C, Riemann D. The association between in- somnia and cardiovascular diseases. Nature and science of sleep. 2010;4(2):71-8. doi: 10.2147/nss.s7471
  22. Batool-Anwar S, Malhotra A, Forman J, et al. Restless legs syndrome and hypertension in middle-aged women. Hypertension. 2011;58(5):791-6. doi: 10.1161/HYPERTENSIONAHA.111.174037
  23. Floras J. Sleep Apnea in Heart Failure: implications of sympathetic ner- vous system activation for disease progression and treatment. Current Heart Fail Reports. 2005;2(4):212-7. doi: 10.1007/bf02696652
  24. Kauta S, Keenan B, Goldberg L, Schwab R. Diagnosis and treatment of sleep disordered breathing in hospitalized cardiac patients: a reduction in 30-day hospital readmission rates. J Clin Sleep Med. 2014;10(10):1051-9. doi: 10.5664/jcsm.4096
  25. Duran J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea-hypop- nea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001;163(3 Pt 1):685-9. doi: 10.1164/ajrccm.163.3.2005065
  26. Arzt M, Young T, Finn L, et al. Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Ar Int Med. 2006;166(16):1716-22. doi: 10.1001/archinte.166.16.1716
  27. Walsleben J, Kapur V, Newman AS et al. Sleep and reported daytime sleepiness in normal subjects: the Sleep Heart Health Study. Sleep. 2004;27(2):293-8. doi: 10.1093/sleep/27.2.293
  28. Gopal M, Sammel M, Pien G, et al. Investigating the associations bet- ween nocturia and sleep disorders in perimenopausal women. J Urol. 2008;180(5):2063-7. doi: 10.1016/j.juro.2008.07.050
  29. Moriyama Y, Miwa K, Tanaka H, et al. Nocturia in men less than 50 years of age may be associated with obstructive sleep apnea syndrome. Urology. 2008;71(6):1096-8. doi: 10.1016/j.urology.2008.02.038
  30. Malhotra A, White D. Obstructive sleep apnoea. Lancet.
  31. ;360(9328):237-45. doi: 10.1016/S0140-6736(02)09464-3
  32. Arnardottir E, Janson C, Bjornsdottir E, et al. Nocturnal sweating–a common symptom of obstructive sleep apnoea: the Icelandic sleep ap- noea cohort. BMJ Open. 2013;3(5):e002795. doi: 10.1136/bmjopen- 2013-002795
  33. Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Int Med. 1997;127(8 Pt 1):581-7. doi: 10.7326/0003-4819-127-8_part_1- 199710150-00001
  34. Pamidi S, Tasali E. Obstructive sleep apnea and type 2 diabetes: is there a link? Frontiers Neurol. 2012;3(126).eCollection. doi: 10.3389/fneur.2012.00126
  35. Байрамбеков Э.Ш., Певзнер А.В., Литвин А.Ю., Елфимова Е.М. Возможности диагностики и частота выявления синдрома обструк- тивного апноэ во время сна у больных с различными формами фиб- рилляции предсердий. Кардиологический вестник. 2016;11(2):34-41 [Bairambekov EhSh, Pevzner AV, Litvin AYu, Elfimova EM. Diagnostic capabilities and the frequency of detection of obstructive sleep apnea syndrome in patients with various forms of atrial fibrillation. Cardiology Bulletin. 2016;11(2):34-41 (In Russ.)].
  36. Курлыкина Н.В., Певзнер А.В., Литвин А.Ю. и др. Распространен- ность синдрома обструктивного апноэ сна у пациентов с ночными нарушениями проводимости сердца. Тезисы. 9-й конгресс Россий- ского общества холтеровского мониторирования и неивазивной электрофизиологии. Материалы конгресса. 2008 [Kurlykina NV, Pevzner AV, Litvin AYu, et al. The prevalence of obstructive sleep apnea syndrome in patients with nocturnal cardiac conduction disorders. Ab- stracts. 9th Congress of the Russian Society of Holter Monitoring and Non-Invasive Electrophysiology. Congress materials. 2008 (In Russ.)].
  37. Shahar E, Whitney C, Redline S, et al. Sleep disordered breathing and cardiovascular disease: cross sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19-25. doi: 10.1164/ajrccm.163.1.2001008
  38. Tietjens J, Claman D, Kezirian E, et al. Obstructive Sleep Apnea in Car- diovascular Disease: a review of the literature and proposed multidis- ciplinary clinical management strategy. J Am Heart Assoc. 2019;8(1):e010440. doi: 10.1161/JAHA.118.010440

Supplementary files

Supplementary Files Action
1.
Incidence of various diseases in patients referred to the sleep apnea laboratory (%).

Download (12KB) Indexing metadata

Statistics

Views

Abstract - 69

PDF (Russian) - 35

Cited-By


PlumX

Dimensions

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Novoslobodskaya str 31c4., Moscow, 127005, Russian Federation

Managing Editor:

 

© 2018 "Consilium Medicum" Publishing house

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies