Low Risk For Obstructive Sleep Apnea Research Articles

High Rates of Obstructive Sleep Apnea Symptoms Among Patients With Schizophrenia

Patients with schizophrenia have high rates of obesity and cardiovascular morbidity, which are strongly associated with obstructive sleep apnea (OSA). The prevalence and risk factors for OSA are not well studied in patients with schizophrenia. The purpose of this study was to evaluate the frequency of OSA symptoms in a sample of outpatients with schizophrenia. This cross-sectional study was a secondary analysis of data generated from an insomnia study that evaluated 175 outpatients with schizophrenia or schizoaffective disorder in a single, large urban community mental health center. Results of scales evaluating insomnia were used to complete the STOP questionnaire, which is a screening tool for OSA validated in surgical populations. Appropriate statistical analysis was done to compare participants across groups. Patients were classified into high risk for OSA (STOP ≥ 2) (57.7%), and low risk for OSA (STOP score < 2) (42.3%). We also identified patients with a known diagnosis of OSA (14.9%). Patients with diagnosed OSA had significantly higher STOP scores (mean 2.7 vs. 1.6 [t = 6.3; p < 0.001]). Only 23.8% of patients in the high-risk group were diagnosed with OSA. Body mass index was significantly higher in the diagnosed group (F[2,169] = 25; p < 0.001) as was diabetes (χ2 [2, N = 175] = 35, p < 0.001). A large number of outpatients with severe mental illness are at high risk for OSA. The STOP questionnaire is easy to use and appears to have a very high clinical utility to detect OSA. Based on our findings, further studies are warranted to validate the tool in patients with severe mental illness.

Predictive value of Berlin Questionnaire and Epworth Sleepiness Scale for obstructive sleep apnea in a sleep clinic population

The Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS) are two of the widely used screening instruments for subjects suffering from sleep disorders. To determine the predictive accuracy of the BQ and ESS in the subjects who were admitted to our sleep clinic, using overnight polysomnography as the 'gold standard'. The BQ and ESS were performed to 1450 subjects hospitalized in our sleep clinic for polysomnographic evaluation. One thousand two hundred thirty of 1450 subjects (84.8%) had apnea-hypopnea index (AHI) ≥ 5, and 70.5% of them were classified as being at high risk of sleep apnea with BQ and 45.9% of them were classified as having excessive daytime sleepiness with ESS. Being in the high-risk group with the self-reported, BQ predicted an AHI ≥ 5 with a sensitivity of 0.73 and a specificity of 0.44, vs a sensitivity of 0.46 and a specificity of 0.60 with the self-reported ESS. Sensitivity of BQ (0.80) was highest when we selected the cut-off value of AHI as 30. When we evaluated the predictive accuracy of BQ and ESS together, specificity of both instruments as 0.72 at AHI cut-off value of 5 was found. AHIs were significantly correlated with the scores in each category and the total scores of BQ (P < 0.0001). The BQ is a poor predictor of obstructive sleep apnea (OSA) in subjects admitted to our sleep clinic. BQ and ESS together may be used to detect patients with low risk for OSA.

Impact of obstructive sleep apnea and snoring on left ventricular mass and diastolic function in hypertensive nigerians.

Background:Systemic hypertension (HTN) and obstructive sleep apnea (OSA) are individually associated with left ventricular structural and functional adaptations. However, little is known about the impact of OSA on the left ventricle in Africans with HTN.Aim:The aim of this study is to determine the association between OSA and left ventricular mass (LVM) and diastolic dysfunction in Nigerian hypertensive subjects.Subjects and Methods:A total of 104 hypertensive subjects were enrolled for this study. Risk for OSA was assessed with the Berlin score. Clinical history and examination were performed. Echocardiography was performed and diastolic dysfunction was diagnosed using the pulse wave Doppler. Statistical analysis was performed using the statistical package for social sciences 17.0. (Chicago Ill, USA). Comparism between groups was done using t-test and Chi-square and P < 0.050 was taken as statistically significant.Results:LVM, posterior wall and interventricular septum were significantly higher among hypertensive patients with high risk for OSA than those with low risk (263.610 g [11.202] g vs. 208.714 g [47.060] g; 12.100 mm [2.712] mm vs. 10.711 mm [2.101] mm; 13.210 [3.114] mm vs. 11.700 mm [2.402] mm respectively). A similar finding was reported between hypertensive snorers and hypertensive non-snorers. Fasting blood glucose was also significantly higher among hypertensive snorers than non-snorers. However, mean transmitral early (E) to late (A) flow E/A ratio was lower among hypertensive with low risk of OSA and snorers than those with a high risk and non-snorers respectively. Left Ventricular hypertrophy was also more common among hypertensive with high risk of OSA than non-snorers and low risk of OSA (39/55, 70.9% vs. 28/49, 57.1% respectively, P < 0.05).Conclusion:OSA is associated with significant additional left ventricular changes in hypertensive subjects. Therefore, aggressive effort at managing OSA and snoring among hypertensive subjects may further reduce their cardiovascular risk.

Prospective assessment of the risk of obstructive sleep apnea in patients attending a tertiary health facility in Sub-Saharan Africa.

IntroductionThe impact of Obstructive sleep apnea (OSA) in worsening outcomes is profound, especially in the presence of comorbid conditions. This study aimed to describe the proportion of patients at a high risk of OSA in our practice setting.MethodsThe STOP BANG questionnaire and the Epworth Sleepiness scale were used to assess for OSA risk and excessive daytime sleepiness respectively. Hospitalized patients and out-patients were recruited. Intergroup differences in continuous variables were compared using the analysis of variance. The proportion of patients with high risk of OSA and excessive daytime sleepiness was presented as frequencies and group differences compared with the Pearson χ2 test. Independent risk predictors for OSA were assessed in multivariate logistic regression analysis.ResultsA total of 1100 patients (53.4% females) participated in the study. Three hundred and ninety nine (36.3%) had a high risk of OSA, and 268 (24.4%) had excessive daytime sleepiness. Of the participants with high OSA risk, 138 (34.6%) had excessive daytime sleepiness compared to 130 (18.5%) of those with low OSA risk (p).ConclusionA significant proportion of patients attending our tertiary care center are at high risk of OSA.

The Correlation Between Sleep Efficiency and the Risk of Obstructive Sleep Apnea

Purpose: The purpose of this correlation research was to identify the relationship between Obstructive Sleep Apnea (OSA) and sleep efficiency. Subjects: A total of six men and twelve women (N=18) form the College of Health Professions fulfilled the requirements for inclusion in this study. Method: This research integrated two investigation methods. 1) STOP-BANG questionnaire was completed by students and faculty from the College of Health Professions at Texas State University. Then, 2) each participant wore an Actigraphy watch for seven days. The result of the STOP-BANG questionnaire was compared to the result of the Actigraphy in regard to low or high risk of OSA and the normal or below normal sleep efficiency. Results: There was no significant relationship between the risk of having OSA according to STOP-BANG and sleep efficiency measured by Actigraphy watch in undiagnosed individuals (r =.240, p =.337). However, there was a positive, significant relationship between age and sleep efficiency. Conclusion and Recommendations: In order to improve the external validity, more participants need to be included in future research. Moreover, the use of medication that could affect sleep and alcohol consumption need to addressed. A full night sleep study in a sleep lab adds a standard for comparison. Finally, using other questionnaires or advanced forms of Actigraphy technology could provide better results.

Effect of Preoperative Obstructive Sleep Apnea on the Frequency of Atrial Fibrillation After Coronary Artery Bypass Grafting

Patients with obstructive sleep apnea (OSA) have intermittent hypoxia leading to atrial remodeling and this has been associated with the development of atrial fibrillation (AF). Postoperative AF is a common complication of coronary artery bypass grafting (CABG). The aim of this prospective study was to determine whether the presence of OSA predicts the occurrence of post-CABG AF (PCAF). This was a prospective single-center study. Patients undergoing elective CABG were evaluated and categorized as confirmed, high-risk, or low-risk OSA according to a modified Berlin questionnaire. PCAF was evaluated by 24-hour cardiac monitoring strip or 12-lead electrocardiography during the postoperative period, and validated by an electrophysiologist. We included 277 patients. OSA prevalence was 47.7%, with body mass index (31.0 vs 26.9 kg/m(2), p ≤0.001), advanced age (63.7 vs 66.4 years, p = 0.031), hypertension (78.0% vs 64.8%, p = 0.015), and diabetes (45.5% vs 28.3%, p = 0.003) more prevalent in the OSA group. PCAF was found to occur in 37.2% of all patients and OSA was found to be a strong predictor of PCAF (45.5% vs 29.7%, p = 0.007). PCAF was also associated with continuous positive airway pressure use (12.6% vs 5.2%, p = 0.027). Increased length of stay was associated with PCAF (6.5 vs 5.3 days, p = 0.006), as was longer time from surgery to occurrence of PCAF (p = 0.001). In conclusion, OSA was found to be a strong predictor of PCAF, which in turn was found to be associated with increased length of stay.

Sleep study on patients with non-cystic fibrosis bronchiectasis: a pilot study

Introduction Due to irreversible dilation of the bronchi, the presence of secretions and airflow obstruction, subjects with bronchiectasis may be predisposed to hypoxemia during sleep or symptoms that might lead to arousal. Therefore, we describe these subjects sleep through the complete nocturnal sleep study (polysomnography). Materials and methods An observational study was carried out involving the evaluation of 21 patients with non-cystic fibrosis bronchiectasis at the Sleep Laboratory of the Master’s and Doctoral Program in Rehabilitation Sciences of the Universidade Nove de Julho in the city of Sao Paulo, Brazil. Results Mean age was 51.6; ± 15.1 years; 57.1% of the patients were female and mean body mass index was 23.9 ± 3.7 kg/m2. Mean income was 1.3 times the minimum wage and only 28.6% had completed high school. The median Epworth Scale score was 7.5 (0–23). A low risk for the obstructive sleep apnea (OSA) syndrome was found in 61.9% (by Berlin) of the subjects and there was a predominance of obstructive lung disease. Mean total sleep time was 282.7 ± 69.5 min, with sleep efficiency of 79.2 ± 29.2%. Stages 1 and 2 were altered and the mean sleep apnea and hypopnea index was 3.7 ± 4.9 events/h. The number of arousals was 5.6 ± 2.9 /h. The oxyhemoglobin desaturation index was 5.9 ± 8.9 /h and minimum oxyhemoglobin saturation was 84.5 ± 5.8%, during polysomnography. Conclusion Patients with non-cystic fibrosis bronchiectasis had a low risk of OSA and changes in sleep quality. Acknowledgements We thank the Foundation for Research Support of the State of Sao Paulo (FAPESP) and National Council for Scientific and Technological Development (CNPq) for supporting this research.

Hypertension and its association with shift work, sleep-disordered breathing and place in the organizational hierarchy

Introduction Hypertension (HT) is a highly prevalent cardiovascular disease and a risk factor for coronary heart disease, stroke, and heart and kidney failure, among others. The obstructive sleep apnea (OSA) is a well-known causative factor of hypertension, but less known is the role of shift work systems and the place in the hierarchy of social organization. Objective: To study the risk factors associated with hypertension in a group of health workers. Materials and methods We conducted a cross-sectional study in a group of health workers, as part of an occupational health program in a public hospital in Santiago, Chile. All subjects underwent a medical evaluation, which included anthropometric parameters, blood pressure measurement, a battery of laboratory tests, and surveys of sleep by Berlin Questionnaire. According to this questionnaire went classified in Low or High Risk of OSA. According to the work schedule, the workers were classified into Daytime work, 3rd Shift, and 4th Shift; and as the plant to which they belonged within the organization in Professional, Administrative, Paramedical technician, and Auxiliary. We examined the association of hypertension with shift work, the risk of OSA, and place within the organizational hierarchy using a logistic regression model adjusted for sex, age, BMI, and smoking. Results The study group consisted of 353 workers, with an average age of 44.2 ± 12.6 years (IQ = 31.8–54.7), of which 266 (75.4%) were women, and 87 (24.6%) were men. Of the total, 87 (24.6%) had hypertension. On the other hand, as the result of the Berlin Questionnaire, 151 (42.8%) had High Risk of OSA. According to the work schedule, 194 (55%) worked in daytime, and 159 (45%) were shift workers (114 in 4th Shift, and 45 in the 3rd Shift). Of the total, 44 (12.5%) were Professionals, 78 (22.1%) Administrative, 148 (41.9%) Paramedical technicians, and 83 (23.5%) Auxiliary. According to logistic regression, the 4th Shift had an OR = 2.03 (95% CI, 0.9–4.58; p = 0.088), 3rd Shift an OR = 4.23 (95% CI, 1, 51–11.83; p = 0.006); the trend test was significant with an OR = 2.05 (95% CI, 1.23–3.41; p = 0.006). The High Risk of OSAS an OR = 4.1 (95% CI, 1.89–8.9; p 0.001). Regarding the location in the organization, the Administrative had an OR = 10.1 (95% CI, 1.76–57.88; p 0.001), Paramedical technicians OR = 5.55 (95% CI, 1.1–28.27; p = 0.039), and the Auxiliary an OR = 5, 76 (95% CI, 1.11–29.86; p = 0.037). Interactions between stratum and shift work and risk of OSA, were not significant in the multiplicative scale. The age variable reached statistical significance ( p = 0.018). The factors sex, BMI, and smoking showed no increased risk associated. Conclusion According to our results, the place within the organizational hierarchy, shift work and sleep-disordered breathing, are independent risk factors of hypertension in health workers. These results also suggest that sex, overweight and obesity, and smoking act through independent risk factors and not by themselves. Acknowledgements To health workers of Felix Bulnes Hospital.

Self-reported Sleep Duration in Relation to Incident Stroke Symptoms: Nuances by Body Mass and Race from the REGARDS Study

To determine, among employed persons with low risk for obstructive sleep apnea (OSA), if sleep duration is associated with incident stroke symptoms, independent of body mass index (BMI), and if sleep duration mediates racial differences in stroke symptoms. In 2008, 5666 employed participants (US blacks and whites, ≥45years) from the longitudinal and nationally representative Reasons for Geographic And Racial Differences in Stroke study self-reported their average sleep duration. Participants had no history of stroke, transient ischemic attack, orstroke symptoms and were at low risk for OSA. After the sleep assessment, self-reported stroke symptoms were collected at 6-month intervals, up to 3years (M=751days). Interval-censored, parametric survival models were conducted toestimate hazard ratios predicting time from sleep duration measurement (<6,6-6.9, 7-7.9 [reference], 8-8.9, ≥9hours) to first stroke symptom. Adjusted models included demographics, stroke risk factors, psychological symptoms, health behaviors, and diet. During follow-up, 224 participants reported 1 or more stroke symptoms. In the unadjusted model, short sleep (<6hours) significantly predicted increased risk of stroke symptoms but not in adjusted models. Stratification by BMI revealed a significant association between short sleep duration and stroke symptoms only for normal BMI persons in unadjusted (hazard ratio: 2.93, 95% confidence interval: 1.38-6.22) and fully adjusted models (hazard ratio: 4.19, 95% confidence interval: 1.62-10.84). The mediating effect of sleep duration on the relationship between race and stroke symptoms was borderline significant in normal weight participants. Among middle-aged to older employed individuals of normal weight and low risk of OSA, self-reported short sleep duration is prospectively associated with increased risk of stroke symptoms.

Age differences in the association of obstructive sleep apnea risk with cognition and quality of life

Using a sample of 2925 stroke-free participants drawn from a national population-based study, we examined cross-sectional associations of obstructive sleep apnea (OSA) risk with cognition and quality of life and whether these vary with age, while controlling for demographics and comorbidities. Included participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were aged 47-93years. OSA risk was categorized as high or low based on responses to the Berlin Sleep Questionnaire. Cognitive function was assessed with standardized fluency and recall measures. Depressive symptoms were assessed with the four-item Center for Epidemiologic Studies Depression Scale. Health-related quality of life (HRQoL) was assessed with the Medical Outcomes Study Short Form-12 (SF-12). Multivariate analyses of covariance (mancova) statistics were applied separately to the cognitive and quality of life dependent variables while accounting for potential confounders (demographics, comorbidities). In fully adjusted models, those at high risk for OSA had significantly lower cognitive scores (Wilks' lambda=0.996, F3,2786 =3.31, P<0.05) and lower quality of life [depressive symptoms and HRQoL] (Wilks' lambda=0.989, F3,2786 =10.02, P<0.0001). However, some of the associations were age-dependent. Differences in cognition and quality of life between those at high and low obstructive sleep apnea risk were most pronounced during middle age, with attenuated effects after age 70years.

Obstructive sleep apnea is associated with reduced quality of life in adult patients with asthma

BackgroundRecent data suggest that obstructive sleep apnea (OSA) is an important contributor to severe uncontrolled asthma. ObjectiveTo investigate the clinical characteristics, asthma control, and asthma-related quality of life in adult patients with asthma at a high risk for OSA. MethodsA total of 217 patients with asthma who visited our tertiary-care clinic were randomly recruited. They completed the Berlin questionnaire, which screens for OSA risk, a quality-of-life questionnaire for adult Korean patients with asthma (QLQAKA), and underwent an asthma control test (ACT). Fraction of exhaled nitric oxide (FeNO), lung function, blood lipid profiles, and body composition were evaluated. ResultsThe mean age was 58.4 ± 15.4, and 91 (41.9%) were male. Eighty-nine subjects (41.0%) were classified as high risk for OSA from the Berlin questionnaire. Patients with a high OSA risk were significantly older, had a higher prevalence of hypertension, higher BMI, non-atopic predisposition, and longer asthma treatment duration in the baseline clinical characteristics. The high OSA risk group had a lower ACT score than the low OSA risk group, but it was not statistically significant (20.9 ± 3.6 vs 21.5 ± 3.3, P = .091). The QLQAKA score was significantly lower in the high OSA risk group compared with the low OSA risk group (64.4 ± 10.9 vs 68.1 ± 11.1, P = .026), especially in the activity-domain (P = .005). The FeNO was not significantly different between the 2 groups. ConclusionQuality of life is significantly decreased in adult patients with asthma with a high risk of OSA. Special consideration is needed for the care and treatment of patients with asthma who have a high risk of OSA.

Abstract WP445: Age Differences in the Impact of Sleep Apnea on Cognition and Quality of Life

Introduction: Using a subsample from the national REasons for Geographic And Racial Differences in Stroke (REGARDS) study, we examined the associations of obstructive sleep apnea (OSA) with cognition and quality of life and whether these associations vary with age while controlling for other demographic factors and comorbid medical conditions. Methods: Stroke-free participants with complete data on OSA risk, cognition, and quality of life as of October 2010 were included (N =2,925; ages 47-93, 43% men, 35% black, 65% white). OSA risk was defined as high or low based on responses to the Berlin Sleep Questionnaire (BSQ). Cognitive function was assessed with three validated fluency and recall measures; quality of life was assessed with the 4-item Center for Epidemiological Studies-Depression (CESD-4) scale and the Medical Outcomes Study Short Form-12 (SF-12). MANCOVA statistics were applied to the cognitive and quality of life outcomes separately while accounting for potential confounders (age, sex, race, education, diabetes and dyslipidemia). Body mass index and hypertension were taken into account as part of the BSQ definition of OSA risk. Results: In fully adjusted models, those at high risk for OSA had significantly lower cognitive scores (p &lt; .05) and lower quality of life (depressive symptoms and SF-12) (p &lt; .0001) than those at low risk. Some of the associations were age-dependent, such that younger participants with high OSA risk had worse cognitive and quality of life scores than both younger participants with low OSA risk and older participants with high OSA risk. Discussion: Lower cognitive function and lower quality of life in those at high risk for sleep apnea remained after accounting for potentially confounding factors in a population-based sample. These relationships were more pronounced during middle age, with attenuated effects after age 70. It may be of particular importance to detect and treat OSA in younger adults.

Abstract TP209: Time Of Stroke Onset Is Not Associated With Risk Of Obstructive Sleep Apnea In Intracerebral Hemorrhage.

Objective: To test the hypothesis that risk status for obstructive sleep apnea (OSA) is associated with time of onset in intracerebral hemorrhage. Background: OSA can affect 30-70% of patients with ischemic strokes, intracerebral hemorrhage and transient ischemic attacks. In normal sleep, blood pressure and heart rate decrease due to increased parasympathetic activity. In OSA, increased sympathetic activity during sleep can lead to a absence of this blood pressure fall. This non-dipping nocturnal blood pressure pattern has been associated with a shift in the timing of sudden cardiac death, from 7am-noon in those without OSA to 12am-6am in those with OSA. Whether this diurnal shift exists in intracerebral hemorrhage cases at high risk for OSA has not been studied. Method: A nested case control study within the interviewed case cohort from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study was performed. OSA risk status was categorized as “high-risk” based on a positive score in 2 out of 3 categories on the Berlin questionnaire, which ascertains snoring, daytime fatigue, body mass index and hypertension. Timing of intracerebral hemorrhage was categorized as “Nocturnal” based on a known time of stroke onset from 22:00pm to 06:00am and “Awake” based on a known time of stroke onset from 06:01am to 21:59pm. Results: Time of stroke onset was known in 434 subjects. The Berlin questionnaire categorized 54.2% of cases as high-risk for OSA. In comparison with low-risk subjects, high-risk cases tended to be younger (59.1±13.7 vs. 61.8±15.7, p=0.05), male (48% vs 58%, p=0.03), have coronary disease (6% vs 11%, p=0.09), have diabetes (27% vs 18%, p=0.02), and have dyslipidemia (43% vs 30%, p=0.006). There were no ethnic differences in the prevalence of high risk for OSA (P=0.60). Nocturnal strokes were seen in 17% of high- and low-risk OSA cases. There was no statistically significant difference in OSA status and timing of stroke (p=0.98). Conclusions: OSA risk status was not associated with timing of hemorrhagic stroke. This finding suggests that a non-dipping nocturnal blood pressure pattern is not seen in intracerebral hemorrhage cases at high-risk for OSA.

Obstructive sleep apnea among commercial vehicle drivers in Malaysia: Issues and initiatives

Obstructive Sleep Apnea (OSA) has been identified by many studies as one of the significant contributing factors for motor vehicle accidents. However, only a small number of studies have been conducted in Malaysia. Objective: This paper aims to highlight the prevalence of OSA among truck drivers and express bus drivers in Malaysia and efforts being undertaken to address issues related to OSA among commercial vehicle drivers. Methodology: Two separate studies were conducted: a cross sectional study among truck drivers and secondly among express bus drivers. The screening process for identifying the high risk group for OSA was done using Berlin questionnaire. Meanwhile, among express bus drivers, OSA was confirmed with sleep study using polysomnography test. Result: Screening of risk group of OSA among truck drivers revealed that 14.6% (19) of drivers were categorized as having high risk of OSA while 85.4% (111) having low risk of OSA. While, in another study, polysomnography test among express bus drivers showed that 83 (28.7%) had mild OSA, 26 (9.0%) had AHI moderate OSA, and 19 drivers (6.6%) severe OSA. Conclusion: This paper highlighted the issues of OSA among commercial vehicle drivers in Malaysia. With an alarming high prevalence, OSA should be a major road safety concern in this country. A special study focusing on sleep and fatigue related crashes may need to be conducted to complement the current studies and full implementation of existing efforts and initiatives to address OSA in road crashes should be realized by the relevant authorities.

A Screening Tool of Obstructive Sleep Apnea

The STOP-Bang questionnaire is a concise and easy-to use screening tool to identify patients with obstructive sleep apnea (OSA). The questionnaire has been validated in medical and surgical patients and in different ethnic groups. A STOP-Bang score of 0 to 2 indicates a low risk of OSA; a STOP-Bang score of 3 to 4 indicates an intermediate risk of OSA; and a STOP-Bang score of 5 to 8 indicates a high risk of OSA; a STOP-Bang score of 3 or greater plus a high serum HCO3– level also increases the specificity for moderate/severe OSA.

Can a Validated Sleep Apena Scoring System Predict Cardiopulmonary Events During Anesthesiolgist-Directed Propofol Sedation for Routine EGD and Colonoscopy? A Prospective Cohort Study

Purpose: With the rise of anesthesiologist-directed propofol (ADPS) for routine EGD and colonoscopy, there is limited data on the risk for sedation related complications (SRC) in patients with undiagnosed obstructive sleep apnea (OSA). Undiagnosed OSA, which is linked to the increased prevalence of obesity, continues to rise in the United States. We attempted to identify the prevalence of OSA and subsequent risk factors for airway complications (AC) and SRC in patients undergoing ADPS for EGD and colonoscopy. Methods: We prospectively enrolled 243 patients who underwent routine EGD or colonoscopy with ADPS. Patients were screened with a previously validated questionnaire for OSA (STOP-BANG, SB) to identify patients at high risk (SB score >3, SB+) or low risk (SB score <3, SB-) for undiagnosed OSA. AC were defined as a chin lift, mask ventilation, placement of nasopharyngeal airway, bag mask ventilation, or endotracheal intubation. SRC included hypoxemia (SPO2<90%), hypotension (SBP<25% of baseline), or early procedure termination due to sedation. Other variables such as age, gender, BMI, history of pulmonary disease, total propofol dose, and use of opioids were also analyzed. In addition, multivariable logistic regression analysis was performed to assess factors associated with AC and SRC, separately. An automated stepwise variable selection method performed on 1,000 bootstrap samples was used to choose the models. Results: Mean age was 50.1 ± 16.2 years and 41% of patients were male. The prevalence of SB+ was 48.1%. The rates of hypoxemia (27.4% vs. 35.9%, P=0.16) and hypotension (42.9% vs. 48.7%, P=0.36) were similar between SB- and SB+ patients. A STOP-BANG score ≥ 3 was found not to be associated with occurrence of AC (OR:1.04; 95% CI:0.58,1.9) or SRC (OR:1.4; 95% CI:0.66,2.8) after adjusting for total and loading dose of propofol, BMI, smoking and age. Higher BMI was associated with higher AC (OR:1.07; 95% CI:1.02,1.1) and SRC (OR:1.06; 95% CI:1.01-1.1). Higher total propofol doses (OR:0.89; 95% CI:0.81,0.98) and loading propofol doses (OR 2.1; 95% CI:1.2,3.5) and smoking (OR: 2.8;95% CI:1.4,5.3) were also associated with increased SRC. Conclusion: A significant number of patients undergoing routine EGD and colonoscopy under ADPS are at risk for OSA. STOP-BANG positive patients are not at higher risk for AC or SRC. However, other risk factors for AC and SCR have been identified and must be taken into account to optimize patient safety.

The use of practice guidelines by the American Society of Anesthesiologists for the identification of surgical patients at high risk of sleep apnea

American Society of Anesthesiologists (ASA) has introduced a simple tool to assess the perioperative risk of surgery/anesthesia in patients with obstructive sleep apnea (OSA). We compared the surgical outcomes in patients at high risk of OSA with the matched controls. This was a case-control study conducted on 3593 surgical patients receiving a general anesthesia at a single institution. On the basis of a preoperative OSA scoring system using the ASA checklist, patients were classified as high-risk OSA (HR-OSA) or low-risk OSA (LR-OSA) groups. Apnea/hypopnea index of >5 h(-1) during a formal preoperative sleep study was used to confirm or rule out the diagnosis of OSA. Receiver operating characteristic curves were plotted to determine the predictive values as well as sensitivity and specificity of the ASA tool in predicting HR-OSA. The HR-OSA group was matched with the patients in LR-OSA using the propensity scoring and logistic regression. Patients were analyzed for premorbid conditions, intraoperative course and postoperative events using cross tabulation, logistic regression model and paired t test. The development of a composite respiratory complication in the postoperative period was considered as the primary end point. The ASA risk tool was found to have 95.1% sensitivity and 52.2% specificity. At a prevalence of 10%, the negative predictive value was 98.5%. Of the 3593 patients, 306 were identified as HR-OSA. The HR-OSA group was found to have a higher incidence of hypertension and diabetes preoperatively when compared with LR-OSA. Postoperatively, the HR-OSA group had higher incidence of hypoxia, reintubation, postoperative use of continuous positive airway pressure and a longer stay in the recovery room. The ASA checklist offers a highly sensitive tool to identify the patients at a higher risk of OSA during the perioperative period. Patients at HR-OSA have a higher incidence of adverse events in the postoperative period when compared with those with LR-OSA.

The Berlin Questionnaire Screens for Obstructive Sleep Apnea in Idiopathic Intracranial Hypertension

Obstructive sleep apnea (OSA) may be associated with idiopathic intracranial hypertension (IIH), a disorder most commonly occurring in young obese women. Because polysomnography, the standard test for diagnosing OSA, is expensive and time consuming, questionnaires have been developed to identify persons with OSA. The Berlin questionnaire (BQ) reliably identifies middle-aged and older persons in the community who are at high-risk for OSA. We aimed to validate the BQ as a screening tool for OSA in IIH patients. Patients with newly diagnosed IIH completed the BQ and then underwent diagnostic polysomnography. The BQ was scored as high or low risk for OSA, and the diagnosis of OSA was based on polysomnography findings. OSA was defined as an apnea-hypopnea index of ≥ 5 on polysomnography. Thirty patients were evaluated (24 women; 15 white and 15 black; age, 16-54 years [median, 32 years]; body mass index, 27.3-51.7 kg/m2 [median, 39.8 kg/m2]). Twenty patients (66.7%) had a high-risk BQ score and 18 (60%) exhibited OSA. Fifteen of 20 (75%) with a high-risk BQ score had OSA, while 3 of 10 (30%) with a low-risk score had OSA (Fisher test, P = 0.045). The sensitivity and specificity of the BQ for OSA in IIH patients were 83% and 58%, respectively, whereas the positive predictive value was 75%. A low-risk BQ score identifies IIH patients who are unlikely to have OSA. Polysomnography should be considered in those with a high-risk score.

Effect of Cardiac Rehabilitation on Inflammatory Markers in Patients with High Risk for Obstructive Sleep Apnea: A Pilot Study

Our primary objective in this study was to determine the differences in inflammatory profile between patients with high risk for obstructive sleep apnea (OSA) versus low risk in a patient population undergoing cardiac rehabilitation and to evaluate the effect of 4 weeks of rehabilitation on cytokine levels in the 2 groups. A total of 20 consecutive patients were screened using the Berlin questionnaire to determine high and low risk of OSA. Of the 20 total consecutive patients, 3 patients did not consent to participate and 1 did not get cytokine analysis. Of the remaining 16 patients (8 men and 8 women), 8 (50%) patients were found to have high risk for OSA as predicted by the Berlin questionnaire. Men predominated the high-risk group (75%). There was a trend of increased cytokine load in the high-risk group; however, it did not reach statistical significance except for monocyte chemoattractant protein-1 (P value=0.02). A significant reduction was noted in cytokine levels after 4 weeks of rehabilitation in the group with OSA, which was statistically significant (P value<0.5). The high-risk group patients had elevated cytokine levels, especially monocyte chemoattractant protein-1. Further, a significant reduction in cytokine levels was noted in the high-risk group after 4 weeks of rehabilitation.

Development of Arabic version of Berlin questionnaire to identify obstructive sleep apnea at risk patients

BACKGROUND:Obstructive sleep apnea (OSA) is a common, under-recognized, under diagnosed, under treated, and serious medical condition in adults. Polysomnography (PSG) is the gold standard for diagnosis of OSA; however, prohibitive cost of the test and rarity of sleep laboratory in the Arabic nations limit its access. So, searching for another simple, economical, reliable, and valid tool for identification of OSA at risk patients is of special public concern.OBJECTIVE:This study was conducted to evaluate the reliability and validity of Arabic version of Berlin questionnaire (ABQ) in detection of OSA at risk patients.METHODS:After hospital ethics approval and formal patients consent, 100 patients were subjected to full night PSG study after their response to the developed ABQ. The patients were classified into both low (30) and high risk (70) for OSA using ABQ and validated against apnea hypopnea index (AHI). Reliability was assessed by internal consistency using Cronbach's alpha test and consistency over time using test retest correlation.RESULTS:The study demonstrated a high degree of internal consistency and stability over time for the developed ABQ. The Cronbach's alpha coefficient for the 10-item tool was 0.92. Validation of ABQ against AHI at cutoff >5 revealed a sensitivity of 97%, specificity of 90%, positive and negative predictive values of 96% and 93%, respectively.CONCLUSION:The ABQ is reliable and valid scale in screening patients for the risk of OSA among Arabic-speaking nations, especially in resource-limited settings.