STOP-BANG Questionnaire Research Articles

Abstract 4120918: Prevalence Of Prediabetes According To Sleep Apnea Status

Aim: The association between obstructive sleep apnea and prediabetes using STOP-Bang questionnaire is unknown. We aimed to investigate prevalence of prediabetes among people according to sleep apnea status. Methods: This cross-sectional study included 10131 Korean adults without diabetes with information of STOP-Bang score were identified from the dataset of the Korea National Health and Nutrition Examination Survey 2019-2021. Prediabetes was categorized into three subsets: fasting blood glucose only (fasting blood glucose 100-125 mg/dL, HbA1c <5.7%), HbA1c only group (fasting blood glucose <100mg/dL, HbA1c 5.7-6.4%) and both fasting blood glucose and HbA1c group (fasting blood glucose 100-125mg/dL, HbA1c 5.7-6.4%). We used multivariable logistic regression to see the odds ratio and 95% confidence intervals for prediabetes. Results: There were 3828 subjects who reported STOP-Bang score of ≥3, which shows increased risk of OSA. Multivariable-adjusted odds ratio (95% confidence interval) for prediabetes meeting both fasting blood glucose and HbA1c comparing STOP-Bang score of ≥3 with <3 was 1.06 (1.01-1.12). In further evaluation of separate gender groups, statistically significant results were seen in women. The multivariable adjusted result correlated with that of the total population. (odds ratio 1.20, 95% confidence interval 1.10-1.30) This was more prominently seen in postmenopausal women. (odds ratio 1.21, 95% confidence interval 1.11-1.32) Conclusion: In Korean general population, the odds of the risk of obstructive sleep apnea was significant in prediabetes group meeting both fasting blood glucose and HbA1c, especially in postmenopausal women.

Abstract 4117927: Prevalence of Obstructive Sleep Apnea Among Consecutive Patients with Atrial Fibrillation Using WatchPAT Home Sleep Testing: A Prospective Cohort Study

Background: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is associated with significant morbidity, mortality, and health system costs. Obstructive sleep apnea (OSA) is a highly prevalent condition affecting more than one third of the global adult population and, among patients with comorbid AF, contributes to poor AF related quality of life. However, the prevalence of undiagnosed OSA in the general AF population is unknown. Methods: In this pragmatic, phase IV prospective cohort study, we performed sleep testing on consecutively enrolled ambulatory AF patients for OSA using a cloud-based disposable home sleep test (the WatchPAT system). The primary outcome of our study was the prevalence of undiagnosed mild (5≤AHI<15) or moderate/severe (AHI≥15) OSA in the general AF population. A prespecified power analysis supports 80% power to detect a <5% difference in OSA prevalence compared to the general population (defined by AHI cut-offs of ≥5 or ≥15). Results: We performed sleep testing in 180 AF patients. Enrollment concluded early after a prespecified interim power analysis showed a larger than predicted difference of OSA prevalence between AF patients and the general population. Among the patients tested, 126 (70.4%) had paroxysmal AF, and 53 (29.6%) had persistent/long standing persistent AF. None had previous sleep testing. Our results show that the prevalence of OSA was 83.3% by AHI≥5 and 47.2% had moderate/severe OSA (AHI≥15). Patients with persistent or long standing persistent AF demonstrated even higher rates of OSA with 51 (96.3%) testing positive for OSA (AHI≥5) and 35 (64.2%) with moderate/severe OSA (AHI≥15). Conversely, standardized OSA screening instruments (Stop-BANG questionnaire or Epworth Sleepiness Scale) were poorly predictive of OSA in AF patients (AUC 0.66 and AUC 0.44, respectively). Conclusions: Undiagnosed OSA is highly prevalent in the general AF population. Our results demonstrate that OSA prevalence in AF patients exceeds that in the general population with a high degree of confidence. Widely used clinical prediction instruments cannot effectively be used to guide sleep testing decisions in AF patients. Our results suggest routine OSA testing should be performed in the comprehensive evaluation of all AF patients.

Sleep-disordered breathing in a multi-ethnic cohort of preterm adolescents and adults: assessment of neonatal and subsequent risk factors.

Determine whether preterm-born adolescents and adults have sleep-disordered breathing (SDB), as documented by abnormal overnight oximetry. This single-center cross-sectional study prospectively enrolled adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or <1500 grams birth weight) or full term to complete a study visit, STOP-Bang questionnaire, and overnight oximetry. Oxygen desaturation index (ODI) was compared in preterm versus term with Poisson regression models. Subgroup analyses in preterm participants evaluated associations of neonatal risk factors with ODI. Ninety-six preterm and 44 term participants completed study procedures. Preterm participants more often reported snoring (25% vs 9%; p=0.03) and excessive fatigue (62% vs 40%; p=0.02), and had higher body mass index, leading to higher STOP-Bang scores (2±1 vs 1±1; p<0.001). Preterm participants had 40% higher ODI (incidence rate ratio (IRR): 1.40; 95% CI [1.07,1.83]; p=0.02). However, after adjusting for classic risk factors for SDB including age and STOP-Bang score in a multivariable model, history of preterm birth did not predict additive risk for SDB. Among neonatal factors, a patent ductus arteriosus was associated with a higher ODI (IRR 1.99; 95% CI [1.37,2.91]; p<0.001). Preterm-born adolescents and adults in this study have higher rates of snoring, daytime fatigue, and nocturnal desaturations compared to those term-born. However, the risk of elevated ODI is best attributed to obesity in this cohort and not the history of prematurity. Additionally, a history of a patent ductus arteriosus increased risk for SDB.

Influence of the partner's obstructive sleep apnea on metabolic syndrome in couples

ObjectivesThis study investigates the relationship between the risk of obstructive sleep apnea, as assessed by the STOP-Bang questionnaire, and metabolic syndrome among couples. It also examines how snoring and observed apnea are associated with metabolic syndrome in couples. Study designCross-sectional study using data from 2436 couples in the Korea National Health and Nutrition Examination Survey (2019–2021). A high risk of obstructive sleep apnea was defined as a STOP-Bang score of 3 or more (excluding the hypertension item). Main outcome measuresMetabolic syndrome in couples. Results47.6 % of husbands and 5.7 % of wives had a high risk of obstructive sleep apnea. The prevalence of metabolic syndrome was 45.5 % among husbands and 24.7 % among wives. After adjusting for sociodemographic factors and health behaviors, wives whose husbands were at high risk of obstructive sleep apnea or who reported snoring or observed apnea had 1.4–1.5 times higher odds of metabolic syndrome. Conversely, husbands' metabolic syndrome was not significantly associated with their wives' risk of obstructive sleep apnea and sleep behaviors. The adjusted odds of metabolic syndrome in both partners were 2.8–4.4 times higher when only husbands had a high risk of obstructive sleep apnea or snoring, and 2.3–2.9 times higher when only wives had these sleep issues, compared with couples without such problems. ConclusionsThis study reveals a gender disparity in the impact of a spouse's risk of obstructive sleep apnea on metabolic syndrome, emphasizing the need for a couple-focused approach in managing these health issues.

Association of sleep disturbances with diminished ovarian reserve in women undergoing infertility treatment

With an aging population seeking infertility treatment, diminished ovarian reserve (DOR) is a prevalent indication for assisted reproductive technology (ART). This study aims to investigate the relationship between sleep parameters and DOR among women attending an infertility clinic. Methods We consecutively enrolled women attending an infertility clinic from July 2020 to June 2021. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale(ESS), and STOP-Bang Questionnaire to assess self-reported sleep quality. DOR-related indices including antral follicle count, anti-Müllerian hormone(AMH), follicle-stimulating hormone (FSH) were evaluated. A total of 979 women were enrolled, with 148 classified into the DOR group and 831 in the non-DOR group. The DOR group was notably older compared to the non-DOR group. Analysis showed that the DOR group exhibited significantly shorter sleep onset latency (p = 0.001) and shorter total sleep duration (p = 0.014) compared to the non-DOR group. Logistic regression analysis identified age, PSQI-sleep latency, and PSQI score as independent factors associated with an increased risk of DOR(all p < 0.05). Furthermore, stratified analysis by age group revealed that snoring and PSQI-sleep latency were particularly notable risk factors for DOR among women aged 35 years and older (OR = 2.489, p = 0.040; OR = 2.007, p = 0.008, respectively). Our study highlights that shorter sleep onset latency and shorter total sleep duration may be associated with DOR among women undergoing ART treatments. Particularly noteworthy, snoring and sleep latency were identified as additional risk factors for DOR among women aged 35 years and older.

Association between Risk of Obstructive Sleep Apnea and Intraocular Pressure based on the Korea National Health and Nutrition Examination Survey VIII.

A higher STOP-BANG score and loud snoring, observed breathing interruptions during sleep, hypertension, and wide neck circumference were individually and in combination associated with high intraocular pressure in Koreans aged 40 years and older. To evaluate the relationship between intraocular pressure (IOP) and the risk of obstructive sleep apnea (OSA). In this population-based, cross-sectional study, we included Korean adults aged 40 years or above recruited between 2019 and 2021. 6315 subjects were included from the Korea National Health and Nutrition Examination Survey Ⅷ database. The risk of OSA was measured by STOP-BANG questionnaire. The IOPs were measured using rebound tonometer. Logistic regression was used to analyze the association between IOP quartiles (highest quartile vs. lower 1-3rd quartiles) with OSA risk after adjusting for sociodemographic characteristics, lifestyle, and diabetes. The adjusted odds ratio for high IOP, was 1.27 (95% CI 1.12 to 1.43) for participants with a STOP-BANG score of 3 to 8 compared with those with a score of 0 to 2. Participants with loud snoring, observed breathing interruptions during sleep, hypertension, or wide neck circumference had 24%-40% higher odds of high IOP than those without these components. The odds ratio for high IOP in the group with all four factors was 2.09 times higher (95% CI 1.26 to 3.46) than in the group without these factors. A higher STOP-BANG score was associated with an increased risk of high IOP in Koreans aged 40 years and older. Furthermore, among the STOP-BANG components, loud snoring, observed breathing interruptions during sleep, hypertension, and wide neck circumference were individually and in combination associated with high IOP.

Knowledge, attitude, and practice of inpatients with cardiovascular disease regarding obstructive sleep apnea

There is a significant interrelationship between cardiovascular disease and obstructive sleep apnea (OSA), as they share common risk factors and comorbidities. This study aimed to investigate the knowledge, attitude, and practice (KAP) of inpatients with cardiovascular disease towards OSA. This cross-sectional study was conducted between January, 2022 and January, 2023 at Zhongda Hospital Affiliated to Southeast University among inpatients with cardiovascular disease using a self-administered questionnaire. A self-designed questionnaire was used to assess KAP, and the STOP-Bang questionnaire was applied to evaluate participants’ OSA risk. Spearman correlation and path analyses were conducted to explore relationships among KAP scores and high OSA risk. Subgroup analyses were conducted within the high-risk population identified by the STOP-Bang questionnaire. In a study analyzing 591 questionnaires, 66.33% were males. Mean scores were 6.81 ± 4.903 for knowledge, 26.84 ± 4.273 for attitude, and 14.46 ± 2.445 for practice. Path analysis revealed high risk of OSA positively impacting knowledge (β = 2.351, P < 0.001) and practice (β = 0.598, P < 0.001) towards OSA. Knowledge directly affected attitude (β = 0.544) and practice (β = 0.139), while attitude influenced practice (β = 0.266). Among high OSA risk individuals, knowledge directly impacted attitude (β = 0.645) and practice (β = 0.133). Knowledge indirectly influenced practice via attitude (β = 0.197). Additionally, attitude directly affected practice (β = 0.305). These findings provide insights into the interplay between OSA risk, knowledge, attitude, and practice. Inpatients with cardiovascular disease demonstrated inadequate knowledge, moderate attitude, and practice towards OSA. The findings highlighting the need for targeted educational interventions to improve awareness and management of OSA.

Insights into the Overlap of Chronic Obstructive Pulmonary Disease and Sleep Apnea: Experience from the Clinic of Pneumology, Târgu Mureș

Introduction: Chronic obstructive pulmonary disease (COPD) has a severe impact on patients’ health and can lead to multiple complications. Material and methods: We analyzed the co-occurrence of obstructive sleep apnea (OSA) in COPD patients hospitalized in the Pneumology Clinic of Târgu Mureș, Romania. Results: A total of 150 COPD patients were investigated by clinical examination, STOP-BANG and Epworth questionnaires, ventilatory polygraphy (PG), EKG, cardiac ultrasound, blood lipids, and sugar. Sixty-eight patients (45.3%) had OSA associated with COPD. A total of 61.7% were COPD gr. E, and 30.8% were gr. B. Frequently shown symptoms were snoring and nonrestorative sleep (100%), somnolence (73.5%), nocturnal awakenings (41.17%), morning headache (32.3%), and aggravated dyspnea. Types of OSA included obstructive (97.05%), central (2.5%), and associated obesity–hypoventilation (39.7%). A total of 76.4% were recently diagnosed with OSA. Men predominated at 70.5%, 76.4% were smokers, and 61.7% had experienced alcohol abuse. A total of 25% were overweight, and 71% had obesity. A total of 13.2% belonged to the category of 38–50-year-olds, 55.8% were in the 51–65-year-old category, 17.6% were in the 66–70-year-old category, and roughly 13.2% were in the 71-year-old category. Overlap syndrome (OS) comorbidities and complications were frequently present: 41% experienced respiratory failure, 66.1% experienced blood hypertension, 58.8% experienced ischemic cardiac disease, 32.35% experienced diabetes mellitus, 50% experienced dyslipidemia, and 29.4% experienced cor pulmonale. Conclusions: OS conferred gravity or directly contributed to cardiovascular, respiratory, and metabolic complications. OS was associated with more severe COPD and obesity. The prevalence of smoking in OS patients was higher than the national/European average.

PROFILE OF PATIENTS WITH SLEEP COMPLAINTS IN A SECONDARY CARE HEALTH INSTITUTION IN THE CITY OF CAMPINAS, SÃO PAULO STATE

Objective: We report data of the profile of patients who sought our outpatient clinic for sleep disorders of the Faculty of Medicine of São Leopoldo Mandic Medical School, during the Week of Sleep, that took place in March, 2022. Methods: All participants responded to a form designed by the researcher, as well as to commonly used questionnaires in Sleep Research, such as the Epworth Sleepiness Scale (ESS), the Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale, the STOP-BANG questionnaire for screening of apnea, and the WHO Quality of Life abbreviated questionnaire (WHOQOL-BREF). Results: 30 patients were evaluated, mean age 51.8 (± 14), 63% women. Main complaints were insomnia (63%), snore/apnea (23%) and excessive daytime sleepiness (10%). ESS scores were significantly higher among men, daytime nappers and alarm clock users. ISI scores were importantly associated with those who woke 2 or more times per night, while physically active, non-obese, normotensive people and those with Modified Mallampatti (MM) classes I and II scored significantly less in STOP-BANG. Obese, MM classes III-IV and people with abnormal cervical and abdominal circumferences performed markedly worse in Domain 1, while women, older people and alarm clock users went worse in Domain 4 of WHOQOL-BREF. Discussion: One or more sleep disturbances were detected in all seekers of Sleep Care, emphasizing the importance of these types of action.

Pentraxin-3 marker as a predictor of cardiovascular events in obstructive sleep apnea; a cross-sectional study

Introduction A large population suffers from obstructive sleep apnea (OSA). Most of these individuals (almost 90%) are either unrecognized or untreated OSA. These patients are at increased risk of cardiovascular diseases. Aim The aim of this study was to assess the prognostic value of Pentraxin 3 (PTX3) in OSA compared with the clinically relevant biological markers (HbA1c, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), uric acid, and fibrinogen) and to evaluate the relationship between PTX3 levels and risk of cardiovascular diseases. Patients and methods This research used a cross-sectional design and enrolled 100 participants with suspected OSA. All the participants underwent a full clinical history, a STOP-Bang questionnaire, and a polysomnography (PSG) study, and the serum biomarkers were also analyzed. Results The apnea-hypopnea index (AHI) from PSG was used to measure the OSA severity, and the individuals were distributed into three groups accordingly. Our findings showed that there was a significant difference in Pentraxin 3 and fibrinogen levels between patients with mild or moderate OSA and those with severe OSA. Pentraxin 3, at a cutoff point of greater than 4.25 ng/ml, had the highest prognostic accuracy in OSA (96%), with an AUC of 0.96. Regression analysis revealed that Pentraxin 3, with a cutoff point greater than 4.25, and CRP were significant predictors of cardiovascular disease in individuals with OSA. Furthermore, Pentraxin 3 (with a cutoff point of greater than 4.25 ng/ml) and fibrinogen were significant predictors of pulmonary embolism in patients with OSA. Conclusion Serum PTX3 was higher in patients with severe OSA than in those with mild- to moderate OSA. Furthermore, we found that OSA severity as indicated by the AHI was significantly correlated with serum PTX3. PTX3 and CRP are useful markers of cardiovascular risk in OSA.

Phenotypic Characterisation of Obstructive Sleep Apnoea in Acute Coronary Syndrome

Recent neutral randomised clinical trials have created clinical equipoise for treating obstructive sleep apnoea (OSA) for managing cardiovascular risk. The importance of defining the links between OSA and cardiovascular disease is needed with the aim of advancing the robustness of future clinical trials. We aimed to define the clinical correlates and characterise surrogate cardiovascular markers in patients with acute coronary syndrome (ACS) and OSA. Overall, 66 patients diagnosed with ACS were studied. Patients underwent an unattended polysomnogram after hospital discharge (median [interquartile range] 62 [37-132] days). The Epworth Sleepiness Scale, Berlin, and STOP-BANG questionnaires were administered. Surrogate measures of vascular structure and function, and cardiovascular autonomic function were conducted. Pulse wave amplitude drop was derived from the pulse oximetry signals of the overnight polysomnogram. OSA (apnoea-hypopnea index [AHI] ≥5) was diagnosed in 94% of patients. Moderate-to-severe OSA (AHI≥15) was observed in 68% of patients. Daytime sleepiness (Epworth Sleepiness Scale ≥10) was reported in 17% of patients. OSA screening questionnaires were inadequate to identify moderate-to-severe OSA, with an area under the receiver operating characteristic curve of approximately 0.64. Arterial stiffness (carotid-femoral pulse wave velocity, 6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s, p=0.002) and carotid intima-media thickness (0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm, p=0.027) was elevated in patients with moderate-to-severe OSA. After adjusting for age, sex and body mass index, these relationships were not statistically significant. No relationships were observed in other surrogate cardiovascular markers. A high prevalence of OSA in a mostly non-sleepy population with ACS was identified, highlighting a gross underdiagnosis of OSA among cardiovascular patients. The limitations of OSA screening questionnaires highlight the need for new models of OSA screening as part of cardiovascular risk management. A range of inconsistent abnormalities were observed in measures of vascular structure and function, and these appear to be largely explained by confounding factors. Further research is required to elucidate biomarkers for the presence and impact of OSA in ACS patients.

Assessment of pharyngeal airway space with MRI In oral submucous fibrosis: A cross-sectional observational study

IntroductionOral submucous fibrosis (OSMF) alters the pharynx, which may affect airway size. MRI will be useful for diagnosing pharyngeal abnormalities. MRI is used to evaluate pharyngeal airway and soft palate changes in OSMF patients. Materials and methodsThis study is a cross-sectional observational study that included a sample size of 42 patients. Group A consisted of 21 patients with OSMF, while Group B consisted of 21 volunteers without OSMF, who served as the control group. The patients with OSMF were classified into Stages I, II, and III according to the categorization established by Pindborg JJ in 1989, Stop-Bang questionnaire was employed to assess obstructive sleep apnoea. Magnetic Resonance Imaging (MRI) was utilized to acquire evaluations of the pharyngeal airway, encompassing measurements in the midsagittal, cross-sectional width, length planes, and cross-sectional area with volume, for all participants. The Shapiro-Wilk test determines distribution normality. We utilized one-way ANOVA to compare the means between groups. ResultsThe average age of OSMF patients was 45.9 ± 8.16, while the control group was 39.19 ± 4.21. Stage I of OSMF had the highest mean Stop Bang questionnaire score (2.75), followed by stage III (2.22), and stage II (1.75). Statistically significant differences (p < 0.001) were seen in volume, linear midsagittal planes, cross-sectional width and length planes, cross-sectional area, and soft palate breadth and length between OSMF and control groups. ConclusionMRI can effectively examine early changes in the pharyngeal airway of patients with OSMF thereby serving as a constructive diagnostic and motivational tool.

Obstructive Sleep Apnea in Metabolic Syndrome.

The metabolic syndrome (MetS), a cluster of cardiovascular risk factors, is associated with obstructive sleep apnea (OSA). OSA is a major contributor to cardiac, cerebrovascular, and metabolic disorders as well as to premature death. This cross-sectional study was done for 1 year in 103 patients of MetS diagnosed by the International Diabetes Federation criteria. All patients were subjected to the STOP-Bang questionnaire, and they were classified into low, intermediate, and high risks depending on the score. Patients falling in intermediate-high risk (score 3-8) were taken for overnight polysomnography to confirm the diagnosis of OSA (apnea-hypopnea index [AHI] ≥5) and were considered Group I. Patients with STOP-Bang score ≤2 or score ≥3 with AHI <5 were considered Group II (non-OSA). Out of 103 MetS patients enrolled in the study, only 70 (68.0%) were diagnosed with OSA, so the prevalence of OSA in MetS patients was 68%. The majority of the OSA cases had moderate-to-severe OSA (68.5%), and only 31.4% had mild OSA. The age of patients enrolled in the study ranged between 29 and 78 years, and the mean age of patients was 54.8 ± 9.4 years. Out of 103 MetS enrolled in the study, 59 (57.3%) were male and the rest were female, so the prevalence of severe OSA was higher in males than in females. The prevalence increases with an increase in age groups. Weight, body mass index (BMI), circumference, and waist circumference (WC) of cases of OSA were found to be significantly higher as compared to that of non-OSA. An incremental trend of increase in weight, BMI, neck circumference, and WC was observed with the increase in the severity of OSA. Patients of OSA as compared to non-OSA had significantly increased WC, blood pressure (BP), fasting, postprandial, random blood sugar, and triglyceride (TG) levels. A trend of increase in WC, BP fasting, postprandial, random blood sugar, and TG levels was associated with an increase in the severity of OSA. Snoring and daytime sleepiness were observed in a significantly higher proportion of OSA cases as compared to non-OSA cases. This study shows that OSA has a high prevalence in subjects with MetS. A high index of clinical suspicion is required for early diagnosis.

Relationship between chronic rhinosinusitis and risk of obstructive sleep apnea

The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) has not yet been fully elucidated. Therefore, the objective of this study was to evaluate the connection between OSA risk and CRS by investigating associations between the STOP-Bang questionnaire and presence of CRS in a nationwide, population-based study. This is a cross-sectional study based on the Korean National Health and Nutrition Examination Survey (KNHANES). We evaluated 10,081 subjects who completed both the STOP-Bang and CRS-related questionnaires. Among the total subjects, 390 (3.9%) were CRS patients. The median STOP-Bang score was 3.0 [2.0; 4.0] in CRS patients, compared to 2.0 [1.0; 3.0] in subjects without CRS. In a low-risk group according to the STOP-Bang questionnaire, 3.1% of subjects were CRS patients. However, a gradual increase was observed among different risk groups. In the higher risk group, CRS patients accounted for 5.3% (P < 0.001). Among the four main symptoms of CRS (nasal obstruction, nasal discharge, facial pain/pressure, and decreased sense of smell), nasal obstruction (4.1 to 7.3%) and a decreased sense of smell (1.9 to 3.3%) increased with higher STOP-Bang scores. This study found that the proportion of patients with CRS was significantly higher in the group at a higher STOP-Bang score in the general population. Among symptoms of CRS, nasal obstruction and anosmia were found to be associated with an increased STOP-Bang score.

Association between health-related behaviors and obstructive sleep apnea among Korean adults

We aimed to investigate the association between health-related behaviors and obstructive sleep apnea (OSA) among Korean adults. A cross-sectional design using national open data was employed. Data from 8,096 adults aged 40 years and above who participated in the Korea National Health and Nutrition Examination Survey between 2019 and 2021 were analyzed. The participants’ OSA risk level was assessed using the STOP-Bang questionnaire. A logistic regression analysis was performed to investigate the association between health-related behaviors and high risk for OSA. The association between health-related behaviors and OSA risk remained significant for former smokers (OR = 1.643) and high-risk drinking (OR = 1.365), after adjusting for variables that showed significant differences in general and metabolic characteristics. Implementing lifestyle modifications is crucial for mitigating the health and societal impact of OSA. Understanding and addressing modifiable risk factors, including high-risk drinking and smoking, should be prioritized in nursing intervention. Nursing interventions are critical for preventing and managing OSA among Korean adults. Prioritizing high-risk behaviors through cessation programs and education is essential. Vulnerability of individuals living alone must be addressed through community outreach and support services. Emphasizing routine screenings for pre-hypertension and pre-diabetes, promoting balanced nutrition, and encouraging physical activity are crucial.

Two-stage screening for obstructive sleep apnea in the primary practice setting.

To evaluate the effectiveness of a two-stage screening model for obstructive sleep apnea (OSA) in primary care that combines the STOP-BANG questionnaire (SBQ) with an automated home sleep apnea test (HSAT). This cross-sectional study was conducted from August 2018 to August 2022 in four Slovenian primary care practices. It included 153 randomly selected patients aged 18 to 70years who visited the practice for any reason. Participants completed the SBQ and underwent HSAT with type III polygraphy on the same night. The HSAT recordings were scored automatically and by an experienced, accredited somnologist. There was a strong correlation between manual and automated HSAT scorings for the detection of OSA (Pearson's r = 0.93). Cohen's kappa was 0.80 for OSA (respiratory event index (REI) ≥ 5) and 0.77 for OSA severity categorization. The two-stage model demonstrated sensitivity of 64%, a specificity of 97.4%, a positive predictive value (PPV) of 96.0%, a negative predictive value (NPV) of 73.8% and an accuracy of 81.1% for any OSA (REI ≥ 5). For moderate to severe OSA (REI ≥ 15), the model showed 72.7% sensitivity, 96.7% specificity, 85.7% PPV, 92.8% NPV and 91.5% accuracy. The two-stage model for OSA screening combining the SBQ and automated HSAT was shown to be effective in primary care, especially for moderate and severe OSA. This method provides a practical and efficient approach for the early detection of OSA.

Portable polygraphic device (Somnocheck micro CARDIO®) provides accurate diagnostic information in psychiatric patients at risk for obstructive sleep apnoea: an observational cohort study

BackgroundSymptoms of obstructive sleep apnoea (OSA) overlap significantly with those of psychiatric disorders, making accurate diagnosis of OSA challenging within psychiatric settings. Diagnosing OSA in psychiatric patients is crucial because untreated OSA can exacerbate psychiatric symptoms, reduce treatment efficacy, and impair overall quality of life. This study aimed to determine the diagnostic accuracy of a readily accessible procedure for psychiatric patients in a real-world clinical setting by comparing the Somnocheck micro CARDIO® (SCm) portable cardiorespiratory polygraphy device with the gold standard polysomnography (PSG).MethodsThis observational cohort study included consecutive psychiatric patients at intermediate to high risk for OSA based on screening with the STOP-Bang questionnaire, admitted to a single tertiary care centre between June 1, 2016 and December 31, 2022. The Apnoea-Hypopnoea-Index (AHI), Apnoea-Index (AI), Oxygen-Desaturation-Index (ODI), and minimum oxygen saturation were measured sequentially by SCm and PSG.ResultsA total of 57 patients were analysed (median age 62.0 [Interquartile Range (IQR), 51.5–72.5] years; 34 [59.6%] men). Regarding AHI, no significant differences (AHI measured by PSG, median, 16.6 [IQR, 6.2–26.7] vs. AHI measured by SCm, median, 14.9 [IQR, 10.0-22.8]; p = 0.812; r = 0.71) were found between SCm and PSG. AI, ODI and minimum oxygen saturation differed significantly between SCm and PSG. Using optimised cut-off values (any OSA: AHISCm ≥ 9.25), SCm showed high sensitivity (0.894) and high specificity (0.800) for the diagnosis of OSA, with an area under the receiver operating characteristic curve of 0.877.ConclusionsThis study found that the SCm portable device was accurate in identifying psychiatric patients with OSA. AHI measurement by SCm provided reliable diagnostic performance in comparison with the gold standard polysomnography. These findings support the integration of polygraphic measurements into the routine sleep assessment of psychiatric patients. Early and accurate diagnosis of OSA in this population can significantly improve the management of both sleep disorders and psychiatric conditions, potentially enhancing overall treatment outcomes and quality of life for these patients.

Relationship between sleep bruxism and obstructive sleep apnoea: A population-based survey.

Sleep bruxism (SB) and obstructive sleep apnoea (OSA) seem to be mutually associated. This study investigates the relationship between current SB and OSA-related symptoms and the difference in OSA-related symptoms between groups based on a history of SB. An online survey was drafted to report the presence of SB and OSA in sample of 243 individuals (M = 129;F = 114;mean(SD)age = 42.4 ± 14.4 years). The Subject-Based Assessment strategy recommended in the 'Standardized Tool for the Assessment of Bruxism' (STAB) was adopted to assess SB. To evaluate OSA-related symptoms, Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaires were adopted. Correlations between current SB and OSA-related symptoms were evaluated by Spearman test. ESS and STOP-BANG scores were compared by Mann-Whitney U test in individuals with and a without positive SB history. Current SB and SB history were reported by 45.7% and 39.1% of the sample, respectively. 73.7%, 21% and 5.3% of the responders showed a low, intermediate and high risk of OSA, respectively. Neither significant correlations between current SB and OSA nor significant differences between SB groups emerged. This study did neither find any significant correlation between self-report of current SB and OSA nor significant differences in ESS and STOP-BANG scores between groups based on SB history.

P121 ROLE OF AMBULATORY BLOOD PRESSURE MONITORING (ABPM) IN THE EVALUATION OF PATIENTS WITH SUSPECTED SLEEP APNEA

Background and Objective: Obstructive sleep apnea (OSA) often coexists with hypertension. Ambulatory blood pressure monitoring (ABPM) is essential for detecting significant blood pressure fluctuations, especially during nighttime. This study seeks to assess the role of ABPM in identifying OSA. Methods: We analyzed a database of patients with suspected OSA using the STOP-BANG questionnaire at a cardiology center from July 2020 to April 2024. Anthropometric characteristics, blood pressure behavior through ABPM, and sleep patterns via polysomnography were evaluated. The influence of risk predictors on OSA development was assessed using multinomial logistic regression. Results: The study included 38 men (50.6%) and 37 women (49.3%); 48 hypertensive patients (64%) and 27 without hypertension (27%). The average STOP-BANG score was 3.8. Of these, 92% had some degree of OSA. The mean age was 60±13.2 years. Neck circumference (NC) and total apnea-hypopnea index were 37.5 cm and 19.7 events/hour, respectively, with a predominance of REM OSA. Only NC and nocturnal diastolic pressure were significant variables. For the development of moderate OSA, NC showed significant relative risk ratios (RRR) (p=0.045). Severe OSA development was influenced by mean nocturnal diastolic blood pressure (MNDAP) and NC, with significant RRRs (p=0.007 and p=0.041, respectively). This means that for each mmHg increase in nocturnal diastolic pressure, the risk of severe OSA increases by 1.3 times compared to healthy patients, predominantly during REM sleep. Conversely, increased daytime diastolic pressure decreases this risk by 25%. Conclusions: An increase in mean nocturnal diastolic pressure measured by ABPM is a significant predictor of severe OSA development. This underscores ABPM's importance in evaluating patients with suspected OSA. While the STOP-BANG questionnaire is useful for initial OSA suspicion, it has limitations in identifying the most severe cases, necessitating tools like ABPM for more accurate assessment. The use of ABPM improves accuracy in detecting severe OSA and enhances understanding of hypertension phenotypes’ pathophysiology. Table 1. Obstructive Sleep Apnea (OSA) Severity Classification and Its Correlation with Mean Nocturnal Diastolic Blood Pressure (MNDAP), Mean Daytime Diastolic Blood Pressure (MDDAP), and Neck Circumference (NC)

P189 HYPERTENSION AND OBSTRUCTIVE SLEEP APNOEA SYNDROME IN ADULTS WITH HEART FAILURE IN NIGERIA: CLINICAL CORRELATES AND ASSOCIATION WITH CLINICAL OUTCOMES

Rationale: Heart failure (HF) is a common endpoint for cardiovascular diseases. It is a major cause of morbidity and mortality worldwide. Hypertension is a leading cause of HF; a significant proportion of HF patients also have obstructive sleep apnea syndrome (OSAS) which is known to impact clinical outcomes adversely. The diagnosis of OSAS is often missed due to inadequate clinical diagnosis and diagnostic backup. This study aims to add to the body of evidence thereby improving outcomes in HF patients. Methods: This cross-sectional descriptive study involved 200 consenting adults with HF at Jos University Teaching Hospital, Nigeria. Each participant had relevant medical history, physical examination (including a six-minute walk test distance) and relevant investigations. OSAS was diagnosed using high-risk scores obtained using Berlin and STOP-Bang questionnaires, daytime somnolence was assessed by Epworth questionnaire and quality of life by Minnesota living with HF questionnaire. Comorbidities were assessed using Charlson comorbidity index (CCI)) and hospitalizations in the preceding 12 months documented. Data was analyzed using Stata version 13. Results: Hypertension was the aetiology of HF in 41% of the study population and 62.8% of the subset with OSAS (p=0.001). OSAS was identified in 47% and 45.5% by high-risk scores obtained using Berlin and STOP-Bang questionnaires respectively. Significant daytime somnolence was identified in 56.0% of the study population and 93.6% of those with OSAS, (p&lt;0.001). Those with OSAS had a significant association with hypertension (p=0.001), atrial fibrillation (p&lt;0.001), obesity (p=0.002), higher comorbidity index (p=0.001), HF with preserved ejection pattern (p=0.001) and NYHA ≥3 (p&lt;0.001). OSAS was significantly associated with six-minute WTD ≤ 300m, hospitalizations (p&lt;0.001) and sub-optimal quality of life (p=0.003). Conclusion: Hypertension and OSAS are significantly associated and are common in HF. It is recommended to routinely screen HF patients for OSAS as the diagnosis is often missed with consequent adverse clinical outcomes. This will facilitate prompt diagnosis, enhance management and favourable clinical outcomes in HF patients.