STOP BANG Research Articles

Preoperative hypoxic biomarkers and postoperative delirium in patients with obstructive sleep apnea.

Postoperative delirium (POD) in patients with obstructive sleep apnea (OSA) is associated with increased mortality and healthcare costs. In this study, we investigated the association of OSA risk, serum biomarkers for central nervous ischemia (S100B and NSE), and POD. After research ethics approval, patients completed the STOP BANG assessment before undergoing elective surgery. Blood was drawn for S100B and NSE measurement, and cognitive performance was tested using the Montreal Cognitive Assessment (MoCA) at study admission and postoperatively at discharge. Delirium assessment was performed using the Nursing Delirium Screening Scale (NuDESC) and the Confusion Assessment Method (CAM). One hundred twenty-four enrolled patients were separated into three OSA-risk groups based on STOP BANG score testing (low risk, n = 22; intermediate risk, n = 67; high risk, n = 35). Preoperative NSE values increased with OSA risk (NSE in ng/ml; mean [range]; low risk: 15.6 [9.2-44.3]; intermediate risk: 21.8 [7.6-114.1]; high risk: 29.2 [10.1-151]; p = 0.039). Postoperative MoCA and NuDESC assessments were not different between the OSA-risk groups. We found a decreasing incidence for POD with increasing OSA risk (positive CAM: low risk: 18.1%, intermediate risk: 12.0%; high risk: 11.5%, p = 0.043). However, this was no longer detectable in a complete case analysis. In patients with POD, postoperative ischemic biomarker values were not different between OSA-risk groups. We found a trend of decreasing POD incidence with increasing OSA risk, which was not robust in a complete case analysis. Our results possibly support the phenomenon of hypoxic preconditioning.

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.

P115 CLINICAL PROFILE AND PREVALENCE OF OBSTRUCTIVE SLEEP APNEA IN A POPULATION OF YOUNG ADULTS REGISTERED IN A PRIMARY CARE UNIT IN RIO DE JANEIRO

Background: Obstructive Sleep Apnea (OSA) is strongly associated with high blood pressure (BP) and cardiovascular risk (CVR). There is a lack of studies and specific screening for younger populations, which could allow for early intervention and potentially reduce CVR. Objective: Analyze the prevalence and clinical profile of OSA, identifying the best screening method in a young population attended by a Family Health Strategy Unit in Rio de Janeiro. Methods: Cross-sectional population study of adults between 20 and 65 years old. Sociodemographic characteristics, anthropometric measures and CVR were obtained. Office BP was calculated using two measurements. The risk of OSA was assessed using STOP-BANG (SB) and Epworth Sleepiness Scale (ESS) questionnaires. All underwent home polysomnography. Result: 67 individuals included [38.9% men; average age of 38.9 ± 8 years]: 35 without OSA, 20 with mild OSA, 9 with moderate OSA and 3 with severe OSA. The prevalence of moderate/severe OSA was 18%. Individuals with moderate/severe OSA were older, more obese, had higher prevalence of increased neck circumference, dyslipidemia and heart rate. High risk for OSA in screening by SB, ESS and both questionnaires was respectively 55.2%, 44.8% and 19.4%. SB confirmed moderate/severe OSA in 30% in high-risk individuals, and excluded in 97% of low risk, with 60% accuracy. The sensitivity, specificity, PPV and NPV of SB to identify moderate/severe OSA were respectively 92%, 53%, 36% and 97%. In those with high risk according to the ESS, moderate/severe OSA was confirmed in 13%, while in those with low risk it was excluded in 78%. The accuracy of the ESS was 49%. The sensitivity, specificity, PPV and NPV of the ESS to identify moderate/severe OSA were respectively 33%, 53%, 13% and 78%. Conclusion: Moderate/severe OSA was more associated with an adverse metabolic profile than with high BP. The best screening questionnaire for this population is the STOP-BANG.

Lipid Profile and Ankle Brachial Index in Obese Male Subjects with Obstructive Sleep Apnea: Cross sectional analytical study

Background &amp; Objective: Obstructive sleep apnea (OSA) and dyslipidemia are common medical disorders that independently increase vascular morbidity and mortality. Currently, there is no conclusive data indicating that Obstructive Sleep Apnea serves as a risk factor for disrupted lipid profiles and subclinical atherosclerosis, as assessed by ankle-brachial index (ABI). The objective of this cross-sectional study was to assess lipid profiles, blood sugar levels, and ankle brachial index in obese male participants with OSA and to compare them with obese individuals lacking OSA. Methods: In the present study, 64 obese males with BMI &gt; 25kg/m2 were included between ages 20 - 45 years. Subjects having acute or chronic inflammatory conditions were excluded. Obstructive sleep apnea (OSA) diagnosis involved two subjective assessment tools, the Berlin and STOP BANG questionnaires, followed by overnight portable pulse oximetry. The study participants were partitioned into two distinct groups, 32 with OSA and 32 without OSA. Following an overnight fast lasting between 10 to 12 hours, blood samples were collected. Fasting blood glucose and lipid profiles were then analyzed using a spectrophotometer. ABI was measured by using a Doppler ultrasound device. The data was collected and then entered SPSS version 22 and analyzed. The study utilized both Independent Samples t-test as well as Mann-Whitney U test to analyze and compare the quantitative variables across the two groups. Results Comparison of ABI between the study groups showed a non-significant difference p-value= 0.435. Fasting blood sugar levels showed insignificant difference (p-value 0.778) among the study groups. Comparison between the groups showed a nonsignificant difference in triglyceride levels (p= 0.413) cholesterol (p-value 0.523), HDL (p-value 0.190), and LDL (p-value 0.888). Conclusion Normal lipid profile and normal ABI indicate the absence of detectable atherosclerosis in young apparently healthy OSA subjects without known comorbidities.

Prevalence of co-morbid insomnia and obstructive sleep apnoea.

The coexistence of insomnia and obstructive sleep apnea (OSA) poses a complex and challenging clinical scenario, commonly referred to as comorbid insomnia and OSA (COMISA). The bidirectional relationship between these two sleep disorders is explored, illuminating how the presence of one can exacerbate the severity and manifestations of the other. We under took this study to understand the prevalence of COMISA in Indians which is never studied. To study the prevalence of COMISA in tertiary hospital in India. All OSA patients diagnosed with polysomnography were interviewed with insomnia severity index. Patients having score of more than 15 were considered to have insomnia. Demographic factors, clinical and physical examination and polysomnography values were noted. 25% of 64 patients were diagnosed to have COMISA. Female gender, BMI, and STOP BANG score had positive association with COMISA, whereas age was not associated with increased risk. COMISA can be more complex to diagnose and manage than insomnia or OSA alone. The symptoms and mechanisms of each condition have synergistic effect and is a barrier to treating COMISA.

Disparities in polysomnography referral in a high-risk cardiac population.

Obstructive sleep apnea (OSA) is associated with metabolic, cardiovascular, and cerebrovascular comorbidities. Appropriate diagnosis and treatment of OSA might mitigate these comorbidities. This retrospective review sought to assess the impact of sex, age, race, ethnicity, and insurance status on polysomnography (PSG) referral rates. An institutional STOP-Bang database of 299,320 patients was filtered for patients admitted to the hospital with an acute cardiac diagnosis between 2015-2020. A cohort of 4,735 patients were risk stratified by STOP-Bang (SB) score and correlations were made between PSG referrals and demographic and clinical variables (sex, age, race, ethnicity, and insurance status). Of the 25.3% of the cohort with high SB scores (5-8) only 21.3% were referred for PSG. Age and female sex were negatively associated with sleep study referrals (p < 0.001). No correlation was found between sleep study referral rates and race or ethnicity. No correlation was found between sleep study referrals and insurance provider. Admitting cardiac diagnosis significantly influenced sleep study referrals with diagnoses of arrhythmias and myocardial infarction being associated with an increased rate of PSG referrals compared to heart failure patients (p < 0.002). Our study found no significant correlation between PSG referral rates and race, ethnicity, or insurance provider. However, we found low overall rates of PSG referral, with negative correlations between older age and female sex and a high-risk cardiac population. This represents a substantial missed opportunity to identify patients at risk for OSA, obtain a diagnosis, and provider adequate treatment.

Regional Anaesthesia with Non Invasive Ventilation and Conscious Sedation: An Alternative to General Anaesthesia in Morbidly Obese Patients with Obstructive Sleep Apnea in Retrograde Intrarenal Surgery

Obstructive sleep apnea(OSA) is a syndrome characterized by obstruction in the upper airway during sleep. OSA patients undergoing procedures under GA are at increased risk for hypoxemia, pneumonia, difficult intubation, atelactasis, myocardial infarction making it a challenge for anesthesiologist. Retrograde intrarenal surgery(RIRS) is normally performed under GA to prevent respiratory embaracement. There are very few studies focusing on Regional anesthesia in RIRS procedure. A Sixty-three-year-old male known case of morbid obesity (BMI- 35 kg/meter square), OSA (on CPAP support at night) presented with left renal pelvis calculus, STOP BANG score (=5) therefore making it a case of difficult airway. Respiratory discomfort improved at 30-35-degree head up due to existing OSA considering the severe OSA and anticipated difficult airway, the surgery was planned under Lumbar subarachnoid block with preparation for management of difficult airway if conversion to GA required. 3 ml of 0.5 percent Bupivacaine heavy and 25 mcg fentanyl injected into subarachnoid space. T6 level block acheived after 3 minutes. The patient was put on his home CPAP machine with 5cm H2O PEEP. The patient was maintained on sponatneous ventilation and monitored using Etco2 at aliquot of 1mg midazolam given to mimic natural sleep pattern. The surgery was uneventful and the risk of induction of GA and difficult intubation was succesfully avoided. Patient with regional anaesthesia who are prone to converted to GA due to multiple risk factors, i.e., OSA with anticipated difficult airway can create a chaotic situation. So as a preliminary step NIV can be used, and along with it, mild sedation can be supplemented to improve acceptance and to avoid asynchrony. In this case NIV was used as a preemptive ventilation strategy even before actual requirement of BiPAP by mimicing the natural sleep pattern and make patient comfortable while a smooth conductance of the procedure.

Pulmonary hypertension in newly diagnosed obstructive sleep apnea-chronic obstructive pulmonary disease overlap syndrome patients attending a tertiary care centre-a cross-sectional analysis.

Overlap syndrome is the association of obstructive sleep apnea (OSA) with chronic obstructive pulmonary disorder and with other chronic respiratory diseases. Patients with overlap syndrome have a worse prognosis compared with chronic obstructive pulmonary disorder or OSA alone. Additionally, patients with combined chronic obstructive pulmonary disorder and OSA are more likely to develop pulmonary hypertension and right heart failure much earlier than those without overlap. To assess the occurrence of pulmonary hypertension (PH) in newly diagnosed OSA-chronic obstructive pulmonary disorder overlap syndrome patients attending a tertiary care centre. This cross-sectional study was conducted at Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala, South India, among patients with OSA above 40years of age who were proactively evaluated to pick out those with undiagnosed overlap. A period of 6months after getting ethical clearance from June 2018 was selected as the study period. Among patients with symptoms suggestive of OSA above 40years of age who gave the informed consent were enrolled after screening with Standard Sleep questionnaires (Berlin questionnaire, STOP BANG and Epworth Sleepiness Scale). Enrolled patients underwent routine spirometry and sleep study using the standard Level 1 overnight polysomnography (Level1 OPSG). Patients were classified in to two groups as OSA patients (group I), having an apnea hypopnea index (AHI) > 5/hr alone and the second group as those OSA patients (group II), with an obstructive spirometry pattern who were the overlap group. Arterial blood gas analysis (a sample of radial arterial blood was drawn with the patient awake and supine, and was analyzed for pH, PaCO2 and PaO2) and echocardiography (ECHO) of the two groups were compared as a non-invasive method to assess pulmonary artery hypertension and results were analyzed in a systematic manner. Among the 84 patients enrolled, 16.7% had overlap syndrome and the rest had OSA alone. Statistically significant higher mean weight and BMI for those with overlap syndrome compared to the OSA group were observed. Mean FVC (forced vital capacity), FEV1 (forced expiratory volume 1s), and FEV1/FVC were lower in those with overlap syndrome compared to OSA group. The mean values of ABG parameters revealed higher PaCO2 and lower PaO2 among the group with overlap syndrome which were statistically significant. However, there was no significant difference in resting room air SaO2 value between the two groups. The mean values of sleep duration and efficiency were significantly lower in those with overlap syndrome with a p value < 0.001. The mean value of arousal and REM (rapid eye movement) sleep percentage were significantly higher among those with overlap syndrome (p < 0.001). Mean value of NREM (non-rapid eye movement) sleep percentage was lower among the group with overlap syndrome compared with the OSA group, and this difference was statistically significant. The mean AHI value of the overlap syndrome group was 39.79 ± 7.54 and this was significantly higher than the OSA group (p < 0.004). Among the 14 patients who had ECHO evidence of pulmonary hypertension, 9 (64.3%) belonged to the overlap group which shows that they are a highly vulnerable group for developing pulmonary hypertension (PH) and requires early detection and more rigorous treatment. This study confirms that OSA patients with modest daytime level of hypoxemia and mild-moderate chronic airflow limitation have a high prevalence of PH. Chronic airway obstruction may be asymptomatic in some subjects and this stresses the necessity of pulmonary function test in OSA.

(332) Predictors of being at High Risk for Obstructive Sleep Apnea in Men Presenting for Low Testosterone Evaluation

Abstract Introduction Obstructive sleep apnea (OSA) is a common condition and is more common in men with obesity and low testosterone (T). In men with OSA, T therapy is associated with the development of polycythemia (POLY). It has been shown that men with OSA have a higher risk of POLY with T therapy. Objective We aimed to identify the predictors of being at high risk for OSA in men presenting for low T assessment. Methods The study population included men undergoing low T assessment who completed the OSA risk assessment questionnaire, the STOP-BANG (SB). SB contains 8 questions: STOP (Snoring, Tiredness, Observed apnea during sleeping and high blood Pressure); BANG (BMI ≥ 35, Age ≥ 50, Neck circumference ≥ 17 inches, Gender). Each question is scored as yes (1) or no (0) and is scored 0-8. Using this score, patients are categorized as low risk of OSA (score 0-2), intermediate risk (score 3-4), or high risk (score ≥ 5 or ≥ 3 plus a BMI ≥ 35 or a neck circumference ≥ 17 inches). We also measured total T and free T levels, hematocrit (HCT), and recorded BMI and demographics. Multivariable analysis (MVA) was performed to define predictors of having a high risk of OSA. Parameters in the model included: age, comorbidities (hypertension, diabetes, dyslipidemia, coronary arterial disease), total T, HCT, and BMI. Receiver operating characteristic (ROC) analysis was performed to identify a BMI cut-off point associated with high risk OSA. Results 321 men were analyzed. Median age was 64 (56, 69) years. Median SB score was 4 (3, 5), 55% were high risk, 25% moderate risk, and 19% low risk. 46% had 2 ≥ comorbidities. 57% had T levels ≤300 ng/dL. Median total and free T were 281 (222, 373) and 7.5 (5.4, 10) ng/dL and median LH was 3.7 (2.2, 6.7). Median HCT was 44% (41, 46). 33% had HCT ≥ 45%, and 4% had HCT &amp;gt; 50%. Median BMI was 29 (26, 33) kg/m2 and 42% had obesity (BMI ≥ 30 kg/m2). On MVA, BMI and ≥2 comorbidities predicted high risk for OSA. ROC analysis showed cut-off point BMI ≥ 27 kg/m2 is associated with high risk for OSA by SB (sensitivity=0.8; specificity=0.6; AUC=0.77; p&amp;lt;0.001). For men with BMI ≥27 kg/m2, the rate of high risk OSA was 71%, versus 29% rate of high risk in men with BMI &amp;lt;27 kg/m2. Conclusions BMI ≥ 27 kg/m2 or higher and the presence of 2 or more comorbidities are the main predictors of high risk OSA. Disclosure No.

Self-Reported Sleepiness, Fatigue and Risk of Obstructive Sleep Apnea Using the STOP BANG Components: Women’s Perspective

Introduction: About 2-4% of adults have obstructive sleep apnoea (OSA), a frequent chronic condition. The disorder is characterised by recurrent bouts of whole or partial collapse of the upper airway, primarily the oropharyngeal tract, while sleeping, which results in a decrease or stoppage of airflow. The aim of the study is to assess the relationship between the self-reported sleepiness, fatigue and the risk of Obstructive Sleep Apnea among the midlife women aged 40 to 65 years Methodology: This was a cross sectional study conducted in the field practice area of rural and urban health and training centre of a tertiary care teaching hospital, Chengalpattu district, Tamilnadu among 380 women aged 40 to 65 years. Results: Mean age of the study population was 49.69 (± 11.2). On risk categorization by STOP-BANG Questionnaire, it was found that 72.9% (277), 26.1% (99) and 1.1% (4) had low, intermediate and high risk for sleep apnea. 16.9% of the study participants had excessive daytime sleepiness. Fatigue severity scale of more than or equal to 36 was seen among 34.5% of the study participants. Conclusion: The STOP-Bang questionnaire has been shown in studies to be a quick, efficient, and accurate OSA screening tool. It can make it easier to allocate resources effectively for detecting and treating OSA that had not yet been recognised.

Assessment of Leptin Levels and Their Correlation With the Severity of Obstructive Sleep Apnea Syndrome: A Case-Control Study.

Background Obstructive sleep apnea (OSA) is characterized by a combination of structural issues in the upper airway and imbalances in the respiratory control system. While numerous studies have linked OSA with obesity, it remains uncertain whether leptin, a hormone associated with fat, plays a role in the functional and anatomical defects that lead to OSA. Therefore, the aim of this study was to investigate whether leptin levels could be used as a predictor of OSA syndrome (OSAS). Methodology A case-control observational study was conducted, enrolling study participants who reported obesity (BMI > 30) within the range of >30 to <35 kg/m2, along with a short neck and a history of snoring, excessive daytime drowsiness, fatigue, or insomnia. Leptin levels and fasting blood sugar (FBS) were measured in all individuals. Additionally, the study evaluated the severity of OSAS using indicators such as the STOP BANG scores, apnea-hypopnea index, uvula grade score, and Epworth Sleepiness Scale scores. Results A total of 80 participants (40 cases and 40 controls) were included in the study. The mean leptin and FBS levels were significantly higher in cases compared to controls. Moreover, leptin levels exhibited a significant correlation with the severity indices of OSAS. Conclusion The study findings indicate that individuals with higher leptin levels tend to exhibit more severe OSAS symptoms. Furthermore, these elevated leptin levels contribute to the worsening of various OSA symptoms. Larger controlled studies have suggested that pharmacologically restoring the altered leptin levels may serve as a beneficial adjunct to treatment for alleviating OSAS symptoms.

Obstructive sleep apnea in type 2 diabetes mellitus patients

Abstract Objective The study aims to identify the prevalence and risk factors for OSA in a group of Egyptian patients with type 2 diabetes. Methods 125 type 2 diabetes mellitus patients visited Mansoura University Hospital (Diabetes Mellitus Outpatient Clinic (OPC) at Specialized Medical Hospital and the Sleep Disordered Breathing Unit of the Chest Department), all of them exposed to history taking, the patients underwent anthropometric measurements (weight, height, body mass index, neck circumference), a test of their tonsillar size, Malampati score, Friedman OSA score, Epworth sleepiness scale (ESS), Berlin questionnaire, STOP BANG questionnaire, full-night polysomnography, fasting, and postprandial blood sugar. Results The study included 125 T2DM Egyptian patients with a mean age of 54.63 ± 9.47 years. Males accounted for 35.2 percent of patients, while females accounted for 64.8%. According to the study of co-morbidity, hypertension constituted 77 (61.1%), ischemic heart disease 28 (22.4%), other cardiac diseases 11 (8.8%), bronchial asthma 6 (4.8%), liver diseases 6 (4.8%), hypothyroidism 3 (2.4%), and renal diseases 3 (2.4%). A total of seven patients (5.6%) had no OSA symptoms, 87 had borderline symptoms, and 31 had positive symptoms. There were 51 (40.8%) normal patients, 12 (9.6%) borderline patients, and 62 (49.6%) sleepy patients on the Epworth scale. According to the Stop-Bang questionnaire, 121 (96.8%) patients answered positively. It was determined that 122 patients (97.6%) were at high risk based on the Berlin questionnaire. There were 17 patients (13.6%) with OSA on polysomnography, of which six were moderate (35.3%) and 11 were severe (64.7%). Among moderate and severe OSA patients, glycosylated hemoglobin levels differed significantly. Multivariate logistic regression analysis for independent predictors of OSA, chronic renal disease patients is the most common associated risk factor (OR = 14.3, CI = 1.2–67) then hypertension (OR = 5.6,CI=1.2–25.5) and heart failure (OR = 4.4). Conclusions OSA affects 13.6% patients with type 2 diabetes patients who are hypertensive are at higher risk of OSA, chronic renal failure is considered another risk factor Furthers studies are needed on a big scale of Egyptian diabetic patients to detect the prevalence of OSA

A hospital based study to assess risk of obstructive sleep apnea in a population visiting dental out patient department

Studies focusing on subjective assessment of risk of obstructive sleep apnea in general population are sparse. The purpose of this cross- sectional study was to assess the risk of obstructive sleep apnea in a population visiting dental Out Patient Department. Three hundred consenting participants between the age group of 18-65yrs reporting to the dental OPD were enrolled in the study. Polysomnography is the gold standard of diagnosis of OSA, however, due to cost and elaborate procedure other methods of diagnosis and risk assessment were used as tools. STOP BANG questionnaire was evaluated for the participants and grouping was done into high, moderate and low-risk OSA patients. Anthropometric patient measurements, including Body Mass Index (BMI), age, neck circumference and gender, were recorded. Blood pressure was assessed by a digital blood pressure instrument to check the systolic and diastolic levels. Data was collected and statistically analyzed. The BMI for males was 24.5±3.9, and for females, it was 24.5±4.6. The mean neck circumference in males was higher (14.4±1.2) compared with females (13.1±1.4). 4.1% of males had a high risk of neck circumference, whereas 3.7% of females had a high risk. 16.1% of males reported hypertensive systole compared with 8.2% of females and 23.9% of males reported hypertensive diastole compared with 18% of females. Risk assessment of OSA based on STOP-BANG scoring revealed that 63.6% of the total study population were at low risk of developing OSA, 32% at high risk and, 4.4% of the study population at very high risk of developing OSA. Males were at higher risk than females. OSA has a high prevalence and a higher tendency to remain underdiagnosed due to a lack of awareness amongst the population as well as dental and healthcare professionals. There can be an essential role of a dentist in identifying the risk factors of OSA and referring those patients to sleep, specialists. In the long run, the dentists' early diagnosis of OSA patients may prevent OSA complications and aid in managing the condition.

0504 STOP BANG FAN, A Novel Screening Tool of OSA in Sleep Clinic

Abstract Introduction We noticed that patients with OSA when admitted to hospital requested a fan even in winter. We explored the literature and did not find any reports about fan use in OSA. STOP-Bang questionnaire has been widely used in preoperative clinics [4-6], sleep clinics [7-8] to detect patients at high-risk of OSA. STOP Bang score 5 or more has high risk of OSA. We did a pilot study to explore if adding the use of FAN, especially in winter, would increase the sensitivity of STOP Bang questionnaire in the sleep clinic. Methods We screened 350 consecutive patients referred to our sleep clinic for suspected OSA in the period of March 2021 to April 2022, with STOP Bang FAN questionnaire. The questionnaire added if they use FAN during sleep in addition to the air condition and if they still use it in winter. Results 255 (73%) used FAN during sleep and 210 (60%) used the fan in winter. 247 patients had PSG, the others did not for variable reasons, including refusing COVID test before the study, insurance issues or no insurance. In the 247 patients who had the PSG the sensitivity of STOP Bang score 5 or more, STOP Bang score 5 or more + Sleeping with FAN and STOP Bang score 5 or more + sleeping with Fan in winter for OSA AHI 5 or more were 78%, 83% and 89%. The sensitivity of STOP Bang score 5 or more, STOP Bang score 5 or more + Sleeping with FAN and STOP Bang score 5 or more + sleeping with Fan in winter for moderate and severe OSA AHI 15 or more were 65%, 74% and 79%. The sensitivity of STOP Bang score 5 or more, STOP Bang score 5 or more + Sleeping with FAN and STOP Bang score 5 or more + sleeping with Fan in winter for severe OSA AHI 30 or more were 55%, 64% and 71%. Conclusion Adding the use of the FAN and especially FAN in winter during sleep to STOP Bang would increase the sensitivity of the questionnaire for suspected OSA in sleep clinic. Support (if any)

Prevalence and determinants of post-stroke sleep disorders: a cross-sectional hospital-based study.

Post-stroke sleep disorders (PSSD) are an important part of post-stroke disability. PSSD is neglected as a part of stroke rehabilitation. We aimed to study the prevalence and determinants of PSSD in a hospital based, single center setting. In a cross-sectional study, adult patients (≥ 18years) with stroke (one month to one year after the onset), were enrolled in the study. Demographic, clinical, radiological, and motor and functional disabilities were assessed. Sleep quality was assessed with Pittsburg Sleep Quality Index (PSQI) and STOP BANG questionnaire (for obstructive sleep apnea [OSA]). Patients with poor sleep quality (PSQI > 5) were analyzed for risk factors. A total of 103 patients were recruited in the study period (January 2021 to June 2022). The self-reported prevalence of PSSD was 16% which increased to 72% when thePSQI was administered. High risk of OSA was present in 33%. In bivariate analysis, factors associated with PSQI > 5 were involvement of ≥ 2 lobes, lower body mass index (BMI), worse modified Rankin Scale (mRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Stroke Specific Quality of Life (SSQoL). In multivariate analysis, only depression was associated with PSQI > 5 (OR: 1.3 (1.0; 1.7); p-value = 0.03). PSSD had a prevalence of 72%. In multivariate analysis, the factor associated with PSQI > 5 was worse HAM-D score.

Bariatric surgeries: Outcome throughout an annum at a specialist center in Malaysia.

Malaysia has the highest number of obese and overweight individuals in South-east Asia. The 2019 National Health & Morbidity survey found 50.1% of Malaysians to be overweight or obese with 30.4% being overweight and 19.7% being obese. This has led to the high rise of the bariatric surgeries demand and needs within the nation. To assess the level of fasting blood sugar (FBS), systolic, diastolic blood pressure, stop BANG score for obstructive sleep apnoea (OSA) and BMI (Body Mass Index) for the patients before and after bariatric surgeries (sleeve/gastric bypass) for a one year follow up period. The study was conducted among 1000 patients who underwent a single weight reduction surgery (sleeve/gastric bypass) by a single surgeon at the Cengild Medical Centre between January 2019 to January 2020. They were followed up for a one-year period through recording the parameters of fasting blood sugar (FBS), systolic, diastolic blood pressure, stop BANG score for obstructive sleep apnoea (OSA) and BMI (Body Mass Index). Study was conducted using universal sampling including all subjects visited the centre and a written consent was obtained from each participant. Descriptive statistics with mean was used and paired t-test was used for comparison and test the difference. The STOP-BANG acronym stands for: Snoring history, Tired during the day, Observed stop breathing while sleep, High blood pressure, BMI more than 35 kg/m2, Age more than 50 years, Neck circumference more than 40 cm and male Gender. The mean age of patients was 38 years old. Mean FBS for the patients one month before the operation was 10.42 mmol/L and 5.84 three months post procedure. The systolic blood pressure one month before the operation and 3 months after was 139.81 mmHg and 123.79 mmHg, while diastolic blood pressure was 86.84 mmHg and 81.07 mmHg respectively. BMI was reduced from 39.69 to 27.99 after one year from the weight reduction operation. All the above parameters showed a significant reduction between one-month pre operation as compared to 3 months and 12 months post operation and that improved the health parameters of the patients significantly. The weight reduction operations showed a significant reduction in the FBS, blood pressure, OSA scores and BMI at 3, 12 months after the operation These patients had better overall health after the significant reduction in these parameters.

Association Between Self And Caregiver Reported Sleep Problems And Polysomnographic Findings In Post-stroke Patients: A Cross Sectional Study. (S20.007)

<h3>Objective:</h3> To determine post-stroke sleep disturbances (PSSD) by polysomnography (PSG) and compare them with patient and caregiver reported symptoms and sleep questionnaires <h3>Background:</h3> Post stroke sleep disturbances (PSSD) are common with prevalence of 70–80%. The awareness of patients and caregivers about the various sleep problems and its implications on quality of life &amp; outcome has not studied extensively. Identification can aid in optimum management and rehabilitation of post-stroke patients. <h3>Design/Methods:</h3> In a cross-sectional study, we screened post-stroke patients (between one month to one year after stroke onset) &amp; their caregivers about various sleep problems. This was done by a screening questionnaire, followed by specific sleep questionnaires (Pittsburgh sleep quality index (PSQI) and STOP BANG questionnaire). A subset of consenting patients underwent overnight PSG. The association of sleep questionnaires with PSG findings were done. <h3>Results:</h3> In the study period (January 2021 and June 2022), 103 post-stroke patients were enrolled, of which 41(39.8%) underwent PSG. While only 15.5% (16/103) patients and/or caregivers reported any sleep disorders themselves, when specifically asked about insomnia, snoring, excessive daytime sleepiness &amp; abnormal leg movements in sleep, this number increased to 60.2% (60/103). Further, a PSQI&gt;5, signifying poor sleep quality was present in 71.8% (74/103), and high risk of obstructive sleep apnea (OSA) by STOP BANG questionnaire was present in 33% (34/103). PSG showed Apnea Hypopnea Index (AHI)&gt;5 in 65.9% (27/41) patients, 39% (16/41) had periodic leg movements (PLMS) and 34.2% (14/41) had disrupted sleep. Even when patients &amp; caregivers had denied any sleep disturbances, the PSG in 29 such patients showed OSA in 62 % (18/29) and PLMS in 34.5% (10/29). <h3>Conclusions:</h3> The study provided insight into the knowledge gap between patient &amp; caregiver perceived sleep disturbances &amp; sleep questionnaires and polysomnography. Longitudinal studies are warranted in this population to assess the effect of treatment of sleep disturbances on outcomes like quality of life and stroke recurrence. <b>Disclosure:</b> Dr. Tayade has nothing to disclose. Dr. Vibha has nothing to disclose. Dr. Tripathi has nothing to disclose. Rajesh Kumar Singh has nothing to disclose. Dr. Elavarasi has stock in Pfizer. Dr. Elavarasi has stock in PGHL. The institution of Dr. Elavarasi has received research support from All India Institute of Medical Sciences, New Delhi. The institution of Dr. Elavarasi has received research support from Indian Council for Medical Research.

Predictive Abilities of Epworth Sleepiness Scale and Stop Bang in Identifying Patients at High Risk of Obstructive Sleep Apnea

Background: The aim of the study is to evaluate the diagnostic precision of utilizing both Stop-bang and Epworth sleepiness scale in predicting obstructive sleep apnea (OSA) for individuals with clinical suspicion, while considering polysomnography as the reference standard. Methods and Material: A cross-sectional (validation) study was conducted between 4th September 2017 and 3rd January 2018 at the Department of Pulmonology, Military Hospital Rawalpindi. A total of two hundred and eight (n=208) clinically suspected cases of OSA between age 40-60 years irrespective of gender were enrolled in the study. ESS and stop-Bang score was measured in all patients compared with apnea-hypopnea index (AHI). Diagnostic accuracy of combined ESS/Stop-Bang was calculated. Results: The findings of our research indicate that the utilization of combined ESS/Stop Bang (with a cut off point of ESS&gt;3/STOP BANG &gt;10) yielded a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 73.7%, 66.7%, 79.7%, 58.8% and 71.2% respectively. Conclusion: ESS/Stop-Bang when combined allow diagnosis of OSA with reasonable accuracy. The outcomes of our investigation revealed that the accuracy, sensitivity, specificity, NPV and PPV were 71.2%, 73.7%, 66.7%, 58.8% and 79.7% correspondingly. Keywords: Epworth sleepiness score, Obstructive sleep apnea, Stop-Bang

Obstructive sleep apnea and excessive daytime sleepiness among commercial motor vehicle drivers in Lusaka, Zambia.

Obstructive sleep apnea (OSA) is a risk factor for a major public health problem, car crashes, due to excessive daytime sleepiness (EDS). Commercial vehicle driving (CVD) is a hazardous occupation, having a high fatality rate worldwide. There have been no studies on EDS and OSA in Zambia despite the high rate of annual road traffic accidents (RTAs). We aim to determine the prevalence of EDS and OSA risk among CVDs in Lusaka, Zambia, to assess the impact of OSA on high RTA rates. This was a cross-sectional study. The STOP BANG questionnaire and the Epworth Sleepiness Scale were used. Consecutive sampling of drivers was done who were divided into low and high risk of OSA (HROSA). The risk factors associated with OSA in the bivariate analyses were subjected to a multivariate logistic regression model. One hundred thirty-six drivers participated in the study (all male) with a mean age of 48 ± 5 years. The prevalence of HROSA was 22.8% out of whom 67.7% also had a EDS. Only 9.6% of the total cohort had EDS without HROSA. Using Fisher's exact test, HROSA was significantly associated with older age (> 50 years, P < .001), obesity (body mass index >30, P < .001), neck circumference of > 40 cm (P = .032), and hypertension (P < .001). Snoring and EDS were significantly associated with RTAs (P < .0001 and P = .007, respectively). High risk of OSA and EDS are common among CMV drivers in Zambia and underdiagnosed. The risk factors for OSA are amenable to preventive interventions. Simpamba K, May JL, Waghat A, Attarian H, Mateyo K. Obstructive sleep apnea and excessive daytime sleepiness among commercial motor vehicle drivers in Lusaka, Zambia. J Clin Sleep Med. 2023;19(7):1191-1198.

PREVALENCE OF OVERLAP SYNDROME AND ITS CORRELATION WITH VARIOUS COMORBIDITIES IN COPD PATIENTS ADMITTED IN A TERTIARY CARE HOSPITAL: A COHORT STUDY

Introduction:Theoverlapsyndromewas first coinedbyDavidC.Flenley in1985 todescribethecoexistenceofobstructive sleep apnoea (OSA) in patients with chronic obstructive pulmonary disease (COPD). Patients with Overlap Syndrome experience more profound nocturnal oxygen desaturation (NOD) than patients with OSA or COPD alone. Little is known about the possible predictors of the overlap syndrome and its association with comorbidities contributing to impaired outcome.Objectives:This study aimed to evaluate the prevalence and possible predictors of the overlap syndrome and its correlation with various comorbidities in a cohort of COPD patients.Materials &amp; Methods:Individuals with COPD (GOLD, riskgroupsA–D) admittedinourhospitalfromMarch2021 toDecember 2021.Informationonage,gender,bodymass index (BMI), waist-hip ratio, smoking status, Adjusted neck circumference Epworth sleepiness scale (ESS),STOP BANG, COPD assessment test score,comorbidities,was collectedanda spirometry wasperformed.Participants underwent Level 1 sleep study in our hospital.An apnoea-hypopnea index (AHI) &gt;5 per hour was considered to indicate OSA. Results:Around 50 patients were enrolled with a mean age of 60.7 of whom male is 52 % and female is 48%. During nocturnal polysomnography, 39.1% had evidence of OSA.AHI had statisticaly correlated with Diabetes,Hypertension (p value&lt;0.005).Also in our study we found AHI had statisticaly correlated between ESS score and severity of COPD (GOLD Class B &amp; C)(p value&lt;0.005).Pulmonary Arterial Hypertension and Diabetes were more common in patients with overlap syndrome. Conclusion: The prevalence of COPD patients with OSA is 24%. BMI and smoking history seems to be a predictoroftheoverlapsyndrome.Thesepatientsmaybemoreaffectedbypulmonaryarterialhypertensionanddiabetes