A single-centre, observational, retrospective study to evaluate coexistence of cardiovascular comorbidities and obstructive sleep apnoea in South Indians using apnea link air home sleep testing device
Keywords:Obstructive sleep apnea, Apnea-hypopnea index, Obesity, Hypertension
Background: The aim of the study was to explore whether there is a relationship between Cardiovascular (CV) comorbidities and the prevalence and severity of Obstructive sleep apnea (OSA).
Methods: Secondary data analysis of 146 patients with suspected sleep-disordered breathing was conducted who were presented to the department of medicine, KIMS Hospital, Hyderabad, from June 2021 to November 2021. Participants aged ≥18 years were included in the analysis. Demographic details, clinical history, comorbidities, medication history, were analyzed. AHI score, ODI (Oxygen desaturation index) score and average O2 saturation were recorded with the help of a home sleep testing device. Data were entered and analyzed with Epi info 7.
Results: The overall prevalence of OSA was 78.8% in patients with suspected sleep-disordered breathing. Prevalence of mild, moderate, and severe OSA was 28.8%, 15.1%, and 34.9%, respectively. Proportions of diabetes and hypertension were significantly high among patients with obstructive sleep apnea. Correlation analysis revealed a weak positive linear relationship (r=0.14) between the number of risk factors and the AHI score.
Conclusions: This study showed high prevalence of OSA among out patients presented with suspected sleep disordered breathing. Hypertension, diabetes and obesity were highly prevalent CV comorbidities among South Indian patients diagnosed with OSA.
Tsara V, Amfilochiou A, Papagrigorakis MJ, Georgopoulos D, Liolios E. Guidelines for diagnosis and treatment of sleep-related breathing disorders in adults and children. Definition and classification of sleep related breathing disorders in adults: different types and indications for sleep studies (Part 1). Hippokratia. 2009;13(3):187-91.
Adeniyi B, Erhabor GE. OBSTRUCTIVE SLEEP APNEA. West Afr J Med. 2020;37(7):713-4.
Cumpston E, Chen P. Sleep Apnea Syndrome. StatPearls. 2021.
Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687-98.
Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217-39.
Tufik S, Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010;11(5):441-6.
Singh A, Prasad R, Garg R, Kant S, Hosmane GB, Dubey A, et al. A study to estimate prevalence and risk factors of Obstructive Sleep Apnoea Syndrome in a semi-urban Indian population. Monaldi Arch Chest Dis. 2017;87(1):773.
Reddy EV, Kadhiravan T, Mishra HK, Sreenivas V, Handa KK, Sinha S, et al. Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: a community-based study. Sleep Med. 2009;10(8):913-8.
Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest. 2006;130(1):149-56.
Prasad CN. Obstructive sleep apnea-hypopnea syndrome: Indian scenario. Perspect Med Res. 2013;1:22-5.
Veluthat C, Souza GD. Prevalence and Risk Factors for OSA among Urban and Rural Subjects in Bengaluru District, South India: A Cross-sectional Study. Sleep Med. 2021;16(1):5-9.
Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136-43.
Barnes M, Goldsworthy UR, Cary BA, Hill CJ. A diet and exercise program to improve clinical outcomes in patients with obstructive sleep apnea--a feasibility study. J Clin Sleep Med. 2009;5(5):409-15.
Kim NH, Cho NH, Yun CH, Lee SK, Yoon DW, Cho HJ, et al. Association of obstructive sleep apnea and glucose metabolism in subjects with or without obesity. Diabetes Care. 2013;36(12):3909-15.
Xia W, Huang Y, Peng B, Zhang X, Wu Q, Sang Y, et al. Relationship between obstructive sleep apnoea syndrome and essential hypertension: a dose-response meta-analysis. Sleep Med. 2018;47:11-8.
Kishan S, Rao MS, Ramachandran P, Devasia T, Samanth J. Prevalence and Patterns of Sleep-Disordered Breathing in Indian Heart Failure Population. Pulm Med. 2021;2021:9978906.
Shanmugam GV, Abraham G, Mathew M, Ilangovan V, Mohapatra M, Singh T. Obstructive sleep apnea in non-dialysis chronic kidney disease patients. Ren Fail. 2015;37(2):214-8.
Bhimwal RK, Makwana M, Jangid R, Bhati RL. To study the prevalence of obstructive sleep apnoea in type 2 diabetes patients in Western Rajasthan, India. Int J Adv Med. 2017;4:894.
Sweed RA, Hassan S, Wahab NHA, Aref SR, Mahmoud MI. Comorbidities associated with obstructive sleep apnea: a retrospective Egyptian study on 244 patients. Sleep Breath. 2019;23(4):1079-85.
Nickerson J, Lee E, Nedelman M, Aurora RN, Krieger A, Horowitz CR. Feasibility of portable sleep monitors to detect obstructive sleep apnea (OSA) in a vulnerable urban population. J Am Board Fam Med. 2015;28(2):257-64.
Burgess KR, Havryk A, Newton S, Tsai WH, Whitelaw WA. Targeted case finding for OSA within the primary care setting. J Clin Sleep Med. 2013;9(7):681-6.
Gać P, Urbanik D, Macek P, Martynowicz H, Mazur G, Poręba R. Coexistence of cardiovascular risk factors and obstructive sleep apnoea in polysomnography. Respir Physiol Neurobiol. 2022;295:103782.
Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015-21.
Ogilvie RP, Patel SR. The Epidemiology of Sleep and Diabetes. Curr Diab Rep. 2018;18(10):82.
Araghi MH, Chen YF, Jagielski A, Choudhury S, Banerjee D, Hussain S, et al. Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis. Sleep. 2013;36(10):1553-62.
Kareem O, Tanvir M, Naqash A, Bader GN. Obstructive Sleep Apnoea: A Risk Factor for Hypertension. Journal of Cardiology and Cardiovascular Sciences. 2018;2(2).
Jhamb M, Unruh M. Bidirectional relationship of hypertension with obstructive sleep apnea. Curr Opin Pulm Med. 2014;20(6):558-64.
Hou H, Zhao Y, Yu W, Dong H, Xue X, Ding J, et al. Association of obstructive sleep apnea with hypertension: a systematic review and meta-analysis. Journal of global health. 2018;8(1).
Chasens ER, Weaver TE, Umlauf MG. Insulin resistance and obstructive sleep apnea: is increased sympathetic stimulation the link? Biol Res Nurs. 2003;5(2):87-96.
Elmasry A, Lindberg E, Berne C, Janson C, Gislason T, Tageldin M, et al. Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med. 2001;249(2):153-61.
Mooe T, Franklin KA, Holmström K, Rabben T, Wiklund U. Sleep-disordered breathing and coronary artery disease: long-term prognosis. Am J Respir Crit Care Med. 2001;164(10):1910-3.
Lee CH, Khoo SM, Chan MY, Wong HB, Low AF, Phua QH, et al. Severe obstructive sleep apnea and outcomes following myocardial infarction. J Clin Sleep Med. 2011;7(6):616-21.
Hagenah GC, Gueven E, Andreas S. Influence of obstructive sleep apnoea in coronary artery disease: A 10-year follow-up. Respir Med. 2006;100(1):180-2.
Alba F, Gemma D, Romero E, Blas JR, López E, Sendon JL. Obstructive sleep apnea and coronary artery disease: from pathophysiology to clinical implications. Pulm Med. 2013;2013:768064.
Markou N, Kanakaki M, Myrianthefs P, Hadjiyanakos D, Vlassopoulos D, Damianos A, et al. Sleep-disordered breathing in nondialyzed patients with chronic renal failure. Lung. 2006;184(1):43-9.