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Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Ryhov County Hospital, Jönköping, Sweden.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0001-7431-2873
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2012 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, no 2, 107-113 p.Article in journal (Refereed) Published
Abstract [en]

Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP andgt; 140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5-14.9/h) and moderate/severe (AHI andgt; 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI andgt; 30 kg/m(2)) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI andgt; 30 kg/m(2), snoring, witnessed apnoeas, and sleep duration andgt; 8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

Place, publisher, year, edition, pages
Informa Healthcare , 2012. Vol. 30, no 2, 107-113 p.
Keyword [en]
Depression, hypertension, obstructive sleep apnoea, sleep, sleep disordered breathing, snoring
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-78805DOI: 10.3109/02813432.2012.675563ISI: 000304602800009OAI: oai:DiVA.org:liu-78805DiVA: diva2:536059
Note

Funding Agencies|Swedish Heart Lung Foundation|20090547|

Available from: 2012-06-21 Created: 2012-06-21 Last updated: 2017-12-07
In thesis
1. Obstructive sleep apnea: General characteristics in hypertensive patients, positional sensitivity, and upper airway sensory neuropathy
Open this publication in new window or tab >>Obstructive sleep apnea: General characteristics in hypertensive patients, positional sensitivity, and upper airway sensory neuropathy
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Obstructive sleep apnea (OSA) is a highly prevalent disorder, especially in populations with cardiovascular disease. Unfortunately most cases with OSA remain undiagnosed. The ability to identify OSA is important for both the individual and the society, as it is a treatable risk factor for cardiovascular disease and also associated with impaired quality of life. This could be particularly important in populations with cardiovascular disease where the most beneficiary treatment effects could be expected. However, the diagnostic process in OSA may be affected by positional dependency (a majority of OSA patients have more breathing interruptions in supine sleep compared to other sleeping positions). Based on the assumption that individuals have different proportions of supine and non-supine sleep on different nights, positional dependency may be a potential confounder in both diagnosis, classification of OSA severity and evaluation of treatment efficacy. Another aspect of OSA is that the pathogenesis is not fully understood. Data indicate that OSA might be a progressive disease, and many patients report years of snoring before witnessed apneas and symptoms occur. One hypothesis on the pathogenesis of OSA is that long-standing, snoring-induced vibrations cause neurogenic lesions in upper airway tissues, progressively damaging the reflex circuits responsible for keeping the upper airway open during sleep.

Aims: To describe the occurrence of undiagnosed OSA and to identify determinants of moderate/severe OSA in patients with hypertension (study I). To describe the prevalence of position dependent OSA (POSA) and its relation to OSA severity classification (study II). To compare two methods for quantitative testing of cold sensory function (as a sign of neuropathy) in the upper airway with special focus on test-retest repeatability (study III). To evaluate signs of upper airway sensory neuropathy, by cold sensory testing, in non-snorers, snorers, and snoring OSA subjects with special reference to AHI and duration of snoring history (study IV).

Methods: In study I 411 consecutive patients with hypertension from four primary care health centers in Sweden were evaluated for OSA as measured by the apnea hypopnea index (AHI) through polygraphic (PG) recordings. Different predictors for moderate/severe OSA were evaluated. In study II the PG recordings of 265 subjects were specially assessed for POSA and the relation between severity classification based on POSA and traditional OSA severity classification. In study III 40 non-snoring subjects were tested for cold detection thresholds at the soft palate and the lip at two separate occasions with two different methods (MLE/MLI). Bland-Altman analysis was used to compare test-retest repeatability. In study IV cold sensory testing of the soft palate and lip was used to evaluate signs of upper airway sensory neuropathy in both non-snorers; snorers, and subjects with OSA (groups were formed based on AHI and snoring history, n=90).

Results and Conclusions: Undiagnosed OSA is common in Swedish primary care patients with hypertension, and male gender, BMI>30 kg/m2, and a clinical history of snoring and witnessed apneas are predictors of moderate/severe OSA. POSA is common both in subjects that by traditional classification had OSA as well as those without OSA. The severity of OSA, if based on total AHI, could be dependent on supine time in a substantial amount of subjects. Cold sensory testing is easily performed in the oropharynx, with acceptable test–retest repeatability. MLI is considerably faster to perform and have a slightly better repeatability than MLE. Therefore MLI should be the used method for cold thermal testing at the soft palate. Both self-reported snoring years and OSA severity are correlated to the degree of cold sensory impairment in the upper airway. Our results strengthen the hypothesis that snoring vibrations may cause a neuropathy in the upper airway, which may contribute to the progression and development of OSA.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 94 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1341
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-85021 (URN)978-91-7519-760-9 (ISBN)
Public defence
2012-12-07, Flemingsalen, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
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Available from: 2012-10-30 Created: 2012-10-30 Last updated: 2014-06-13Bibliographically approved

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Broström, AndersFranzén Årestedt, KristoferJohansson, PeterUlander, MartinRiegel, BarbaraSvanborg, Eva

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Broström, AndersFranzén Årestedt, KristoferJohansson, PeterUlander, MartinRiegel, BarbaraSvanborg, Eva
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Nursing ScienceFaculty of Health SciencesCardiologyDepartment of Cardiology in LinköpingClinical NeurophysiologyDepartment of Clinical Neurophysiology
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Scandinavian Journal of Primary Health Care
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