Utility of polygraphic studies for sleep apnea screening in the setting of tertiary care hypertension outpatient clinic
Abstract
Background: Prevalence of obstructive sleep apnea (OSA) in patients with hypertension outnumbers the prevalence reported in the general population. Concurrently, majority of patients remain undiagnosed. Given the fact that untreated OSA contributes to ineffective hypotensive treatment, and higher rate of complications is ascribed to hypertension, early OSA diagnosis and its elimination constitutes one of the key clinical goals. Polysomnography comprises a golden standard in sleep apnea diagnosis, however it is a time-consuming and expensive procedure which requires hospitalization. Therefore, we assessed the utility of simplified polygraphic (PG) studies in the OSA screening of patients with hypertension requiring regular tertiary care.
Material and methods: The study was conducted in the Outpatient Tertiary Care Clinic of the Medical University Hospital of Gdansk. We enrolled consecutive patients regardless of OSA symptoms presence (n = 243), as well as patients with OSA suspicion (n = 75). A total of 318 patients (39% females) were subjected to ambulatory, one night polygraphic study (ApneaLink™). The following signals were recorded: airflow (pressure cannula), respiratory movements, and pulse oximetry. Additionally, anthropometrics, Epworth Sleepiness Scale (ESS), selected clinical symptoms, and drug-regimen were recorded.
Results: Three hundred and eight (97%) patients completed the study (10 dropouts due to study failure). Patients were 57.7 ± 11.5 years old, had BMI = 30.0 ± 5.0 kg/m2, and average ESS = 5.7 ± 4.6. 65.3% of all patients were characterized by AHI ≥ 5 (62.2% vs. 74.7% in Random vs. Symptomatic group, respectively; P = 0.49), whereas 27.6% of patients were diagnosed with AHI ≥ 15 (23.6% in Random group and 40.0% in Symptomatic group). In logistic regression analysis, nocturia (> 2) increased the odds of AHI ≥ 30 diagnosis approximately 3.5 times in a fully adjusted model.
Conclusions: Our results justify routine polygraphic screening of hypertensive patients requiring tertiary care. Abridged medical history may substantially increase the odds for positive screening.
Keywords: polygraphynocturiahypertensionsleep apnea
References
- Chobanian AV, Bakris GL, Black HR, et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289(19): 2560–2572.
- Logan AG, Perlikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001; 19(12): 2271–2277.
- Masa JF, Corral J, Pereira R, et al. Spanish Sleep Group. Effectiveness of sequential automatic-manual home respiratory polygraphy scoring. Eur Respir J. 2013; 41(4): 879–887.
- Escourrou P, Grote L, Penzel T, et al. ESADA Study Group. The diagnostic method has a strong influence on classification of obstructive sleep apnea. J Sleep Res. 2015; 24(6): 730–738.
- Fan Yu, Wei F, Lang Y, et al. Meta-analysis of nocturia and risk of all-cause mortality in adult population. Int J Cardiol. 2015; 195: 120–122.
- Oztura I, Kaynak D, Kaynak H. Nocturia in sleep-disordered breathing. Sleep Med. 2006; 7(4): 362–367.
- Miyazaki T, Kojima S, Yamamuro M, et al. Nocturia in Patients With Sleep-Disordered Breathing and Cardiovascular Disease. Circ J. 2015; 79(12): 2632–2640.
- Wang T, Huang W, Zong H, et al. The Efficacy of Continuous Positive Airway Pressure Therapy on Nocturia in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Int Neurourol J. 2015; 19(3): 178–184.
- Calhoun DA, Jones D, Textor S, et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment. Circulation. 2008; 117: e510–526.
- Tykarski A, Narkiewicz K, Gaciong Z, et al. 2015 guidelines for the management of hypertension. Recommendations of the Polish Society of Hypertension - short version. Kardiol Pol. 2015; 73(8): 676–700.
- Siddiqui M, Dudenbostel T, Calhoun DA. Resistant and Refractory Hypertension: Antihypertensive Treatment Resistance vs Treatment Failure. Can J Cardiol. 2016; 32(5): 603–606.
- Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of Hypertension. 2013; 31(7): 1281–1357.
- Parati G, Lombardi C, Hedner J, et al. European Respiratory Society, EU COST ACTION B26 members. Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea. J Hypertens. 2012; 30(4): 633–646.
- Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000; 342(19): 1378–1384.
- Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000; 320(7233): 479–482.
- Walia HK, Li H, Rueschman M, et al. Association of severe obstructive sleep apnea and elevated blood pressure despite antihypertensive medication use. J Clin Sleep Med. 2014; 10(8): 835–843.
- Marin JM, Agusti A, Villar I, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA. 2012; 307(20): 2169–2176.
- Tsioufis C, Kasiakogias A, Thomopoulos C, et al. Managing hypertension in obstructive sleep apnea: the interplay of continuous positive airway pressure, medication and chronotherapy. J Hypertens. 2010; 28(5): 875–882.
- Young T, Shahar E, Nieto FJ, et al. Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002; 162(8): 893–900.
- Ng SSS, Chan TO, To KW, et al. Validation of a portable recording device (ApneaLink) for identifying patients with suspected obstructive sleep apnoea syndrome. Intern Med J. 2009; 39(11): 757–762.
- Lesser DJ, Haddad GG, Bush RA, et al. The utility of a portable recording device for screening of obstructive sleep apnea in obese adolescents. J Clin Sleep Med. 2012; 8(3): 271–277.
- Weinreich G, Armitstead J, Töpfer V, et al. Validation of ApneaLink as screening device for Cheyne-Stokes respiration. Sleep. 2009; 32(4): 553–557.
- Douglas N. Home diagnosis of the obstructive sleep apnoea/hypopnoea syndrome. Sleep Medicine Reviews. 2003; 7(1): 53–59.
- Collop NA, Anderson WM, Boehlecke B, et al. Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007; 3(7): 737–747.