Vol 20, No 1 (2016)
Original paper
Published online: 2016-03-31

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Utility of polygraphic studies for sleep apnea screening in the setting of tertiary care hypertension outpatient clinic

Maria Nowak, Anna Komand, Dawid Ostrówka, Marta Jancewicz, Eliza Miszkowska-Nagórna, Anna Szyndler, Jacek Wolf, Krzysztof Narkiewicz
DOI: 10.5603/AH.2016.0002
Arterial Hypertension 2016;20(1):5-10.


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.


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