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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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Open Access 01-06-2012 | Reports of Original Investigations

Health effects of identifying patients with undiagnosed obstructive sleep apnea in the preoperative clinic: a follow-up study

Authors: Vanita Mehta, MD, Rajeev Subramanyam, MD, Colin M. Shapiro, PhD, Frances Chung, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 6/2012

Abstract

Background

Undiagnosed obstructive sleep apnea (OSA) is a highly prevalent breathing disorder. The purpose of this study was to determine the effects of preoperative screening and subsequent treatment for OSA on the health of patients.

Methods

We conducted a two-year follow-up study of patients previously enrolled in a large prospective study in which patients were given the STOP questionnaire for OSA screening (n = 2,467). All patients who underwent a polysomnography were considered eligible (n = 211) and were asked to complete a paper-based mailed questionnaire. The severity of OSA, comorbidities, and treatment modalities and their effects were evaluated from the returned questionnaire. Research ethics board approval was obtained and returning the questionnaire implied informed patient consent.

Results

The response rate was 67%. One hundred twenty-eight (82%) of the 156 patients who responded had OSA established by polysomnography. Among these 128 patients with OSA, 88 (69%) were prescribed continuous positive airway pressure (CPAP) therapy and 40 (31%) were prescribed other (non-CPAP) treatment. Among those 88 patients receiving CPAP, 40 (45%) were compliant and 48 (55%) were non-compliant. The CPAP compliant patients had a greater reduction in medication for comorbidities than the CPAP non-compliant or the other treatment group (38% vs 3% vs 0%, respectively; P < 0.001). A significant improvement in snoring, sleep quality, and daytime sleepiness was reported by CPAP compliant users compared with CPAP non-compliant or other treatment groups (P < 0.001).

Conclusion

The preoperative patients who were identified to have OSA and were compliant with CPAP use may have health benefits in terms of improved snoring, sleep quality, and daytime sleepiness. Timely diagnosis and treatment compliance may reduce symptoms of OSA and severity of associated comorbidities along with a reduction in medications.

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Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165: 1217-39.PubMedCrossRef

Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 1998; 157: 144-8.PubMed

Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001; 163: 608-13.PubMed

Kuniyoshi FH, Garcia-Touchard A, Gami AS, et al. Day-night variation of acute myocardial infarction in obstructive sleep apnea. J Am Coll Cardiol 2008; 52: 343-6.PubMedCrossRef

Sin DD, Fitzgerald F, Parker JD, et al. Relationship of systolic BP to obstructive sleep apnea in patients with heart failure. Chest 2003; 123: 1536-43.PubMedCrossRef

Mehra R, Benjamin EJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: the Sleep Heart Health Study. Am J Respir Crit Care Med 2006; 173: 910-6.PubMedCrossRef

Ohayon MM, Guilleminault C, Priest RG, Zulley J, Smime S. Is sleep-disordered breathing an independent risk factor for hypertension in the general population (13,057 subjects)? J Psychosom Res 2000; 48: 593-601.PubMedCrossRef

Chan W, Coutts SB, Hanly P. Sleep apnea in patients with transient ischemic attack and minor stroke: opportunity for risk reduction of recurrent stroke? Stroke 2010; 41: 2973-5.PubMedCrossRef

Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004; 25: 735-41.PubMedCrossRef

10.

Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anesth 2010; 57: 423-38.PubMedCrossRef

11.

Ramachandran SK, Josephs LA. A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology 2009; 110: 928-39.PubMedCrossRef

12.

Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008; 108: 812-21.PubMedCrossRef

13.

Ong TH, Raudha S, Fook-Chong S, Lew N, Hsu AA. Simplifying STOP-BANG, use of a simple questionnaire to screen for OSA in an Asian population. Sleep Breath 2010; 14: 371-6.PubMedCrossRef

14.

Montserrat JM, Ferrer M, Hernandez L, et al. Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo. Am J Respir Crit Care Med 2001; 164: 608-13.PubMed

15.

Engleman HM, Cheshire KE, Deary IJ, Douglas NJ. Daytime sleepiness, cognitive performance and mood after continuous positive airway pressure for the sleep apnoea hypopnoea syndrome. Thorax 1993; 48: 911-4.PubMedCrossRef

16.

Tun Y, Hida W, Okabe S, et al. Can nasal continuous positive airway pressure decrease clinic blood pressure in patients with obstructive sleep apnea? Tohoku J Exp Med 2003; 201: 181-90.PubMedCrossRef

17.

Hassaballa HA, Tulaimat A, Herdegen JJ, Mokhlesi B. The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea. Sleep Breath 2005; 9: 176-80.PubMedCrossRef

18.

Pepin JL, Leger P, Veale D, Langevin B, Robert D, Levy P. Side effects of nasal continuous positive airway pressure in sleep apnea syndrome: study of 193 patients in two French sleep centers. Chest 1995; 107: 375-81.PubMedCrossRef

19.

Zozula R, Rosen R. Compliance with continuous positive airway pressure therapy: assessing and improving treatment outcomes. Curr Opin Pulm Med 2001; 7: 391-8.PubMedCrossRef

20.

Anonymous. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22: 667-89.

21.

Engleman HM, Asgari-Jirhandeh N, McLeod AL, Ramsay CF, Deary IJ, Douglas NJ. Self-reported use of CPAP and benefits of CPAP therapy: a patient survey. Chest 1996; 109: 1470-6.PubMedCrossRef

22.

Aguillard RN, Riedel BW, Lichstein KL, Grieve FG, Johnson CT, Noe SL. Daytime functioning in obstructive sleep apnea patients: exercise tolerance, subjective fatigue, and sleepiness. Appl Psychophysiol Biofeedback 1998; 23: 207-17.PubMedCrossRef

23.

Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991; 14: 540-5.PubMed

24.

Celen YT, Hedner J, Carlson J, Peker Y. Impact of gender on incident diabetes mellitus in obstructive sleep apnea: a 16-year follow-up. J Clin Sleep Med 2010; 15: 244-50.

25.

Shapiro GK, Shapiro CM. Factors that influence CPAP adherence: an overview. Sleep Breath 2010; 14: 323-35.PubMedCrossRef

26.

Krieger J, Kurtz D, Petiau C, Sforza E, Trautmann D. Long-term compliance with CPAP therapy in obstructive sleep apnea patients and in snorers. Sleep 1996; 19: S136-43.PubMed

27.

Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365: 1046-53.PubMed

28.

Marshall NS, Wong KK, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all cause mortality: the Busselton Health Study. Sleep 2008; 31: 1079-85.PubMed

29.

Renko AK, Hiltunen L, Laakso M, Rajala U, Keinanen-Kiukaanniemi KS. The relationship of glucose tolerance to sleep disorders and daytime sleepiness. Diabetes Res Clin Pract 2005; 67: 84-91.PubMedCrossRef

30.

Becker HF, Jerrentrup A, Ploch T, et al. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 2003; 107: 68-73.PubMedCrossRef

31.

Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 2002; 359: 204-10.PubMedCrossRef

32.

Dhillon S, Chung SA, Fargher T, Huterer N, Shapiro CM. Sleep apnea, hypertension, and the effects of continuous positive airway pressure. Am J Hypertens 2005; 18: 594-600.PubMedCrossRef

33.

Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000; 283: 1829-36.PubMedCrossRef

34.

Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163: 19-25.PubMed

35.

Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342: 378-84.CrossRef

36.

Dimsdale JE, Loredo JS, Profant J. Effect of continuous positive airway pressure on blood pressure: a placebo trial. Hypertension 2000; 35: 144-7.PubMed

37.

Faccenda JF, Mackay TW, Boon NA, Douglas NJ. Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 2001; 163: 344-8.PubMed

38.

Giles TL, Lasserson TJ, Smith B, White J, Wright J, Cater CJ. Continuous positive airways pressure for obstructive sleep apnea in adults. Cochrane Database Syst Rev 2006; 3: CD001106.

39.

Gay P, Weaver T, Loube D, Positive Airway Pressure Task Force, Standards of Practice Committee, American Academy of Sleep Medicine. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 2006; 29: 381-401.PubMed

40.

Gottlieb DJ, Whitney CW, Bonekat WH, et al. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med 1999; 159: 502-7.PubMed

41.

Ballester E, Badia JR, Hernandez L, et al. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 1999; 159: 495-501.PubMed

42.

Engleman H, Kingshott RN, Wraith PK, Mackay TW, Deary IJ, Douglas NJ. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 1999; 159: 461-7.PubMed

43.

Hossain JL, Ahmad P, Reinish LW, Kayumov L, Hossain NK, Shapiro CM. Subjective fatigue and subjective sleepiness: two independent consequences of sleep disorder? J Sleep Res 2005; 14: 245-53.PubMedCrossRef

44.

Santamaria J, Iranzo A, Ma Montserrat J, de Pablo J. Persistent sleepiness in CPAP treated obstructive sleep apnea patients: evaluation and treatment. Sleep Med Rev 2007; 11: 195-207.PubMedCrossRef

45.

Tarasiuk A, Greenberg-Dotan S, Brin YS, Simon T, Tal A, Reuveni H. Determinants affecting health-care utilization in obstructive sleep apnea syndrome patients. Chest 2005; 128: 1310-4.PubMedCrossRef

46.

Hillman DR, Murphy AS, Pezzullo L. The economic cost of sleep disorders. Sleep 2006; 29: 299-305.PubMed

47.

Albarrak M, Banno K, Sabbagh AA, et al. Utilization of health-care resources in obstructive sleep apnea syndrome: a 5-year follow-up study in men using CPAP. Sleep 2005; 28: 1306-11.PubMed

Title: Health effects of identifying patients with undiagnosed obstructive sleep apnea in the preoperative clinic: a follow-up study
Authors: Vanita Mehta, MD
Rajeev Subramanyam, MD
Colin M. Shapiro, PhD
Frances Chung, MD
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 6/2012
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-012-9694-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Health effects of identifying patients with undiagnosed obstructive sleep apnea in the preoperative clinic: a follow-up study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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