Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity

Mercan, Yeliz; Ersoy, Ersin

doi:10.4274/jtsm.galenos.2020.02886

Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity

Ersin ERSOY, (Kırklareli Üniversitesi Sağlık Bilimleri Enstitüsü, Halk Sağlığı Anabilim Dalı, Kırklareli, Türkiye)

Yeliz MERCAN (Kırklareli Üniversitesi Sağlık Fakültesi Sağlık Yönetimi Bölümü, Kırklareli, Türkiye)

Türk Uyku Tıbbı Dergisi

3 0

Yıl: 2021 Cilt: 8 Sayı: 1 Sayfa Aralığı: 20 - 27 Metin Dili: İngilizce DOI: 10.4274/jtsm.galenos.2020.02886 İndeks Tarihi: 23-01-2022

Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity

Öz:

Objective: The purpose of the study was to identify the factors that affect Obstructive Sleep Apnea Syndrome (OSAS) in adults and determine the association between obstructive sleep apnea and daytime sleepiness, obesity and comorbidity. Materials and Methods: This retrospective study was conducted in Çanakkale from July 2017-June 2018 with 682 adults (≥18 yr). An Apnea-hypopnea index (AHI) score ≥5 obtained from polysomnography measurement was considered as OSAS. The Epworth Sleepiness Scale (ESS) was used to identify excessive daytime sleepiness (EDS). Results: A total of 22.1% of adults had mild, 15.8% moderate and 36.5% severe OSAS. According to multivariate logistic regression analysis, high OSAS risk was associated with men of age greater than 50 years, who were alcohol users, EDS, overweight or obese and had at least two comorbidities (p<0.05). OSAS risk was higher in patients with hypertension and chronic obstructive pulmonary disease (COPD) (p<0.05). According to adjusted multivariate linear regression analysis, with each 1-unit increase in ESS score [β: 0.416, 95% confidence interval (CI): 0.124, 0.708], Body Mass index (BMI) (β: 1.701, 95% CI: 1.390, 2.011) and comorbidity (β: 2.441, 95% CI: 0.121, 4.762), AHI increased significantly. Conclusion: Approximately three out of every four participants had OSAS. Male gender, advanced age, alcohol use, EDS, obesity and the presence of comorbidities increased the risk of OSAS. The risk was higher with hypertension or COPD. AHI increased as the ESS score, BMI and number of comorbidities increased. Healthcare professionals should identify those at risk when detecting undiagnosed OSAS cases and refer them to appropriate clinics for early diagnosis and intervention.

Anahtar Kelime:

Obstrüktif Uyku Apnesinde Risk Faktörleri, Obstrüktif Uyku Apnesi ile Gündüz Uykululuğu, Obezite ve Komorbidite İlişkisi

Öz:

Amaç: Araştırmada yetişkinlerde Obstrüktif Uyku Apne Sendromunu (OSAS) etkileyen faktörleri saptamak ve OSAS ile gündüz uykululuğu, obezite ve komorbidite sayısı arasındaki ilişkiyi belirlemek amaçlandı. Gereç ve Yöntem: Bu retrospektif araştırma Çanakkale’de Temmuz 2017-Haziran 2018 tarihleri arasında 18 yaş ve üstü 682 yetişkin ile yürütüldü. Polisomnografi ölçümünden elde edilen Apne-hipopne indeksi (AHİ) ≥5 ise OSAS olarak değerlendirildi. Gündüz uykululuğunu belirlemede Epworth Uykululuk Ölçeği (EUÖ) kullanıldı. Bulgular: Katılımcıların %22,1’i hafif, %15,8’i orta, %36,5’i şiddetli düzeyde OSAS’lidir. Multivariate lojistik regresyon analizine göre: OSAS riski erkeklerde, 50 yaş ve üzerinde, alkol kullananlarda, gündüz uykululuğu olanlarda, fazla kilolu ve obezlerde, iki ve daha fazla hastalığı olanlarda yüksektir (p<0,05). Hipertansiyon ve kronik obstrüktif akciğer hastalığı (KOAH) hastalarında OSAS riski daha yüksektir (p<0,05). Düzeltilmiş multivariate lineer regresion analizine göre; EUÖ skorunun [β: 0,416, %95 güven aralığı (GA): 0,124-0,708)], Vücut Kütle indeksinin (VKİ) (β: 1,701, %95 GA: 1,390-2,011) ve komorbiditenin (β: 2,441, %95 GA: 0,121-4,762) her 1-birim artışında AHİ artmaktadır (p<0,05). Sonuç: Yaklaşık her dört katılımcıdan üçü OSAS’lidir. Erkek cinsiyet, ileri yaş, alkol kullanma, aşırı gündüz uykululuğu, fazla kilo ve obezite, komorbidite OSAS riskini artırmaktadır. Hipertansiyon ve KOAH hastalarında risk daha yüksektir. EUÖ skoru, VKİ ve komorbidite arttıkça AHİ artmaktadır. Sağlık çalışanları tanı konmamış OSAS olgularının tespitinde risk altında olanları saptamalı, erken tanı ve girişim için ilgili kliniklere yönlendirmelidir

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Venkataraman S, Vungarala S, Covassin N, Somers VK. Sleep apnea, hypertension and the sympathetic nervous system in the adult Population. J Clin Med 2020;9:1-12.
2. Celikhisar H, Dasdemir Ilkhan G. Comparison of clinical and polysomnographic characteristics in young and old patients with obstructive sleep apnea syndrome. Aging Male 2020;1-8.
3. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev 2017;34:70-81.
4. Abad J, Muñoz-Ferrer A, Cervantes MÁ, Esquinas C, Marin A, Martínez C, Morera J, Ruiz J. Automatic video analysis for obstructive sleep apnea diagnosis. Sleep 2016;39:1507-15.
5. Wang S, Niu X, Zhang P, Su D, Zhang J, Liu W. Analysis of OSAS incidence and influential factors in middle-aged and elderly patients with hypertension. Minerva Med 2019;110:115-20.
6. Sertogullarindan B, Komuroglu AU, Ucler R, Gunbatar H, Sunnetcioglu A, Cokluk E. Betatrophin association with serum triglyceride levels in obstructive sleep apnea patients. Ann Thorac Med 2019;14:63-8.
7. Traaen GM, Øverland B, Aakerøy L, Hunt TE, Bendz C, Sande L, Aakhus S, Zaré H, Steinshamn S, Anfinsen OG, Loennechen JP, Gullestad L, Akre H. Prevalence, risk factors, and type of sleep apnea in patients with paroxysmal atrial fibrillation. Int J Cardiol Heart Vasc 2019;26:100447.
8. Yosunkaya S, Kutlu R, Vatansev H. Effects of smoking on patients with obstructive sleep apnea syndrome. Clin Respir J 2020. doi: 10.1111/ crj.13278. Online ahead of print.
9. Degache F, Sforza E, Dauphinot V, Celle S, Garcin A, Collet P, Pichot V, Barthélémy JC, Roche F, PROOF Study Group. Relation of central fat mass to obstructive sleep apnea in the elderly. Sleep 2013;36:501-7.
10. Singh A, Prasad R, Garg R, Kant S, Hosmane GB, Dubey A, Agarwal A, Verma RK. A study to estimate prevalence and risk factors of Obstructive Sleep Apnea syndrome in a semi-urban Indian population. Monaldi Arch Chest Dis 2017;87:773.
11. Mokhlesi B, Ham SA, Gozal D. The effect of sex and age on the comorbidity burden of OSA: An observational analysis from a large nationwide US health claims database. Eur Respir J 2016;47:1162-9.
12. Bielicki P, Pływaczewski R, Brzóska K, Kumor M, Barnaś M, Jonczak L, Stępkowski TM, Piechuta A, Chazan R, Śliwiński P, Kruszewski M. Impact of polymorphism of selected genes on the diagnosis of type 2 diabetes in patients with obstructive sleep apnea. Pol Arch Intern Med 2019;129:6-11.
13. Saraç S, Çetintaş Afşar G. Comorbidity of obstructive sleep apnea syndrome, cronic obstructive lung disease and asthma chronic airway diseases and sleep apnea. J Turk Sleep Med 2017;4:43-7.
14. Yumrukuz Şenel M, Bağnu Yüceege M, Fırat H. The role of the metabolic syndrome criterias to determine moderate to severe sleep apnea patients. J Turk Sleep Med 2020;3:118-23.
15. Appleton SL, Gill TK, Lang CJ, Taylor AW, McEvoy RD, Stocks NP, González-Chica DA, Adams RJ. Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey. Sleep Health 2018;4:13-9.
16. Jung JH, Park JW, Kim DH, Kim ST. The effects of obstructive sleep apnea on risk factors for cardiovascular diseases. Ear Nose Throat J 2019;145561319882548. doi: 10.1177/0145561319882548.
17. Wu WT, Tsai SS, Shih TS, Lin MH, Chou TC, Ting H, Wu TN, Liou SH. The association between obstructive sleep apnea and metabolic markers and lipid profiles. PLoS One 2015;10:e0130279. doi: 10.1371/journal.pone.0130279.
18. Léger D, Stepnowsky C. The economic and societal burden of excessive daytime sleepiness in patients with obstructive sleep apnea. Sleep Med Rev 2020;51:101275.
19. Arita A, Sasanabe R, Hasegawa R, Nomura A, Hori R, Mano M, Konishi N, Shiomi T. Risk factors for automobile accidents caused by falling asleep while driving in obstructive sleep apnea syndrome. Sleep Breath 2015;19:1229-34.
20. Celikhisar H, Dasdemir Ilkhan G. The association of obstructive sleep apnea syndrome and accident risk in heavy equipment operators. Medicina (Kaunas) 2019;55:599.
21. Sunwoo JS, Hwangbo Y, Kim WJ, Chu MK, Yun CH, Yang KI. Prevalence, sleep characteristics, and comorbidities in a population at high risk for obstructive sleep apnea: A nationwide questionnaire study in South Korea. PLoS One 2018;13:e0193549. doi: 10.1371/ journal.pone.0193549.
22. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Ward SLD, Tangredi MM, American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: Update of the 2007 AASM manual for the scoring of sleep and associated events. deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8:597-619.
23. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, Don Carlos L, Hazen N, Herman J, Katz ES, Kheirandish-Gozal L, Neubauer DN, O’Donnell AE, Ohayon M, Peever J, Rawding R, Sachdeva RC, Setters B, Vitiello M, Ware JC, Hillard PJA. National Sleep Foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Health 2015;1:40-3.
24. Agargun MY, Cilli AS, Kara H, Bilici M, Telcioglu M, Semiz UB, Başoğlu C. Validity and reliability of the epworth sleepiness scale. Turk J Psychiatry 1999;10:261-7.
25. Xu T, Lin Y, Sun S, Zhang Q. Changes in four plasma adipokines before and after sleep in OSAS patients. Clin Respir J 2017;11:968-74.
26. Gilat H, Vinker S, Buda I, Soudry E, Shani M, Bachar G. Obstructive sleep apnea and cardiovascular comorbidities: a large epidemiologic study. Medicine (Baltimore) 2014;93:e45. doi: 10.1097/ MD.0000000000000045.
27. Zhou L, Ouyang R, Luo H, Peng Y, Chen P, Ren S, Liu G. Dysfunction of Nrf2-ARE signaling pathway: Potential pathogenesis in the Development of Neurocognitive Impairment in patients with moderate to severe obstructive sleep Apnea-Hypopnea syndrome. Oxid Med Cell Longev 2018;2018:3529709.
28. Zhang DM, Pang XL, Huang R, Gong FY, Zhong X,Xiao Y. Adiponectin, omentin, ghrelin, and visfatin levels in obese patients with severe obstructive sleep apnea. Biomed Res Int 2018;2018:3410135.
29. Bonsignore MR, Baiamonte P, Mazzuca E, Castrogiovanni A, Marrone O. Obstructive sleep apnea and comorbidities: a dangerous liaison. Multidiscip Respir Med 2019;14:8.
30. Angelico F, del Ben M, Augelletti T, de Vita R, Roma R, Violi F, Fabiani M. Obstructive sleep apnoea syndrome and the metabolic syndrome in an internal medicine setting. Eur J Intern Med 2010;21:191-5.
31. Altintop Geckil A, Ermis H. The relationship between anxiety, depression, daytime sleepiness in the REM-related mild OSAS and the NREM-related mild OSAS. Sleep Breath 2020;24:71-5.
32. Chiang CL, Chen YT, Wang KL, Su VY, Wu LA, Perng DW. Comorbidities and risk of mortality in patients with sleep apnea. Ann Med 2017;49:377-83.

APA	Ersoy E, Mercan Y (2021). Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. , 20 - 27. 10.4274/jtsm.galenos.2020.02886
Chicago	Ersoy Ersin,Mercan Yeliz Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. (2021): 20 - 27. 10.4274/jtsm.galenos.2020.02886
MLA	Ersoy Ersin,Mercan Yeliz Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. , 2021, ss.20 - 27. 10.4274/jtsm.galenos.2020.02886
AMA	Ersoy E,Mercan Y Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. . 2021; 20 - 27. 10.4274/jtsm.galenos.2020.02886
Vancouver	Ersoy E,Mercan Y Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. . 2021; 20 - 27. 10.4274/jtsm.galenos.2020.02886
IEEE	Ersoy E,Mercan Y "Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity." , ss.20 - 27, 2021. 10.4274/jtsm.galenos.2020.02886
ISNAD	Ersoy, Ersin - Mercan, Yeliz. "Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity". (2021), 20-27. https://doi.org/10.4274/jtsm.galenos.2020.02886

APA	Ersoy E, Mercan Y (2021). Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. Türk Uyku Tıbbı Dergisi, 8(1), 20 - 27. 10.4274/jtsm.galenos.2020.02886
Chicago	Ersoy Ersin,Mercan Yeliz Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. Türk Uyku Tıbbı Dergisi 8, no.1 (2021): 20 - 27. 10.4274/jtsm.galenos.2020.02886
MLA	Ersoy Ersin,Mercan Yeliz Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. Türk Uyku Tıbbı Dergisi, vol.8, no.1, 2021, ss.20 - 27. 10.4274/jtsm.galenos.2020.02886
AMA	Ersoy E,Mercan Y Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. Türk Uyku Tıbbı Dergisi. 2021; 8(1): 20 - 27. 10.4274/jtsm.galenos.2020.02886
Vancouver	Ersoy E,Mercan Y Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity. Türk Uyku Tıbbı Dergisi. 2021; 8(1): 20 - 27. 10.4274/jtsm.galenos.2020.02886
IEEE	Ersoy E,Mercan Y "Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity." Türk Uyku Tıbbı Dergisi, 8, ss.20 - 27, 2021. 10.4274/jtsm.galenos.2020.02886
ISNAD	Ersoy, Ersin - Mercan, Yeliz. "Risk Factors for Obstructive Sleep Apnea and the Association of Obstructive Sleep Apnea with Daytime Sleepiness, Obesity and Comorbidity". Türk Uyku Tıbbı Dergisi 8/1 (2021), 20-27. https://doi.org/10.4274/jtsm.galenos.2020.02886