Screening obstructive sleep apnea-hypopnea syndrome in hypertensive patients: a comparative study of the efficiency of the Epworth sleepiness scale

Long-term effects on blood pressure of soft tissue surgery for obstructive sleep apnea treatment in adults: a systematic review and meta-analysis

OBJECTIVE

To conduct a systematic review and meta-analysis to evaluate long term effect of soft tissue surgery on blood pressure (BP) in adults with obstructive sleep apnea (OSA).

SEARCH METHODS

PubMed, Scopus, the Cochrane library, and Ovid Medline databases were searched through January 2024. Manual searches were also obtained. This review included studies assessing impact of soft tissue surgery for the treatment of OSA in adults on long-term BP.

RESULT

A total of five studies (299 patients) met our inclusion criteria. Pooled random effects analysis demonstrated a statistically significant long-term postoperative reduction of BP, with average systolic BP reduction of 14.04 mmHg [95%CI (-21.97, -6.11); P = 0.0005]. Pooled random effects analysis of data from four studies (277 patients) also demonstrated statistically significant long-term postoperative reduction of diastolic BP by 6.88 mmHg compared with preoperative baseline [95%CI (-13.31, -0.45); P = 0.04].

CONCLUSION

Soft tissue surgery for OSA treatment in adults significantly resulted in long-term blood pressure reduction.

The Weighted Combination of the Epworth Sleepiness Scale and the STOP-Bang Questionnaire Improved the Predictive Value of for OSAHS in Hypertensive Patients

Purpose

Hypertension interrelated with obstructive sleep apnea hypopnea syndrome (OSAHS), worsening morbidity and mortality. It is urgent to screening OSAHS from hypertensive patients. An ideal effective questionnaire screening approach for OSAHS is lacking. In this study, we aimed to explore a new OSAHS screening method via weighted combining the current used Epworth sleepiness scale (ESS) and STOP-Bang questionnaire (SBQ) upon calculation.

Patients and Methods

Three hundred and sixteen hypertensive patients with suspicion of the OSAHS were enrolled and randomized in the study into ESS, SBQ and portable respiratory polysomnography (RP) tests. The predictive value of ESS, SBQ and weighted combination were evaluated by calculating the area under curve (AUC), sensitivity and specificity, positive and negative likelihood ratio.

Results

Both the two scales alone and weighted combination were closely related with apnea hypopnea index (AHI), minimum oxygen saturation and average oxygen saturation at night (P < 0.05). The AUC, sensitivity and specificity, positive predictive value (PPV) and negative predictive value (NPV) of ESS in predicting OSAHS were 79.0%, 74.8%, 75.6%, 80.1% and 57.5%, respectively. For SBQ, they were 73.6%, 67.0%, 68.6%, 65.1% and 75.2%, respectively. In contrast, the AUC, sensitivity, and specificity of the combined approach were 82.5%, 73.9% and 82.6%.

Conclusion

The weighted combination of ESS and SBQ could improve the diagnostic ability of OSAHS in patients with hypertension, not only in the accuracy and sensitivity, but also for its easy procedure and accessibility and in hospital. Therefore, the weighted combination approach of ESS and SBQ is promising for OSAHS screening.

Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review

Obstructive sleep apnea (OSA) is a serious, potentially life-threatening condition. Epidemiologic studies show that sleep apnea increases cardiovascular diseases risk factors including hypertension, obesity, and diabetes mellitus. OSA is also responsible for serious illnesses such as congestive heart failure, stroke, arrhythmias, and bronchial asthma. The aim of this systematic review is to evaluate evidence for the association between OSA and cardiovascular disease morbidities and identify risk factors for the conditions. In a review of 34 studies conducted in 28 countries with a sample of 37,599 people, several comorbidities were identified in patients with severe OSA—these were: heart disease, stroke, kidney disease, asthma, COPD, acute heart failure, chronic heart failure, hyperlipidemia, thyroid disease, cerebral infarct or embolism, myocardial infarction, and psychological comorbidities including stress and depression. Important risk factors contributing to OSA included: age > 35 years; BMI ≥ 25 kg/m²; alcoholism; higher Epworth sleepiness scale (ESS); mean apnea duration; oxygen desaturation index (ODI); and nocturnal oxygen desaturation (NOD). Severe OSA (AHI ≥ 30) was significantly associated with excessive daytime sleepiness and oxygen desaturation index. The risk of OSA and associated disease morbidities can be reduced by controlling overweight/obesity, alcoholism, smoking, hypertension, diabetes mellitus, and hyperlipidemia.

Prediction of obstructive sleep apnea using GOAL questionnaire in adults with or without excessive daytime sleepiness: A cross-sectional study

OBJECTIVE

Obstructive sleep apnea (OSA) is a prevalent disorder and excessive daytime sleepiness (EDS) is a frequently associated complaint. Our objectives were (1) to evaluate the predictive performance of the GOAL questionnaire in patients with or without EDS and (2) to compare its discrimination with that of 3 other validated instruments: STOP-Bang, No-Apnea, and NoSAS.

METHODS

A cross-sectional study from July 2019 to March 2020 was designed with consecutive adults undergoing full polysomnography. Participants were grouped into 2 cohorts according to the Epworth Sleepiness Scale (ESS): without EDS (ESS <11) or with EDS (ESS ≥11). Discrimination was assessed by area under the curve, while predictive parameters were calculated using contingency tables. OSA severity was classified based on apnea/hypopnea index thresholds: ≥ 5.0/h (OSA_≥5), ≥ 15.0/h (OSA_≥15), and ≥ 30.0/h (OSA_≥30).

RESULTS

Overall, 2627 patients were enrolled. In 1477 individuals without EDS, for the screening of OSA_≥5, OSA_≥15, and OSA_≥30, GOAL showed sensitivities ranging from 79.3% to 91.5% and specificities ranging from 60.6% to 40.2%. In 1150 individuals with EDS, for the screening of OSA_≥5, OSA_≥15, and OSA_≥30, GOAL reported sensitivities ranging from 86.2% to 94.5% and specificities ranging from 63.9% to 36.0%. In both cohorts, GOAL showed similar discrimination to STOP-Bang, No-Apnea, and NoSAS for predicting OSA_≥5, OSA_≥15, and OSA_≥30 (all P values >.05).

CONCLUSIONS

The GOAL questionnaire, a practical 4-item instrument, showed adequate predictive performance for the prediction of OSA. Moreover, its discrimination was satisfactory and non-inferior to that of STOP-Bang, No-Apnea, and NoSAS.