Introduction: Obstructive sleep apnoea syndrome affects 4% men and 2% women. It is the most common sleep disordered breathing and is associated with recurrent episodes of upper airway collapse during sleep. Arousal from sleep is required to re-establish the airway patency. This distortion of sleep pattern, repetitive awakening and nocturnal hypoxia lead to pulmonary and systemic hypertension as well as other cardiac and metabolic complications. Cardiovascular disturbances like systemic hypertension, acute myocardial infarction, nocturnal arrhythmias, corpulmonale and sudden nocturnal death are serious complications of obstructive sleep apnoea syndrome.
Aim: To study the association between cardiovascular abnormalities/ cardiovascular risk factors and apnoea hypopnoea index (AHI) in patients diagnosed with obstructive sleep apnoea syndrome.
Methods and Material: 50 patients diagnosed with obstructive sleep apnoea syndrome were divided in to 3 grades-mild, moderate and severe OSAS as per American Academy of Sleep Medicine. Patients were interviewed in detail, clinically examined and investigated (random blood sugar, lipid profile, thyroid function tests chest roentgenogram, ECG and 2D echocardiogram). On basis of history, examination and investigations patients were diagnosed of having hypertension, diabetes mellitus, hypothyroidism, hyperlipidemia and ischaemic heart disease. The prevalence of these associated disease with OSAS and its statistical association with grades of severity of OSAS was calculated.
Statistical Analysis: Frequency and Percentage table, association among study group: Chi-Square test and Fisher Exact test.
Results: In our study the prevalence of hypertension was 48%, diabetes mellitus was 38%, hypothyroidism was 18%, hyperlipidaemia was 30% and ischaemic heart disease was 34%. 24% patients of OSAS in our study had history of smoking.
24% patients has ST-T changes on electrocardiogram, 18% had left ventricular hypertrophy and 18% had left ventricular ejection fraction less than 45% on 2D echocardiography. The prevalence of Pulmonary hypertension was 30%.
Statistically significant co-relation was observed between hypertension, diabetes mellitus, hyperlipidaemia, ischaemic heart disease with grades of severity of OSAS.
Conclusions: Cardiovascular abnormalities and risk factors are more common in obstructive sleep apnoea patients and hence patients should undergo periodic evaluation.
Ramirez JM, Garcia AJ, 3rd, Anderson TM, Koschnitzky JE, Peng YJ, Kumar GK, et al. Central and peripheral factors contributing to obstructive sleep apneas. Respiratory physiology & neurobiology. 2013 Nov 1;189(2):344-53.
Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annual review of medicine. 1976;27:465-84.
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 Mar 19-25;365(9464):1046-53.
Konecny T, Kara T, Somers VK. Obstructive sleep apnea and hypertension: an update. Hypertension. 2014 Feb;63(2):203-9.
Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. Increased incidence of cardiovascular disease in middleaged men with obstructive sleep apnea: a 7-year followup. American journal of respiratory and critical care medicine. 2002 Jul 15;166(2):159-65.
Garcia-Rio F, Alonso-Fernandez A, Armada E, Mediano O, Lores V, Rojo B, et al. CPAP effect on recurrent episodes in patients with sleep apnea and myocardial infarction. International journal of cardiology. 2013 Sep 30;168(2):1328-35.
Koehler U, Schafer H. Is obstructive sleep apnea (OSA) a risk factor for myocardial infarction and cardiac arrhythmias in patients with coronary heart disease (CHD)? Sleep. 1996 May;19(4):283-6.
Liston R, Deegan PC, McCreery C, McNicholas WT. Role of respiratory sleep disorders in the pathogenesis of nocturnal angina and arrhythmias. Postgraduate medical journal. 1994 Apr;70(822):275-80.
Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. The New England journal of medicine. 2005 Mar 24;352(12):1206-14.
Kuniyoshi FH, Pusalavidyasagar S, Singh P, Somers VK. Cardiovascular consequences of obstructive sleep apnoea. The Indian journal of medical research. 2010 Feb;131:196-205.
Alchanatis M, Tourkohoriti G, Kosmas EN, Panoutsopoulos G, Kakouros S, Papadima K, et al. Evidence for left ventricular dysfunction in patients with obstructive sleep apnoea syndrome. The European respiratory journal. 2002 Nov;20(5):1239-45.
Laks L, Lehrhaft B, Grunstein RR, Sullivan CE. Pulmonary hypertension in obstructive sleep apnoea. The European respiratory journal. 1995 Apr;8(4):537-41.
Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest. 1996 Feb;109(2):380-6.
Udwadia ZF, Doshi AV, Lonkar SG, Singh CI. Prevalence of sleep-disordered breathing and sleep apnea in middleaged urban Indian men. American journal of respiratory and critical care medicine. 2004 Jan 15;169(2):168-73.
Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest. 2006 Jul;130(1):149- 56.
Kiely JL, McNicholas WT. Cardiovascular risk factors in patients with obstructive sleep apnoea syndrome. The European respiratory journal. 2000 Jul;16(1):128-33.
Joo S, Lee S, Choi HA, Kim J, Kim E, Kimm K, et al. Habitual snoring is associated with elevated hemoglobin A1c levels in non-obese middle-aged adults. Journal of sleep research. 2006 Dec;15(4):437-44.
Elmasry A, Lindberg E, Berne C, Janson C, Gislason T, Awad Tageldin M, et al. Sleep-disordered breathing and glucose metabolism in hypertensive men: a populationbased study. Journal of internal medicine. 2001 Feb;249(2):153-61.
C. W. Atwood Jr., D. McCrory, J. G. Garcia, S. H. Abman, and G. S. Ahearn, “Pulmonary artery hypertension and sleep-disordered breathing: ACCP evidence-based clinical practice guidelines,” Chest, vol. 126, no. 1, supplement, pp. 72S–77S, 2004.
Ancoli-Israel S, Gehrman P, Kripke DF, Stepnowsky C, Mason W, Cohen-Zion M, et al. Long-term follow-up of sleep disordered breathing in older adults. Sleep medicine. 2001 Nov;2(6):511-6.
Abou Shehata ME MEE-D, Abd El-Razek Maaty,, Amina M. Abd-ElMaksoud LAS. Pulmonary hypertension in obstructive sleep apnea hypopnea syndrome. Egyptian Journal of Chest Diseases and Tuberculosis. 2013;62(3):459-65.
Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. Jama. 2002 Oct 9;288(14):1723-7.
Young T. Sleep-disordered breathing in older adults: is it a condition distinct from that in middle-aged adults? Sleep. 1996 Sep;19(7):529-30.
Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men: I. Prevalence and severity. American journal of respiratory and critical care medicine. 1998 Jan;157(1):144-8.
Ip MS, Lam B, Tang LC, Lauder IJ, Ip TY, Lam WK. A community study of sleep-disordered breathing in middleaged Chinese women in Hong Kong: prevalence and gender differences. Chest. 2004 Jan;125(1):127-34.
Newman AB, Nieto FJ, Guidry U, Lind BK, Redline S, Pickering TG, et al. Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. American journal of epidemiology. 2001 Jul 1;154(1):50-9.
Jennum P, Hein HO, Suadicani P, Gyntelberg F. Cardiovascular risk factors in snorers. A cross-sectional study of 3,323 men aged 54 to 74 years: the Copenhagen Male Study. Chest. 1992 Nov;102(5):1371-6.
Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax. 1991 Feb;46(2):85-90.
Silverberg DS, Oksenberg A, Iaina A. Sleep-related breathing disorders as a major cause of essential hypertension: fact or fiction? Current opinion in nephrology and hypertension. 1998 Jul;7(4):353-7.
Fletcher EC, DeBehnke RD, Lovoi MS, Gorin AB. Undiagnosed sleep apnea in patients with essential hypertension. Annals of internal medicine. 1985 Aug;103(2):190-5.
Hla KM, Young TB, Bidwell T, Palta M, Skatrud JB, Dempsey J. Sleep apnea and hypertension. A populationbased study. Annals of internal medicine. 1994 Mar 1;120(5):382-8.
Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Archives of internal medicine. 1997 Aug 11-25;157(15):1746-52.
Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleepdisordered breathing. Jama. 2000 Dec 20;284(23):3015- 21.
Casale PN, Devereux RB, Kligfield P, Eisenberg RR, Miller DH, Chaudhary BS, Phillips MC. Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol. 1985 Sep;6(3):572-80.
Resta O, Pannacciulli N, Di Gioia G, Stefano A, Barbaro MP, De Pergola G. High prevalence of previously unknown subclinical hypothyroidism in obese patients referred to a sleep clinic for sleep disordered breathing. Nutrition, metabolism, and cardiovascular diseases : NMCD. 2004 Oct;14(5):248-53.
Parish JM, Adam T, Facchiano L. Relationship of metabolic syndrome and obstructive sleep apnea. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2007 Aug 15;3(5):467-72.
Hanly P, Sasson Z, Zuberi N, Lunn K. ST-segment depression during sleep in obstructive sleep apnea. The American journal of cardiology. 1993 Jun 1;71(15):1341-5.
Peled N, Abinader EG, Pillar G, Sharif D, Lavie P. Nocturnal ischemic events in patients with obstructive sleep apnea syndrome and ischemic heart disease: effects of continuous positive air pressure treatment. Journal of the American College of Cardiology. 1999 Nov 15;34(6):1744-9.
Franklin KA, Nilsson JB, Sahlin C, Naslund U. Sleep apnoea and nocturnal angina. Lancet. 1995 Apr 29;345(8957):1085-7.
Philip P, Guilleminault C. ST segment abnormality, angina during sleep and obstructive sleep apnea. Sleep. 1993 Sep;16(6):558-9.
Hedner J, Ejnell H, Caidahl K. Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnoea. Journal of hypertension. 1990 Oct;8(10):941-6.
Noda A, Okada T, Yasuma F, Nakashima N, Yokota M. Cardiac hypertrophy in obstructive sleep apnea syndrome. Chest. 1995 Jun;107(6):1538-44.
Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation. 1998 Jun 2;97(21):2154-9.
Wang H, Parker JD, Newton GE, Floras JS, Mak S, Chiu KL, et al. Influence of obstructive sleep apnea on mortality in patients with heart failure. Journal of the American College of Cardiology. 2007 Apr 17;49(15):1625-31.