Background: Obstructive sleep apnea syndrome (OSAS) is an increasingly common, yet under-recognized and underreported sleep-related breathing disorder (SRBD) with momentous clinical, psychological, epidemiological, economic and healthcare implications. We conducted this study to decipher the clinical profile of patients with OSAS at the Pulmonary Medicine Department of a tertiary care center in Mumbai, India.
Methodology: Patients presenting to our outpatient department with either symptoms of OSAS or who were referred with risk factors for OSAS were evaluated with polysomnography (PSG) after a comprehensive history, detailed clinical examination, calculation of various pre-test probability scores and relevant pre-requisite workup.
Results: One hundred thirty patients were included, of these, 92 (71%) were male patients, while 38 were females (29%). Mean age of the study group was 49.5 years. Thirty-nine patients (30%) were overweight, while 35 (27%), 23 (17.7%) and 15 (11.5%) patients had mild, moderate and morbid obesity respectively. Average neck circumference in our group of patients was 40.1 (±4) cm. Average Epworth sleepiness score (ESS) for the group was 13.8 (±3.5). Average adjusted neck circumference score (ANCS) in our patients was 47.6 (±5.2). Average STOP-BANG score of our group was 5.3 (±1.4). The average APNEIC score was 4 (±1.2), and average Berlin score was 2.4 (±0.89). Of all the comorbidities present in these OSAS patients, hypertension was the commonest, present in 86 patients (66%), followed by GERD in 80 patients (61.5%), diabetes mellitus in 56 patients (43%), ischemic heart disease in 31 patients (24%), and hypothyroidism in 22 patients (17%). Mild pulmonary artery hypertension (PH) was present in 94 (72%), 20 patients had no PH (15.4%), while 11 patients (8.5%) had moderate PH. Seventy three patients (56%) had a normal spirometry, 36 patients (27.7%) had a restrictive, while 17 (13%) patients had an obstructive abnormality. Four patients had a spirometry suggestive of upper airway obstruction. PSG revealed 29 patients with mild OSAS (22%). 38 patients had moderate OSAS (29%), while 63 patients had severe OSAS (48.5%). Although there was a positive correlation seen between ANCS, STOP-BANG, APNEIC and ESS scores with the AHI, it was not a linear correlation.
Conclusion: Obstructive sleep apnea syndrome (OSAS) in a tertiary center in India shows a predilection towards male sex, obesity, and a frequent association with cardiovascular comorbidities such as hypertension and IHD. Pretest probability scores help predict the likelihood of OSAS.
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