Obstructive sleep apnea and multimorbidity

Abstract

BackgroundObstructive sleep apnea (OSA) is becoming increasingly prevalent in North America and has been described in association with specific chronic diseases, particularly cardiovascular diseases. In primary care, where the prevalence of co-occurring chronic conditions is very high, the potential association with OSA is unknown. The purpose of this study was to explore the association between OSA and 1) the presence and severity of multimorbidity (multiple co-occurring chronic conditions), and 2) subcategories of multimorbidity.MethodsA cluster sampling technique was used to recruit 120 patients presenting with OSA of various severities from the records of a sleep laboratory in 2008. Severity of OSA was based on the results of the polysomnography. Patients invited to participate received a mail questionnaire including questions on sociodemographic characteristics and the Disease Burden Morbidity Assessment (DBMA). They also consented to give access to their medical records. The DBMA was used to provide an overall multimorbidity score and sub-score of diseases affecting various systems.ResultsBivariate analysis did not demonstrate an association between OSA and multimorbidity (r = 0.117; p = 0.205). However, severe OSA was associated with multimorbidity (adjusted odds ratio = 7.33 [1.67-32.23], p = 0.05). OSA was moderately correlated with vascular (r = 0.26, p = 0.01) and metabolic syndrome (r = 0.26, p = 0.01) multimorbidity sub-scores.ConclusionsThis study showed that severe OSA is associated with severe multimorbidity and sub-scores of multimorbidity. These results do not allow any causal inference. More research is required to confirm these associations. However, primary care providers should be aware of these potential associations and investigate OSA when deemed appropriate.

Gelatinases and their tissue inhibitors in a group of subjects with obstructive sleep apnea syndrome

“…OSAS is independently associated with an increased risk of morbidity and mortality [28] considering that the most important complications are arterial hypertension, coronary artery disease, and cerebrovascular accidents [7,21,37,39]. Atherosclerosis is common in OSAS, and several studies have demonstrated that the elevated mortality in OSAS is associated with the severity of the atherosclerosis [33].…”

A clinical risk matrix for obstructive sleep apnea using Bayesian network approaches

“…Using a simple back of the envelope calculation, the relatively small district hospital where our cohort was recruited could potentially perform 466 PSG (yearly extrapolation of 194 PSG in 5 months). Given a 20% specificity of our model, from the 158 normal PSG (yearly extrapolation of 66 normal PSG in 5 months), 32 would not have been referred to perform PSG. Considering Portuguese mandamus number 207/2017, each PSG is priced at e939,14 leading to a total saving of e30.052,48.…”

“…Central sleep apnea is a reduction in the respiratory effort resulting in reduced or absent ventilation, while mixed apnea begins with central apneas that leads to obstructive events [5,22]. In OSA, respiratory effort is maintained but ventilation decreases or disappears because of partial/total occlusion of the upper airway [6,22,23,28,32].…”

Sleep apnoea adversely affects the outcome in patients who undergo posterior lumbar fusion

“…Similarly, Robichaud-Hallé et al[[25]] reported correlations between the severity of sleep apnoea and morbidity indicating the coexistence of vascular disease (r = 0.26, p = 0.01) or metabolic syndrome (r = 0.26, p = 0.01), and a significant relationship between the presence of severe sleep apnoea and cardiovascular morbidity as defined by the score (OR = 7.33, CI 1.67–32.23, p = 0.05). [[26]] It has been suggested that patients with sleep apnoea should be screened for diabetes regularly, and vice versa.…”