Value of Clinical, Functional, and Oximetric Data for the Prediction of Obstructive Sleep Apnea in Obese Patients

Herer, Bertrand; Roche, Nicolás; Carton, Matthieu; Roig, Catherine; Poujol, Vincent; Huchon, G

doi:10.1378/chest.116.6.1537

Cited by 39 publications

(40 citation statements)

References 30 publications

(49 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…So far, such studies have never been conducted on consecutive morbidly obese patients who were enrolled for reasons different from the symptoms they complained. As a matter of fact, some studies worked out prediction models of OSAHS obtained from groups of patients enrolled because they complained of OSAHS symptoms and had a BMI ranging from normal to very high [23, 24], whereas other studies were conducted on severely obese patients complaining of typical signs of OSAHS [18, 25, 26]. A recent study performed on asymptomatic subjects suffering from obesity of moderate degree has found predictive factors in the waist-hips ratio, male gender, neck circumference and nocturnal reduction of saturation; the sensitivity and specificity of the model shown were fairly good [6].…”

Section: Discussionmentioning

confidence: 99%

Sleep Apnea in Morbidly Obese Patients: Prevalence and Clinical Predictivity

Palla

Digiorgio²,

Carpenè³

et al. 2008

Respiration

View full text Add to dashboard Cite

Background: Little is known about the prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) in morbidly obese patients and whether such patients show peculiar clinical findings that may make it easier to suspect and diagnose OSAHS. Objectives: To investigate prevalence of OSAHS in patients with morbid obesity and find a simple structured model for predicting the results of polysomnography. Methods: The study enrolled a group of 101 consecutive inpatients (33 males, age range 20–80 years) with a body mass index ≥40, whose symptoms of OSAHS were not known, and a validation group of 45 patients. Results: Habitual snoring, nocturnal apneas or awakening as well as diurnal sleepiness were frequent findings (90.1, 40.6, 50.5 and 61.4%, respectively). Chronic obstructive pulmonary disease, hypertension, diabetes and myocardial ischemia were also frequently associated (22.8, 56.4, 30.7 and 6.9%, respectively). OSAHS was found in 61 (60.4%) patients, in 33.7% it was of severe degree. A multivariate logistic regression model allowed to select the independent predictors of OSAHS: age, male sex, diurnal sleepiness and the value of minimum nocturnal saturation. Sensitivity of 97%, specificity of 77% as well as positive and negative predictive values of 87% and 95%, respectively, were obtained; similar results were found in the validation group. When the best obtainable cutoff on the receiver operating characteristic curve is below 40%, the instrumental diagnosis might be excluded in as many as 33% of cases, since they are not affected by OSAHS or have OSAHS of mild degree. Conclusions: OSAHS is present in almost two thirds of morbidly obese patients. By applying the prediction model we propose, one may calculate the probability of a morbidly obese patient of being affected by OSAHS.

show abstract

Section: Discussionmentioning

confidence: 99%

Sleep Apnea in Morbidly Obese Patients: Prevalence and Clinical Predictivity

Palla

Digiorgio²,

Carpenè³

et al. 2008

Respiration

View full text Add to dashboard Cite

show abstract

“…To minimise potential overestimation of sleep duration, subjects completed a sleep diary to exclude wakefulness before turning lights off from the analysis. An AHI .15 events?h -1 [26] with o85% of events scored as obstructive or an ODI .10 events?h -1 [33] was considered a diagnostic of SDB. An AHI .15-30 events?h -1 indicated mild OSAS and .30 events?h -1 indicated moderateto-severe OSAS.…”

Section: Clinical Datamentioning

confidence: 99%

Association between C-reactive protein and unrecognised sleep-disordered breathing in the elderly

Roche¹,

Jm²,

Pichot³

et al. 2009

European Respiratory Journal

View full text Add to dashboard Cite

Elevated levels of C-reactive protein (CRP) have been reported in patients with sleep-disordered breathing (SDB) and may represent an inflammatory marker of cardiovascular risk. However, the association of CRP with SBD in presumed healthy elderly subjects is unknown.In total, 851 (58.5% females) 68-yr-old subjects, who were free of any known cardiac or sleep disorders, were prospectively examined. Subjects underwent unattended polygraphy, and the apnoea/hypopnoea index (AHI) and oxyhaemoglobin desaturation index (ODI) were assessed. Elevated levels of CRP were found on the morning after the sleep study in patients with more severe SDB. A significant correlation was found between CRP levels, time spent at night with arterial oxygen saturation ,90% and ODI. No association was found between CRP levels and AHI. After adjustments for body mass index, smoking status, hypertension, diabetes and dyslipidaemia, a significant association remained between CRP levels and ODI .10 events?h -1 .CRP levels were frequently increased in a large sample of elderly subjects free of major cardiovascular disease. CRP levels were not correlated with the AHI and the indices of sleep fragmentation; the ODI .10 events?h -1 was the strongest predictor of raised CRP level.The present results suggest that, in the elderly, intermittent hypoxaemia may underlie inflammatory processes leading to cardiovascular morbidity. KEYWORDS: C-reactive protein, elderly, hypoxaemia, inflammation, sleep apnoea O bstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder affecting 2-4% of the general population and is considered an independent risk factor for cardiovascular diseases [1-3], particularly hypertension, coronary artery disease, heart failure and stroke [4,5]. Furthermore, newly diagnosed OSAS patients, free of classical cardiovascular risk factors, such as hypertension, diabetes and smoking, may have early signs of atherosclerosis [6]. Although the pathophysiology of cardiovascular risk is mutifactorial, sympathetic hypertonia [7], endothelial dysfunction [8, 9] and insulin resistance [10] have been postulated as factors initiating and sustaining inflammatory microvascular alterations and therefore atherosclerosis [11,12]. In middle-aged OSAS patients, C-reactive protein (CRP), a marker of inflammation in atherosclerotic lesions [13], is elevated in severe cases [14] and decreases after treatment with nasal continuous positive airway pressure [15]. Despite the putative role of CRP in cardiovascular risk in OSAS, studies conducted to date have yielded contradictory results, with some showing an independent association with disease severity in adults [16][17][18][19] and children [20,21], and others showing no relationship [22,23]. Moreover, the association between obesity and CRP [24] raised the question as to whether elevated CRP reflects the effects of obesity or whether it is specific to OSAS itself.In the elderly, the prevalence of sleep-disordered breathing (SDB) is estimated to be higher than in middle-aged subjects. AN...

show abstract

“…Given the wide prevalence of OSA, many health systems have been overwhelmed by the demand for PSG, which is expensive and time consuming (Lévy et al 1996, Herer et al 1999, Gagnadoux et al 2002, Kirk et al 2003. Nocturnal pulse oximetry is widely used in many medicine areas to determine patient's blood oxygen saturation (SaO 2 ) and heart rate because of its non-invasive nature and simplicity.…”

Section: Introductionmentioning

confidence: 99%

Nonlinear characteristics of blood oxygen saturation from nocturnal oximetry for obstructive sleep apnoea detection

Álvarez¹,

Hornero²,

Abásolo³

et al. 2006

Physiol. Meas.

View full text Add to dashboard Cite

Nocturnal oximetry is an attractive option for the diagnosis of obstructive sleep apnoea (OSA) syndrome because of its simplicity and low cost compared to polysomnography (PSG). The present study assesses non-linear analysis of blood oxygen saturation (SaO 2 ) from nocturnal oximetry as a diagnostic test to discriminate between OSA positive and OSA negative patients. A sample of 187 referred outpatients, clinically suspected of having OSA, were studied using nocturnal oximetry performed simultaneously with complete PSG. A positive OSA diagnosis was found for 111 cases, while the remaining 76 cases were classified as OSA negative. The following oximetric indexes were obtained: cumulative time spent below a saturation of 90% (CT90), oxygen desaturation indexes of 4% (ODI4), 3% (ODI3) and 2% (ODI2), and the delta index (∆ index). SaO 2 records were subsequently processed applying two non-linear methods: central tendency measure (CTM) and Lempel-Ziv (LZ) complexity. Significant differences (p < 0.01) were found between OSA positive and OSA negative patients. Using CTM we obtained a sensitivity of 90.1% and a specificity of 82.9%, while with LZ the sensitivity was 86.5% and the specificity was 77.6%. CTM and LZ accuracy was higher than that provided by ODI4, ODI3, ODI2 and CT90. The results suggest that non-linear analysis of SaO 2 signals from nocturnal oximetry could yield useful information in OSA diagnosis.

show abstract

Value of Clinical, Functional, and Oximetric Data for the Prediction of Obstructive Sleep Apnea in Obese Patients

Cited by 39 publications

References 30 publications

Sleep Apnea in Morbidly Obese Patients: Prevalence and Clinical Predictivity

Sleep Apnea in Morbidly Obese Patients: Prevalence and Clinical Predictivity

Association between C-reactive protein and unrecognised sleep-disordered breathing in the elderly

Nonlinear characteristics of blood oxygen saturation from nocturnal oximetry for obstructive sleep apnoea detection

Contact Info

Product

Resources

About