Download PDF
Sleep Breath 2003; 07(4): 177-184
DOI: 10.1055/s-2003-814760
ORIGINAL ARTICLE

Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Obstructive Sleep Apnea in a Referral Population in India

Ajit Vigg1 , Avanti Vigg2 , Arul Vigg2
  • 1Department of Pulmonary Medicine, Apollo Hospitals, Hyderabad, India
  • 2Institute of Sleep Medicine, Saifabad, Hyderabad, India
Further Information

Publication History

Publication Date:
07 January 2004 (online)

    Permissions and Reprints

ABSTRACT

There are few published studies of obstructive sleep apnea in the Asian subcontinent. The objectives were to describe the syndrome and evaluate the utility of computed tomography (CT) cephalometry in patients found to have obstructive sleep apnea (OSA) by polysomnography. This article reports on a retrospective case series in a referral population. A total of 880 patients (560 males and 320 females) were seen in a referral center in Hyderabad, South India, during the last 7 years. All patients with suspected obstructive sleep apnea were evaluated with 16-channel polysomnogram by overnight sleep study; 600 subjects (68%; 480 males and 120 females) underwent evaluation with CT cephalometry. Mean age was 51.4 ± 9.5 years (standard deviation). The mean apnea-hypopnea index (AHI) was 27.93 ± 3.8. The majority of patients had more than 10 AHI; mean percentage of sleep efficiency was 80.62 ± 15.38; mean percentage of rapid eye movement (REM) sleep was 13.79 ± 7.89; mean awake arterial oxygen saturation (SaO2) was 90%; mean sleep SaO2 was 84% ± 4.4%; mean Epworth Sleepiness Scale (ESS) score was 12.3 ± 2.8. The tongue base area (TBA) was found to be significantly associated with obstructive sleep apnea (OSA), with mean TBA 1032.8 ± 427 mm2 compared with normal controls at 561.1 ± 197.6 mm2 (p < 0.001). Mean gonion-gnathion-hyoid angle (Go-Gn-H) was 28.5 ± 10.5 in OSA and 16 ± 16.7 in controls; uvula area was 452.5 ± 145.8 mm2 in OSA and 221.4 ± 49.85 mm2 in controls; uvula diameter was 13.8 ± 2.74 mm in OSA and 10.1 ± 1.72 mm in controls. A total of 704 patients with OSA (80%) were found to be hypertensive, with daytime mean blood pressure of 160/100 ± 8.5/4.8 mm Hg. Mean duration of reported hypertension was 2 years. The present study showed moderate to severe OSA in a majority of suspected cases referred for polysomnogram. Mild disease was seen in 20.45% of patients (n = 180). On CT cephalometry, the TBA correlated significantly with OSA; hypertension is common in patients with OSA.

KEYWORDS

Obstructive sleep apnea - hypertension - CT cephalometry - polysomnogram

REFERENCES

  • 1 Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome: a risk factor for hypertension: population study.  Br Med J . 2000;  320 479-482
    CrossrefPubMedGoogle Scholar
  • 2 Nieto F J, Young T, Lind B K. et al . Association of sleep disordered breathing sleep apnoea & hypertension in a large community based study.  JAMA . 2000;  283 1829-1836
    CrossrefPubMedGoogle Scholar
  • 3 Grote L, Ploch T, Heitmann J. et al . Sleep related breathing disorders is an independent risk factor for systemic hypertension.  Am J Respir Crit Care Med . 1999;  160 1875-1882
    PubMedGoogle Scholar
  • 4 Peppard P E, Young T, Palta M. et al . Prospective study of the association between sleep-disordered breathing and hypertension.  N Engl J Med . 2000;  342 1378-1384
    CrossrefPubMedGoogle Scholar
  • 5 He J, Kryger M H, Zorick F J, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea: experience in 385 male patients.  Chest . 1988;  94 9-14
    PubMedGoogle Scholar
  • 6 Bahammam A, Delaive K, Ronald J, Manfreda J, Roos L, Kryger M H. Health care utilization in males with obstructive sleep apnea syndrome two years after diagnosis and treatment.  Sleep . 1999;  22 740-747
    PubMedGoogle Scholar
  • 7 Findley L J, Unverzagt M E, Suratt P M. Automobile accidents involving patients with obstructive sleep apnea.  Am Rev Respir Dis . 1988;  138 337-340
    PubMedGoogle Scholar
  • 8 Barbe F, Pericas J, Munoz A. et al . Automobile accidents in patients with sleep apnoea syndrome: an epidemiological and mechanistic study.  Am J Respir Crit Care Med . 1998;  158 18-22
    PubMedGoogle Scholar
  • 9 Findley L J, Weiss J W, Jabour E R. Drivers with untreated sleep apnoea: a cause of death and serious injury.  Arch Intern Med . 1991;  151 1451-1452
    CrossrefPubMedGoogle Scholar
  • 10 Harbison J, O'Reilly P, Mc Nicholas T W. Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: effects of nasal continuous positive pressure.  Chest . 2000;  118 591-595
    CrossrefPubMedGoogle Scholar
  • 11 Shahar E, Whitney C W, Redline S. et al . Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study.  Am J Respir Crit Care Med . 2001;  163 19-25
    CrossrefPubMedGoogle Scholar
  • 12 Hira H S, Sharma S K. Sleep apnoea syndrome. In: Sharma SK, Behera D, Mohan A, eds. Recent Advances in Respiratory Medicine New Delhi: Jaypee Brothers Medical Publishers 1998: 52-72
    Google Scholar
  • 13 Li K K, Powell N B, Kushida C. et al . A comparison of Asian and white patients with obstructive sleep apnoea syndrome.  Laryngoscope . 1999;  109 1937-1940
    PubMedGoogle Scholar
  • 14 Ip M SM, Tsan W T, Lam W K. et al . Obstructive sleep apnoea syndrome: an experience in Chinese adults in Hong Kong.  Clin Med J . 1998;  111 257-260
    PubMedGoogle Scholar
  • 15 Ong K C, Clerk A A. Comparison of severity of sleep disordered breathing in Asian & Caucasian patients seen at a sleep disorders centre.  Respir Med . 1998;  92 843-849
    PubMedGoogle Scholar
  • 16 Kripke D F, Ancoli-Israel S, Klauber M R. et al . Prevalence of sleep disordered breathing in ages 40-60 yrs. A population based study.  Sleep . 1997;  20 65-76
    Google Scholar
  • 17 Redline S, Tishler P V, Hans M G. et al . Racial difference in sleep disordered breathing in African-Americans & Caucasians.  Am J Respir Crit Care Med . 1997;  155 186-192
    PubMedGoogle Scholar
  • 18 Schmidt-Nowara W W, Coultas D B, Wiggins C. et al . Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity.  Arch Intern Med . 1990;  150 597-601
    CrossrefPubMedGoogle Scholar
  • 19 Cakirer B, Hans M G, Graham G. et al . The relationship between craniofacial morphology and obstructive sleep apnoea in whites and in African-Americans.  Am J Respir Crit Care Med . 2001;  163 947-950
    PubMedGoogle Scholar
  • 20 Janardhan Rao J, Vinay Kumar C E. Determination of obstructive site in obstructive sleep apnoea.  Ind J Otolaryngol Head Neck Surg . 1993;  45 50-56
    PubMedGoogle Scholar
  • 21 Bernard D, Borowick B, Andrews K, Robert H I, Blanks S, Irvine G. Cephalometric analysis for diagnosis and treatment of obstructive sleep apnoea.  Laryngoscope . 1988;  98 226-234
    PubMedGoogle Scholar
  • 22 Maltair F, Carier G, Cormier Y, Series F. Cephalometric measurements in snorers, nonsnorers and patients with sleep apnoea.  Thorax . 1991;  46 419-423
    PubMedGoogle Scholar
  • 23 Cutellari S, Orzinaolo C, Feroali T R, Fitzpatrick M F. Cephalometry and digital radiographics. Technical note.  Radiol Med . 1993;  86 899-903
    PubMedGoogle Scholar
  • 24 Dempsey J A, Skatrud J B, Jackques A J. et al . Anatomic determinants of sleep-disordered breathing across the spectrum of clinical and non-clinical male subjects.  Chest . 2002;  122 840-851
    CrossrefPubMedGoogle Scholar
  • 25 Ip M S, Lam B, Landes I J. et al . A community study of sleep disordered breathing in middle aged Chinese men in Hong Kong.  Chest . 2001;  119 62-69
    CrossrefPubMedGoogle Scholar
  • 26 Li K K, Kushida C, Powell N B. et al . Obstructive sleep apnoea syndrome, a comparison between Far-East Asian and white men.  Laryngoscope . 2000;  110 1689-1693
    CrossrefPubMedGoogle Scholar
  • 27 Rechtschaffen A, Kales A. A manual of standardized terminology, techniques and scoring systems for sleep stages of human subjects.  Bethesda, MD: US Government Printing Office; 1968
    Google Scholar
  • 28 Taha B H, Dempsey J A, Weber S M. et al . Automated detection and classification of sleep-disordered breathing from conventional polysomnography data.  Sleep . 1997;  20 991-1001
    PubMedGoogle Scholar
  • 29 Mc Nicholas T W, Levy P. Sleep related breathing disorders: definition and measurements.  Eur Respir J . 2000;  15 988-989
    CrossrefPubMedGoogle Scholar
  • 30 The report of American Academy of Sleep Medicine Task Force. Sleep related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research.  Sleep . 1999;  22 667-689
    PubMedGoogle Scholar
  • 31 Quan S F, Gillin J C. New definitions of sleep disordered breathing-not yet a mandate for change in clinical practice.  Sleep . 1999;  22 662
    PubMedGoogle Scholar
  • 32 Littner M R, Shepard J W. Recommendations for research into measurement and classification of sleep disordered breathing; gazing into the crystal ball.  Sleep . 1999;  22 665-666.
    PubMedGoogle Scholar
  • 33 Young T, Peppard P, Palta M. et al . Population based study of sleep disordered breathing as a risk factor for hypertension.  Arch Intern Med . 1997;  157 1746-1752
    PubMedGoogle Scholar
  • 34 Young T, Blusten J, Finn L. et al . Sleep disordered breathing and motor vehicle accidents in a population based sample of employed adults.  Sleep . 1997;  20 608-613
    PubMedGoogle Scholar
  • 35 Wilcox I, Grunstein R R, Hedner J A. et al . Effect of nasal continuous positive airway pressure during sleep on 24-hour blood pressure in obstructive sleep apnoea.  Sleep . 1993;  16 539-544
    PubMedGoogle Scholar
  • 36 Suzuki M, Otsuka K, Guilleminault C. Long term continuous positive airway pressure administration can normalize hypertension in obstructive sleep apnoea patients.  Sleep . 1993;  16 545-549
    PubMedGoogle Scholar
  • 37 Young T, Peppard P, Finu L, Colditz G A. Association of allergic rhinitis with habitual snoring and sleep disordered breathing.  J Allergy Clin Immunol . 1997;  99 57-58
    PubMedGoogle Scholar
      >