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      Overnight pulse oximetry for screening of obstructive sleep apnea in at-risk adult patients in the primary care setting: prospective case series

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          Abstract

          Objective: To estimate prevalence of OSA among at risk adult patients in primary care setting. To test the correlation and agreement between overnight pulse oximetry and polysomnography (PSG). To test the OSA screening performance of overnight pulse oximetry.

          Design and Setting: Prospective case series involving adult Chinese patients with risk factors for OSA at a primary care clinic of Hong Kong.

          Methods: The prevalence and severity of OSA were established based on overnight pulse oximetry derived oxygen desaturation index (ODI). Screening performance of overnight pulse oximetry was compared directly with gold standard diagnostic test PSG.

          Results: Three hundred and five male and 229 female patients were recruited. Snoring (48.3%) was the top presenting symptom. Three hundred and twenty five patients (60.9%) were screened positive to have OSA. One hundred and nine patients had performed PSG, the ODI_4 and apnoea-hypopnea index (AHI) had Pearson correlation coefficient 0.71 ( P<0.001). Bland and Altman plot showed good agreement. Using designation criteria of ODI_4≥5 events/hr, the sensitivity and specificity for OSA diagnosis are 94.4% and 78.9% respectively.

          Conclusion: The prevalence of OSA is 60.9% among adult primary care population who are at risk for OSA. Overnight pulse oximetry shows good performance as a screening tool for the screening of OSA.

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          Most cited references 27

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          Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women.

          The proportion of sleep apnea syndrome (SAS) in the general adult population that goes undiagnosed was estimated from a sample of 4,925 employed adults. Questionnaire data on doctor-diagnosed sleep apnea were followed up to ascertain the prevalence of diagnosed sleep apnea. In-laboratory polysomnography on a subset of 1,090 participants was used to estimate screen-detected sleep apnea. In this population, without obvious barriers to health care for sleep disorders, we estimate that 93% of women and 82% of men with moderate to severe SAS have not been clinically diagnosed. These findings provide a baseline for assessing health care resource needs for sleep apnea.
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            Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study.

            Sleep-disordered breathing recurrent intermittent hypoxia and sympathetic nervous system activity surges provide the milieu for cardiac arrhythmia development. We postulate that the prevalence of nocturnal cardiac arrhythmias is higher among subjects with than without sleep-disordered breathing. The prevalence of arrhythmias was compared in two samples of participants from the Sleep Heart Health Study frequency-matched on age, sex, race/ethnicity, and body mass index: (1) 228 subjects with sleep-disordered breathing (respiratory disturbance index>or=30) and (2) 338 subjects without sleep-disordered breathing (respiratory disturbance index<5). Atrial fibrillation, nonsustained ventricular tachycardia, and complex ventricular ectopy (nonsustained ventricular tachycardia or bigeminy or trigeminy or quadrigeminy) were more common in subjects with sleep-disordered breathing compared with those without sleep-disordered breathing: 4.8 versus 0.9% (p=0.003) for atrial fibrillation; 5.3 versus 1.2% (p=0.004) for nonsustained ventricular tachycardia; 25.0 versus 14.5% (p=0.002) for complex ventricular ectopy. Compared with those without sleep-disordered breathing and adjusting for age, sex, body mass index, and prevalent coronary heart disease, individuals with sleep-disordered breathing had four times the odds of atrial fibrillation (odds ratio [OR], 4.02; 95% confidence interval [CI], 1.03-15.74), three times the odds of nonsustained ventricular tachycardia (OR, 3.40; 95% CI, 1.03-11.20), and almost twice the odds of complex ventricular ectopy (OR, 1.74; 95% CI, 1.11-2.74). A significant relation was also observed between sleep-disordered breathing and ventricular ectopic beats/h (p<0.0003) considered as a continuous outcome. Individuals with severe sleep-disordered breathing have two- to fourfold higher odds of complex arrhythmias than those without sleep-disordered breathing even after adjustment for potential confounders.
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              Sleep-disordered breathing and insulin resistance in middle-aged and overweight men.

              Sleep-disordered breathing is a prevalent condition associated with impairment of daytime function and may predispose individuals to metabolic abnormalities independent of obesity. The primary objective of this study was to determine the metabolic consequences and community prevalence of sleep-disordered breathing in mildly obese, but otherwise healthy, individuals. One hundred and fifty healthy men, without diabetes or cardiopulmonary disease, were recruited from the community. Measurements included polysomnography, a multiple sleep latency test, an oral glucose tolerance test, determination of body fat by hydrodensitometry, and fasting insulin and lipids. The prevalence of sleep-disordered breathing, depending on the apnea-hypopnea index (AHI) cutoff, ranged from 40 to 60%. After adjusting for body mass index (BMI) and percent body fat, an AHI gt-or-equal, slanted 5 events/h was associated with an increased risk of having impaired or diabetic glucose tolerance (odds ratio, 2.15; 95% CI, 1.05-4.38). The impairment in glucose tolerance was related to the severity of oxygen desaturation (DeltaSa(O(2))) associated with sleep-disordered breathing. For a 4% decrease in oxygen saturation, the associated odds ratio for worsening glucose tolerance was 1.99 (95% CI, 1.11 to 3.56) after adjusting for percent body fat, BMI, and AHI. Multivariable linear regression analyses revealed that increasing AHI was associated with worsening insulin resistance independent of obesity. Thus, sleep-disordered breathing is a prevalent condition in mildly obese men and is independently associated with glucose intolerance and insulin resistance.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Compuscript (Ireland )
                2009-8774
                2305-6983
                October 2017
                October 2017
                : 5
                : 3
                : 215-222
                Affiliations
                1Family Medicine and General Outpatient Department, Kwong Wah Hospital, Hong Kong
                Author notes
                CORRESPONDING AUTHOR: Lap-Kin Chiang, Family Medicine and General Outpatient Department, 1/F, Tsui Tsin Tong Outpatient Building, Kwong Wah Hospital, 25 Waterloo Road, Mongkok, Hong Kong, Tel.: +852-35-172301, Fax: +852-35-172401, E-mail: chialk@ 123456ha.org.hk
                Article
                FMCH.2017.0123
                10.15212/FMCH.2017.0123
                Copyright © 2017 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                Product
                Self URI (journal page): http://fmch-journal.org/
                Categories
                China Focus

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