Smoking status in relation to obstructive sleep apnea severity (OSA) and cardiovascular comorbidity in patients with newly diagnosed OSA

Introduction: the relationship between smoking and sleep disturbance has been well documented. Smoking is a common risk factor for both obstructive sleep apnea (OSA) and cardiovascular diseases. The study aimed to: 1) evaluate the incidence of newly diagnosed OSA in patients presenting with symptoms suggestive of a sleep disorder, 2) assess the relation between smoking status and OSA severity; and 3) compare the prevalence of cardiovascular comorbidities in ever- and never smokers with newly diagnosed OSA. Material and methods: a retrospective analysis of 5,353 patients suspected of OSA was performed. OSA was diagnosed on the basis of polysomnography. The influence of smoking status on indices of OSA severity was evaluated and the incidence of self–reported cardiovascular diseases and diabetes mellitus type 2 was analyzed in relation to smoking history. Results: OSA was diagnosed in 3,613 patients (67.5%); of these, 21.6% were ever-smokers. Smokers with OSA had a higher apnea-hypopnea index [AHI; 31 (18.4–53.29) vs 29 (18.3–47.7), p = 0.03], lower mean oxygenation during sleep [92 (90–93) vs 92 (91–94), p < 0.01] and a higher daytime sleepiness (Epworth Sleepiness Scale score 11.7 ± 5.5 vs 11.0 ± 5.5, p < 0.001). The most frequent comorbidity was hypertension, followed by obesity, diabetes mellitus type 2 and coronary artery disease, with a statistically higher incidence of hypertension in non-smokers (59.2 vs 64.7 %, p = 0.005). Conclusion: smoking is related with OSA severity and increased daytime sleepiness. Our study confirmed the elevated frequency of cardiovascular comorbidities in OSA patients in general but did not show an increased incidence of these comorbidities in smokers

Prevalence of metabolic syndrome diagnosis in patients with obstructive sleep apnoea syndrome according to adopted definition

 WSTĘP: Zespół metaboliczny (ZM) jest związany ze zwiększonym ryzykiem chorób sercowo-naczyniowych i występuje często u chorych na OBS. Celem pracy jest cena częstości ZM w zależności od zastosowanej definicji (NCEP-ATP III z 2001 oraz IDF z 2005 roku) u chorych na OBS.MATERIAŁ I METODY: Materiał stanowiło 155 mężczyzn i 18 kobiet z OBS (AHI 44 ± 22 h-1), w większości otyłych (BMI 31,8 ± 5,0 kg/m2), w wieku 53,9 ± 9,3 roku (średnie ± SD). U badanych oznaczano w surowicy: lipidogram, stężenie glukozy oraz wykonano pomiar wskaźnika masy ciała (BMI), obwodu w pasie (OP) oraz wskaźnik talia-biodra (WHR).WYNIKI: Posługując się definicją pierwszą (NCEP-ATP III z 2001), zespół metaboliczny rozpoznano u 98 chorych (56% całej grupy — grupa ZM1), stosując definicję IDF z 2005 — u 120 osób (69% całej grupy — grupa ZM2) (p < 0,05). Pomiędzy grupami nie stwierdzono istotnych różnic wielkości BMI i OP. Natomiast statystycznie istotną różnicę stwierdzono w WHR (ZM1: 1,005 ± 0,05 v. ZM2: 1,027 ± 0,06, p < 0,05). W grupie ZM2 stwierdzono istotnie wyższe stężenie HDL w porównaniu z grupą ZM1 (52,3 ± 12,1 mg/dl v. 42,3 ± 12,1 mg/dl, p < 0,05). W grupie ZM1 istotnie wyższe w porównaniu z grupą ZM2 było stężenie triglicerydów w surowicy (228,2 ± 122,5 mg/dl v. 122,5 ± 49,1 mg/dl, p < 0,05). Grupy ZM1 i ZM2 nie różniły się istotnie stopniem ciężkości OBS. Zaobserwowano korelacje pomiędzy rozpoznaniem zespołu metabolicznego a wartością AHI (r = 0,19 dla ZM1 i r = 0,21 dla ZM2, p < 0,05). Są one jednak klinicznie nieistotne.WNIOSKI: Definicja zespołu metabolicznego IDF z 2005 roku istotnie zwiększa częstość rozpoznawania zespołu metabolicznego u chorych na OBS. Nie zaobserwowano znamiennych klinicznie korelacji pomiędzy stopniem ciężkości OBS a rozpoznaniem zespołu metabolicznego. INTRODUCTION: Metabolic syndrome (MS), which is connected with enlarged cardiovascular risk, is common in patients with OSAS. The aim of the study was to estimate the prevalence of MS in patients with OSAS according to two definitions of MS (criteria from NCEP-ATP III from 2001 versus criteria from IDF 2005).MATERIAL AND METHODS: Materials consisted of 155 males and 18 females with OSAS (mean AHI 44 ± 22 h-1), obesity (BMI 31.8 ± 5.0 kg/m2), aged 53.9 ± 9.3 years (mean ± SD). Serum lipids, glucose, body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were measured in all patients.RESULTS: According to first definition (NCEP — ATP III from 2001), MS was diagnosed in 98 patients (56% of the whole group — MS1 group) compared to 120 patients (69% of the whole group — MS2 group) diagnosed according to the second definition (IDF from 2005), p < 0.05. No differences in BMI and WC between the groups were found. Significant differences in WHR were noted (MS1 group: 1.005 ± 0.05 vs. MS2 group: 1.027 ± 0.06, p < 0.05). Patients from the MS2 group had higher cholesterol HDL compared to the MS1 group (52.3 ± 12.1 mg/dl vs. 42.3 ± 12.1 mg/dl, p < 0.05). Serum triglyceride concentrations were significantly higher in the MS1 group than in the MS2 group (228 ± 122 mg/dl vs. 122 ± 49 mg/dl, p < 0.05). There were no differences in OSAS severity between the MS1 and MS2 group. In both groups weak correlations between diagnosis of MS and AHI were f ound (r = 0.19 for MS1 and r = 0.21 for MS2, p < 0.05) They are, however, clinically insignificant.CONCLUSIONS: The IDF definition from 2005 of metabolic syndrome indeed increases the frequency of diagnosis of metabolic syndrome in patients with OSAS. We did not observe essential clinical correlation among the degree of OSAS severity and recognition of metabolic syndrome in the MS1 or in the MS2 group

Obstructive sleep apnoea syndrome in younger and older age groups - differences and similarities

The prevalence of OSA rises with age, however it is also diagnosed in patients below the age of 35 years. Aim of the paper was the camparison of the severity and clinical features of OSA in young and elderly subjects. The study was a retrospective analysis of 561 subjects aged > 65yrs and 319 subjects aged < 35yrs who were investigated in our Sleep Laboratory between 1992-2005 due to snoring or daytime sleepiness. They all underwent full polisomnography or a limited recording. In patients with diagnosed OSA (AHI > 10) we initiated CPAP therapy. Results: OSA was diagnosed in 383 (63,3%) older patients and in 144 (45,1%) younger patients. BMI was significantly higher in younger subjects than in older (32,2 &plusmn; 6,9 vs. 28,9 &plusmn; 5,1 kg/m2).The prevalence of OSA among women was significantly higher in older patients than in younger (26,4 vs. 5,8%). Younger patients with OSA had a significantly higher AHI(42,7 &plusmn; 32,1 vs. 32, 2 &plusmn; 18,4)and a longer duration of apneas expressed as percentage of total sleep time spent in apnea (31,6 &plusmn; 23,2 vs. 26,5 &plusmn; 17,7%). CPAP therapy was initiated in 185 older patients and 41% of them continue therapy. In younger group patients CPAP therapy was started in 51 patients and 47% of them continue therapy. The mean therapeutic pressure was significantly higher in younger patients with OSA (9,2 &plusmn; 2,2 vs. 8,2 &plusmn; 2,2 cm H2O). Conclusions: 1/ OSA is more frequent in elderly patients ; 2/ in young patients OSA is more severe and requires higher pressures in CPAP therapy; 3/ OSA among women is four time more frequent in older patients than in younger

Czynnościowa chirurgia nosa w leczeniu Obturacyjnego Bezdechu Podczas Snu (OBPS)

The study included 22 males with significant decrease in nasal patency, at age of 44 &plusmn; 7 yrs with body mass index 28,9 &plusmn; 3,8 kg/m2, diagnosed with obstructive sleep apnea syndrome (OSAS) by polysomnography. All patients underwent functional, corrective nasal surgery. In one patient an infection in the wound occurred. Postoperatively 19 (86%) patients reported significant subjective improvement. With regard to polysomnography, one patient was cured and in another one a decrease of AHI to more than 50% of baseline was found. In 6 (27,3%) patients AHI rose from 33,2 &plusmn; 13 to 53,6 &plusmn; 21,2. Conclusion: Nasal surgery in OSAS shows limited effectiveness. Because of multilevel decrease in airway patency, some of the patients may need a step-wise approach to surgical treatment

Obturacyjny bezdech podczas snu u pacjentów w trybie zmianowym

The aim of the study was to compare intensity of sleep disordered breathing in standard nocturnal polisomnography (PSG) and diurnal PSG after night shift in shift workers with obstructive sleep apnea syndrome. METHODS: 25 shift workers (24 M, 1 F), aged 45,4 &plusmn; 9,1 yrs, of mean BMI 31,9 &plusmn; 4,02 kg/m2 were studied. Nocturnal PSG and diurnal PSG after night shift were performed in all participants. RESULTS: The mean apnea/hypopnea index (AHI) in diurnal PSG was higher than AHI in nocturnal PSG, 47,8&plusmn;27,4/h vs. 38,0&plusmn;24,1/h respectively, (

Familial clustering of symptoms typical for OSAS

The aim of the study was to compare the incidence of obstructive sleep apnoea syndrome (OSAS) symptoms in relatives of subjects with OSAS and in relatives without OSAS but with clinical symptoms of this disease. The study group consisted of 186 relatives of patients with OSAS and 117 relatives of patients with symptoms of OSAS in whom the disease was not confirmed by polysomnography. They were all mailed a questionnaire with questions concerning anthropometric data, the presence of symptoms typical for OSAS and the presence of concomitant diseases. Analysis of the obtained data revealed an increased frequency of snoring, sleep apnea and nycturia in the relatives of patients with OSAS when compared to relatives of patients without OSAS, but the difference was not statistically significant.The incidence of daytime OSAS symptoms was significantly higher in the group of relativesof patients with OSAS. No differences in the incidence of arterial hypertension, ischaemic heart disease and diabetes mellitus were found. Pneumonol. Alergol. Pol. 2006, 74, 1-1

Serum concentration of homocysteine and the risk of atherosclerosisin patients with obstructive sleep apnea syndrome

Aim: to evaluate usefulness of serum homocysteine concentration in assessing the risk of atherosclerosis in patients with OSAS. Materials and methods: 47 patients (mean age 50.6 &plusmn; 10.3 years, mean BMI 31.52 &plusmn; 6.04 kg/m2), with OSAS confirmed by polisomnography and 12 healthy snoring subjects (mean age 42.8 &plusmn; 16.8 years, mean BMI 26.9 &plusmn; 2.95 kg/m2) were enrolled to the study. OSAS patients were divided into two groups - subjects with normal blood pressure (group A, n = 32, mean age 51.3 &plusmn; 10.3 years, mean BMI 30.6 &plusmn; 4.4 kg/m2) and subjects with arterial hypertension (group B, n = 15, mean age 52.7 &plusmn; 9.8 years, mean BMI 31.4 &plusmn; 5.0 kg/m2). None of the study subjects was treated with statins or fibrates. Serum concentration of homocysteine, uric acid, glucose level and lipid profile was evaluated in all subjects. Results: We found significant abnormalities in the lipid profile in all the study groups. The mean concentrations of cholesterol (mg/dL), triglycerides (mg/dL) and homocysteine (&#956;mol/L) were as follows: 215.0 &plusmn; 34.2, 200.0 &plusmn; 173.0, 8.2 &plusmn; 2.9 in group A, 216.5 &plusmn; 43.1, 189.3 &plusmn; 138.8, 8.40 &plusmn; 1.67 in group B. 195.0 &plusmn; 32.9, 154.3 &plusmn; 133.0, 9.3 &plusmn; 2.1 in the control group. No significant correlation between the homocysteine concentration and level of cholesterol or triglycerides was found. Conclusions: the serum concentration of homocysteine seems not to be a good marker in the evaluation of the risk of atherosclerosis in patients with OSAS

Three month continuous positive airway pressure (CPAP) therapy decreases serum total and LDL cholesterol, but not homocysteine and leptin concentration in patients with obstructive sleep apnea syndrome (OSAS)

Wstęp: Leczenie za pomocą CPAP zmniejsza zachorowalność i umieralność z przyczyn sercowo-naczyniowych u chorych na OBPS. Homocysteina i leptyna mogą odgrywać rolę w rozwoju choroby niedokrwiennej serca (ChNS) u tych pacjentów. Celem pracy była ocena wpływu 3-miesięcznego leczenia za pomocą CPAP na czynniki ryzyka ChNS u chorych na OBPS bez współistniejącej ChNS (OBPS bez ChNS) oraz na OBPS i ChNS. Materiał i metody: Leczenie za pomocą CPAP rozpoczęto u 42 chorych na OBPS bez ChNS oraz u 23 chorych na OBPS i ChNS. Przed i po 3-miesięcznym leczeniu oznaczano stężenie homocysteiny, leptyny, CRP, fibrynogenu oraz lipidogram i parametry określające otyłość brzuszną. Wyniki: Po 3-miesięcznym leczeniu nie stwierdzono istotnych zmian stężenia homocysteiny, leptyny, fibrynogenu oraz CRP w żadnej z grup. W grupie OBPS i ChNS nie stwierdzono zmian parametrów lipidowych, a także stopnia otyłości. W grupie OBPS bez ChNS stwierdzono istotne zmniejszenie stężenia cholesterolu całkowitego oraz cholesterolu frakcji LDL (202,5 &#177; 38,5 mg/dl v. 186,7 &#177; 33,5 mg/dl, p = 0,001 oraz 127,3 &#177; 32,9 mg/dl v. 116,4 &#177; 26,9 mg/dl, p = 0,02). Podczas obserwacji nie uległy istotnie zmianie BMI (30,4 &#177; 3,8 v. 30,6 &#177; 3,6 kg/m2, p = 0,5), ilość tkanki tłuszczowej wisceralnej (obwód w pasie 108,5 &#177; 8,0 cm v. 107,0 &#177; 7,5 cm, p = 0,09) ani WHR (1,03 &#177; 0,04 v. 1,01 &#177; 0,03, p = 0,07). Wnioski: Trzymiesięczne leczenie CPAP nie wpłynęło na stężenie homocysteiny i leptyny we krwi u chorych na OBPS, ale w istotny sposób obniżyło stężenie parametrów lipidowych w surowicy krwi u chorych na OBPS bez współistniejącej ChNS, co potwierdza korzystny wpływ tej metody leczenia na czynniki ryzyka ChNS. Pneumonol. Alergol. Pol. 2011; 79, 3: 173-183Introduction: In OSAS patients CPAP therapy decreases cardiovascular morbidity and mortality. Homocysteine and leptin may play a role in development of ischaemic heart disease (IHD) in patients with OSAS. The aim of the study was to assess the influence of 3 month CPAP therapy on cardiovascular risk factors in patients with OSAS without IHD (pure OSAS) and with OSAS and IHD. Material and methods: Therapy with CPAP was started in 42 OSAS without IHD (pure OSAS) and 23 OSAS and IHD patients. Plasma concentration of homocysteine, serum concentration of leptin, C-reactive protein (CRP), fibrinogen, lipids, and markers of visceral adiposity (MVA) were measured before and after treatment. Results: There were no significant changes in homocysteine, leptin, fibrinogen and CRP concentrations in neither group. In OSAS and IHD no change in serum lipids and MVA were found. In pure OSAS group total cholesterol and LDL cholesterol concentrations significantly decreased (202.5 &#177; 38.5 mg/dl v. 186.7 &#177; 33.5 mg/dl, p = 0.001 and 127.3 &#177; 32.9 mg/dl v. 116.4 &#177; 26.9 mg/dl, p = 0.02, respectively). Triglycerides did not significantly change (p = 0.09). There were no significant changes in BMI (30.4 &#177; 3.8 v. 30.6 &#177; 3.6, p = 0.5), waist circumference (108.5 &#177; 8.0 cm v. 107.0 &#177; 7.5 cm, p = 0.09) and waist to hip ratio (1.03 &#177; 0.04 v. 1.01 &#177; 0.03, p = 0.07). Conclusions: Three month CPAP therapy did not change homocysteine and leptin concentration in neither group. However, it significantly decreased serum lipids concentration in patients with pure OSAS, but not in patients with OSAS and IHD, suggesting beneficial effects of CPAP therapy on cardiovascular risk factors. Pneumonol. Alergol. Pol. 2011; 79, 3: 173-18