The Danish National Database for Obstructive Sleep Apnea

Poul Jørgen Jennum,1 Preben Larsen,2 Charlotte Cerqueira,3 Thor Schmidt,4 Philip Tønnesen1 1Department of Clinical Neurophysiology, Faculty of Health Sciences, Danish Center for Sleep Medicine, University of Copenhagen, Rigshospitalet, Copenhagen, 2Section of Respiratory Disease, Medical Department, Fredericia Hospital, Fredericia, 3Registry Support Centre (East) – Epidemiology and Biostatistics, Research Centre for Prevention and Health, 4Registry Support Centre (East) – Clinical Quality Improvement and Health Informatics, Capital Region of Denmark, Copenhagen, Denmark Aim: The aim of the Danish National Database for Obstructive Sleep Apnea (NDOSA) was to evaluate the clinical quality (diagnostic, treatment, and management) for obstructive sleep apnea and obesity hypoventilation syndrome in Denmark using a real-time national database reporting to the Danish National Patient Registry. Study population: All patients diagnosed with obstructive sleep apnea or obesity hypoventilation syndrome at public and private in- and out-hospital departments in Denmark were included. Main variables: The NDOSA contains information about baseline characteristics, comorbidity, diagnostic procedures conducted, treatment (continuous positive airway pressure and similar treatments, surgery, mandibular advancement devices, etc) complications, and treatment status. Descriptive data: Yearly report with indicators for diagnostic procedures, treatment, and follow-up comparing different departments was involved in the management of sleep apnea in Denmark for the purpose of quality improvement. Conclusion: The NDOSA has proven to be a real-time national database using diagnostic and treatment procedures reported to the Danish National Patient Registry. Keywords: obstructive sleep apnea, obesity hypoventilation syndrome, quality of care, clinical registr

GENETIC ASPECTS OF HYPERTENSION AND METABOLIC DISEASE IN THE OBSTRUCTIVE SLEEP APNOEA-HYPOPNOEA SYNDROME.

Considerable evidence is available in support of an independent association between obstructive sleep apnoea syndrome (OSAS) and cardiovascular disease, which is particularly strong for systemic arterial hypertension and growing for ischaemic heart disease, stroke, heart failure, atrial fibrillation and cardiac sudden death. The pathogenesis of cardiovascular disease in OSAS is not completely understood but likely to be multifactorial, involving a diverse range of mechanisms including sympathetic nervous system overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism. The present report, which arose out of a European Union Cooperation in the field of Scientific and Technical Research (COST) action on OSAS (COST B26), reviews the current evidence for an independent association and proposes research priorities to identify the underlying mechanisms involved, with a view to identifying novel therapeutic strategies. Large-scale collaborative studies of carefully defined patient populations with obstructive sleep apnoea syndrome, adequately controlled for potential confounders, are needed. Such studies carry the prospect of evaluating potential interactions between different basic mechanisms operating in obstructive sleep apnoea syndrome and cardiovascular disease, and interactions with other related disorders, such as obesity, diabetes and dyslipidaemia. Furthermore, translational studies involving cell culture and animal models linked to studies of obstructive sleep apnoea syndrome patients are necessary to integrate basic mechanisms with the clinical disorder