Obstructive sleep apnoea syndrome and the metabolic syndrome in an internal medicine setting
ABSTRACT Obstructive sleep apnoea syndrome (OSAS) is widely accepted as a cardiovascular risk factor. Lately it has been considered in turn as both a component and one of the causes of the metabolic syndrome (MS).
We studied 281 heavy snorers of both sexes consecutively attending a metabolic clinic. Aim was to evaluate the association of OSAS and MS in a large series of patients within an internal medicine setting. Patients underwent a clinical and biochemical work up and performed unattended polysomnography.
Of 226 non-diabetic snorers, 48 had primary snoring; 54 mild, 51 moderate, and 73 severe OSAS. A positive association was found between OSAS severity, central obesity indices and the mean metabolic score (p=0.016). Prevalence of hypertension increased with OSA severity (p=0.010). Polysomnographic indices were correlated with the metabolic score, insulin levels and central obesity indices. At regression analysis, male sex (t=3.92; p=0.000) and waist circumference (t=3.93; p=0.000) were independently associated with AHI (apnoea/hypopnoea index), while ODI (oxygen desaturation index) and waist circumference were the independent predictors (t=2.16; p=0.033 and t=3.74; p=0.000 respectively) of the metabolic score. Prevalence of OSA was 83% in 55 patients with diabetes and 34% had severe OSA. Almost all diabetics with OSA had MS. The metabolic score was higher in diabetic OSA as compared to non-diabetic OSAS (p=0.000).
Our findings show a high prevalence of OSAS among patients referred to a metabolic outpatient clinic because of suspected metabolic disorders and heavy snoring and suggest a strong bidirectional association between OSAS and MS.
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ABSTRACT: Tandartsen kunnen een belangrijke rol spelen bij de behandeling van patiënten met slaapapneu en bij snurkers. De tandheelkundige behandeling bestaat uit een mandibulair repositie apparaat (MRA). Een MRA biedt vele voordelen in vergelijking met andere therapiemogelijkheden omdat het goedkoop, niet-ingrijpend, simpel te fabriceren en reversibel is. Patiënten met slaapapneu klagen vaak over overmatige slaperigheid overdag, vermoeidheid overdag en het niet-uitgerust wakker worden als gevolg van de verstoorde slaapconditie. Daarnaast is snurken een veel voorkomende klacht. Slaapapneu wordt bovendien geassocieerd met een verhoogde bloeddruk, hartinfarcten en herseninfarcten. Deze groep patiënten heeft bovendien een verhoogd risico op verkeersongelukken, omdat men tijdens het besturen van een motorvoertuig in slaap kan vallen. Onbehandelde slaapapneu kan dus ernstige medische en maatschappelijke gevolgen hebben. Het is daarom van belang dat slaapapneu op tijd effectief wordt behandeld. Continue positieve luchtdruk behandeling (CPAP) wordt internationaal beschouwd als de gouden standaardbehandeling van patiënten met slaapapneu. Deze behandeling wordt echter vaak niet geaccepteerd door slaapapneu patiënten. Ghizlane Aarab laat zien dat een mandibulair repositie apparaat (MRA) even effectief is als CPAP bij de behandeling van milde en matige vormen van slaapapneu. Bovendien werd een MRA-behandeling beter geaccepteerd door patiënten dan een CPAP-behandeling.
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ABSTRACT: Obstructive sleep apnea/hypopnea syndrome (OSAHS) and metabolic syndrome are both growing health concerns, owing to the worldwide obesity epidemic. This study evaluates the potential association between the parameters of metabolic syndrome and OSAHS. A total of 125 consecutive patients undergoing complete full night polysomnography were included. Insulin resistance (IR) was estimated using the homeostasis model assessment (HOMA), and metabolic syndrome was diagnosed according to the National Cholesterol Education Program (NCEP) criteria. The prevalence of metabolic syndrome was 23.8% among patients with OSAHS. We found that IR, age, weight, hypertension, and metabolic syndrome prevalence increased significantly with severity of OSAHS. There were no differences between groups for lipid panels including total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Subjects with metabolic syndrome had significantly lowest desaturation value (76% vs. 81%) desaturation (76% vs. 81%, P = 0.003), lower mean nocturnal oxygen saturation (89.9% vs. 92.3%, P < 0.00.1), higher apnea-hypopnea index (AHI) (40.9 vs. 17, P < 0.001), and higher oxygen desaturation index (38 vs. 17, P = 0.002). Lowest desaturation and mean nocturnal oxygen saturation were significantly lower in subjects with IR (76% vs. 85%, P = 0.004 and 90.4% vs. 93.0%, P = 0.02). In multivariate analysis, the percent of time below 90% saturation [%T < 90]) (P = 0.04) was independently associated with IR. Our results suggested that metabolic syndrome prevalence increased with severity of OSAHS and vice versa. Nocturnal hypoxic episodes in OSAHS patients could be a risk factor for developing hypertension and IR.Metabolic syndrome and related disorders 10/2010; 9(1):13-8. DOI:10.1089/met.2010.0033 · 1.92 Impact Factor
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ABSTRACT: We assessed the socio-demographic correlates of snoring and also the patterns of health behaviour and co-morbidity associated with different types of snoring in the Hungarian population. We wanted to study whether different types of snoring are associated with high-risk health behaviour, chronic illnesses, daytime consequences of poor sleep, and with frequent accidents compared with non-snoring individuals. This is a cross-sectional study. Interviews were carried out in the homes of 12,643 people. This was the largest nationally representative study in Central Europe about health behaviour. In the Athens Insomnia Scale, questions about snoring and sleep behaviour, life-style factors and health behaviour, as well as questions on their history and current medical treatment were included in the questionnaire. Thirty-seven percent of males and 21% of females reported loud snoring with breathing pauses. We found a significant increasing trend for the consumption of alcohol and coffee as well as smoking among non-snorers, habitual snorers and loud snorers, respectively. In an ordinal regression model male gender, the presence of smoking, the presence of three or more co-morbid conditions and alcohol consumption were independent predictors of snoring (OR [95% CI], 1.99 [1.85-2.1], 1.76 [1.60-1.92], 1.45 [1.30-1.62] and 1.22 [1.04-1.43], respectively, P < 0.001) after controlling for multiple socio-demographic and clinical variables. The frequency of accidents was higher in the loud snoring group than among non-snoring individuals (24% vs 17%, P < 0.0001). Snoring is common in the Hungarian adult population. Snoring, especially loud snoring with breathing pauses, is strongly associated with high-risk health behaviour, higher co-morbidity and a higher frequency of accidents.Sleep And Breathing 11/2010; 15(4):809-18. DOI:10.1007/s11325-010-0442-4 · 2.87 Impact Factor