Characteristics and Clinical Presentations of Patients at the Siriraj Snoring Clinic

Sarin  Rungmanee; Wish  Banhiran; Phawin  Keskool; Paraya  Assanasen; Wattanachai  Chotinaiwattarakul; Nongyoaw  Nujchanart

doi:10.33192/Smj.2020.27

Authors

Sarin Rungmanee Siriraj Sleep Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand http://orcid.org/0000-0003-2662-6370
Wish Banhiran Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand http://orcid.org/0000-0002-4029-6657
Phawin Keskool Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 http://orcid.org/0000-0003-2743-4688
Paraya Assanasen Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
Wattanachai Chotinaiwattarakul Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand http://orcid.org/0000-0002-4909-1615
Nongyoaw Nujchanart Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 http://orcid.org/0000-0002-2813-5332

DOI:

https://doi.org/10.33192/Smj.2020.27

Keywords:

Obstructive sleep apnea, clinical presentation, characteristic, prevalence

Abstract

Objective: To describe characteristics and clinical presentations of patients in Siriraj snoring clinic and to analyze their relationships with obstructive sleep apnea (OSA) severity.
Methods: Three hundred and seventy-three patients’self-administered questionnaires regarding sleep problems recorded between January 2012 and December 2013 and 275 polysomnographic reports were reviewed.
Results: Among 373 respondents, there were 247 males (66.2%) and 126 females (33.8%), with an average age of 48 years and body mass index of 28.2 kg/m². Their most common complaints and comorbidities were snoring ≥3 nights/week (87.9%), worrying about complications from apnea (72.4%), dyslipidemia (36.7%), hypertension (34.3%), and diabetes mellitus (12.1%), respectively. Using apnea-hypopnea index (AHI) of ≥5 and ≥30 events/hour, there were 76.7% and 38.5% of patients diagnosed as OSA and severe OSA, respectively. While using respiratory disturbance index (RDI) with similar cut-off, almost everyone (98.8%) and 60.2% of patients will be diagnosed as OSA and severe OSA, respectively. Characteristics significantly associated with AHI ≥15 events/hour were snoring ≥3 nights/week, witnessed apneas, and nocturia (p < 0.05). The comorbidities which significantly associated with OSA group were hypertension, diabetes, and dyslipidemia. There were only weak significant relationships between AHI (and RDI) with ESS and quality of life.
Conclusion: The most common complaints in our clinic were loud snoring and worrying about OSA consequences, not excessive daytime sleepiness. Based on RDI criteria, almost everyone were diagnosed as OSA; however, it had poor relationship with patients’symptoms, comorbidities and quality of life. Thus, for better OSA evaluation, we should use data from several aspects, not only AHI nor RDI for proper patient management.

References

1. Harly Greenberg VL, Steven M. Scharf. Obstructive Sleep Apnea: Clinical Features, Evaluation, and Principles of Management. In: Meir Kryger OR, editor. Principles and practice of sleep medicine ,Sixth edition. Philadelphia, PA Elsevier; 2017.p.1110-24.
2. Baldwin CM, Griffith KA, Nieto FJ, O'Connor GT, Walsleben JA, Redline S. The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep 2001;24:96-105.
3. Parish JM, Somers VK. Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc 2004;79:1036-46.
4. Park JG, Ramar K, Olson EJ. Updates on definition, consequences, and management of obstructive sleep apnea. Mayo Clin Proc 2011;86:549-54.
5. Punjabi NM, Newman AB, Young TB, Resnick HE, Sanders MH. Sleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas. Am J Respir Crit Care Med 2008;177:1150-5.
6. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: An american heart association/american college of cardiology foundation scientific statement from the american heart association council for high blood pressure research professional education committee, council on clinical cardiology, stroke council, and council on cardiovascular nursing in collaboration with the national heart, lung, and blood institute national center on sleep disorders research (national institutes of health). J Am Coll Cardiol 2008;52:686-717.
7. Yaffe K, Laffan AM, Harrison SL, Redline S, Spira AP, Ensrud KE, et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA 2011;306:613-9.
8. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005;353:2034-41.
9. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.
10. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006-14.
11. Neruntarat C, Chantapant S. Prevalence of sleep apnea in HRH Princess Maha Chakri Srinthorn Medical Center, Thailand. Sleep Breath 2011;15:641-8.
12. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20:705-6.
13. Iber C, Ancoli-Israel S, Chesson A. Quan SF, for the American Academy of Sleep Medicine: The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester: American Academy of Sleep Medicine; 2007.
14. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-5.
15. Banhiran W, Assanasen P, Nopmaneejumruslers C, Metheetrairut C. Epworth sleepiness scale in obstructive sleep disordered breathing: the reliability and validity of the Thai version. Sleep Breath 2011;15:571-7.
16. Banhiran W, Assanasen P, Metheetrairut C, Nopmaneejumruslers C, Chotinaiwattarakul W, Kerdnoppakhun J. Functional outcomes of sleep in Thai patients with obstructive sleep-disordered breathing. Sleep Breath 2012;16:663-75.
17. Pang KP, Terris DJ. Screening for obstructive sleep apnea: an evidence-based analysis. Am J Otolaryngol 2006;27:112-8.
18. Stansbury RC, Strollo PJ. Clinical manifestations of sleep apnea. J Thorac Dis 2015;7:E298-310.
19. Frank Y, Kravath RE, Pollak CP, Weitzman ED. Obstructive sleep apnea and its therapy: clinical and polysomnographic manifestations. Pediatrics 1983;71:737-42.
20. Chervin RD. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 2000;118:372-9.
21. Peppard PE, Hagen EW. The Last 25 Years of Obstructive Sleep Apnea Epidemiology-and the Next 25? Am J Respir Crit Care Med 2018;197:310-2.
22. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-84.
23. Peker Y, Kraiczi H, Hedner J, Loth S, Johansson Å, Bende M. An independent association between obstructive sleep apnoea and coronary artery disease. Eur Respir J 1999;14:179-84.
24. MacGregor M, Block AJ, Ball Jr WC. Topics in clinical medicine: serious complications and sudden death in the Pickwickian syndrome. Johns Hopkins Med J 1970;126:279-95.
25. Vidal S, Ferrer M, Masuet C, Somoza M, Ballarín JIM, Monasterio C. Spanish version of the Functional Outcomes of Sleep Questionnaire: scores of healthy individuals and of patients with sleep apnea-hypopnea syndrome. Arch Bronconeumol 2007;43:256-61. [Article in Spanish]
26. Rey de Castro J, Rosales-Mayor E, Weaver TE. Reliability and Validity of the Functional Outcomes of Sleep Questionnaire - Spanish Short Version (FOSQ-10SV) in Peruvian Patients With Obstructive Sleep Apnea. J Clin Sleep Med 2018;14:615-21.