THE PREVALENCE OF COMORBIDITIES IN PATIENTS DIAGNOSED WITH OBSTRUCTIVE SLEEP APNEA IN SLEEP MEDICINE CENTER SPLIT

Cilj: Utvrditi zastupljenost komorbiditeta povezanih s OSA-om kao najznačajnijim poremećajem disanja tijekom spavanja u pacijenata Centra za medicinu spavanja Medicinskog fakulteta Sveučilišta u Splitu i Kliničkog bolničkog centra Split, te istražiti povezanost čimbenika rizika i komorbiditeta povezanih s OSA-om pomoću STOP upitnika. Ispitanici i metode: Provedeno je kliničko istraživanje koje je uključivalo ukupno 2950 ispitanika (2060 muškaraca i 890 žena), medijana životne dobi 55 godina (18-98). Podatci su uzeti iz arhive Centra za medicinu spavanja Medicinskog fakulteta Sveučilišta u Splitu i Kliničkog bolničkog centra Split od listopada 2009. do srpnja 2018. godine. Dijagnostička obrada pacijenata uključivala je cjelonoćnu poligrafiju i cjelonoćnu polisomnografiju nakon koje je pomoću AHI vrijednosti procijenjen stupanj OSA-e u skladu sa smjernicama za dijagnostiku OSA-e prema Američkoj akademiji za medicinu spavanja (engl. American Academy of Sleep Medicine, AASM) i Europskom društvu za istraživanje spavanja (engl. European Sleep Research Society, ESRS). U dijagnostičkoj obradi korišteni su i probirni upitnici, STOP upitnik i Epworthova ljestvica pospanosti (engl. Epworth Sleepiness Scale, ESS). Rezultati: Od ukupnog broja ispitanika, nakon cjelonoćne polisomnografije ili poligrafije, OSA je bila dijagnosticirana u 84,5 % ispitanika. Tešku je OSA-u imalo 37,5 % ispitanika, umjerenu OSA-u 18,6 % ispitanika, blagu OSA-u 28,4 % ispitanika, dok 15,5 % ispitanika nije imalo OSA-u. Udio bolesnika s arterijskom hipertenzijom i šećernom bolesti tipa 2 povećavao se s povećanjem stupnja OSA-e i bio je najveći u kategoriji teške OSA-e (58,9 % vs. 37,8 %), dok je u bolestima GERB, astma i depresija udio oboljelih bio podjednak u svim stupnjevima OSA-e prema AHI vrijednostima. Prekomjernu dnevnu pospanost imalo je 42 % ispitanika kojima je dijagnosticirana teška OSA. AHI vrijednost bila je značajno veća u ispitanika koji su imali izražene simptome OSA-e, a to su hrkanje, zamijećenost zastoja disanja tijekom spavanja i arterijska hipertenzija (P < 0,001). Povećani rizik za OSA-u prema rezultatima STOP upitnika imalo je 79% ispitanika pri čemu su ti ispitanici u odnosu na ispitanike bez rizika za OSA-u bili muškoga spola (71 %), starije dobi, s povećanim indeksom tjelesne mase (30,35 ± 6,18 vs. 27,32 ± 5,51 kg/m2, P < 0,001), povećanim opsegom vrata (42,10 ± 5,18 vs. 39,67 ± 4,67 cm, P < 0,001) i većom pospanošću (7,91 ± 4,71 vs. 5,05 ± 4,14, P < 0,001). Zaključak: Naše je istraživanje pokazalo da je u OSA bolesnika među popratnim bolestima najveća učestalost arterijske hipertenzije, GERB-a i šećerne bolesti tipa 2. Pojavnost arterijske hipertenzije i šećerne bolesti tipa 2 u OSA pacijenata povećava sa stupnjem OSA-e. Primjena STOP upitnika u populaciji pacijenata koji dolaze zatražiti liječničku pomoć uslijed poremećaja disanja tijekom spavanja ukazuje na veću učestalost navedenih popratnih bolesti u ispitanika koji imaju povećan rizik za OSA. To pak upućuje na važnost primjene STOP upitnika u probiru čime se može postići pravovremeno prepoznavanje, dijagnosticiranje i liječenje OSA pacijenata, a tako će se utjecati i na ishode liječenja najvažnijih kroničnih bolesti današnjice, a to su arterijska hipertenzija i šećerna bolest tipa 2.Aim: To determine the prevalence of comorbidities related to OSA as the most prevalent sleep related breathing disorder in Sleep medicine center Split patients and to investigate correlation of risk factors and OSA related comorbidities using STOP questionnaire. Subjects and Methods: We conducted a clinical cross-sectional population study involving overall 2950 subjects (2060 men and 890 women), with median age of 55 (18-98) years. The data was taken from the archive of Sleep medicine center Split, from October 2009. to July 2018. Diagnostic procedure included screening questionnaires such as STOP questionnaire and Epworh Sleepiness Scale (ESS), polygraphy and full-night polysomnography, following which severity of OSA was evaluated on the basis of AHI according to the guidelines for the OSA diagnosis given by the American Academy of Sleep Medicine (AASM) and European Sleep Research Society (ESRS). Results: OSA was diagnosed in 84.5 % of overall number of patients after performing whole night polysomnography or polygraphy. Severe OSA was diagnosed in 37.5 % of patients, 18.6 % had moderate OSA, 28.5 % had mild OSA while 15.5 % of patients did not have OSA. Proportion of patients with hypertension and diabetes mellitus 2 increased with OSA severity and was highest at severe OSA (58.9 % vs. 37.8 %), while in comorbidities like GERD, asthma and depression proportion remained similar in all OSA categories. Among patients diagnosed with severe OSA, 42 % of them had excessive daytime sleepiness. AHI value was significantly higher among OSA patients who suffered from symptoms such as snoring, being observed to stop breathing while asleep and arterial hypertension (P < 0.001). There were 79 % of patients who had increased risk for OSA (STOP ≥ 2) and they were, comparing to the patients who did not have risk for OSA, mostly men (71 %), elderly people with the peak in age group 61-70 (84 %), higher BMI (30.35 ± 6.18 vs. 27.32 ± 5.51 kg/m2 , P < 0.001), larger neck circumference (42.10 ± 5.18 vs. 39.67 ± 4.67 cm, P < 0.001) and intensive sleepiness (7.91 ± 4.71 vs. 5.05 ± 4.14, P < 0.001). Men were more present in all comorbidities related to OSA especially diabetes mellitus type 2 (71.3 %) and hypertension (68 %). Among four symptoms used in calculating the risk for OSA, snoring has the best correlation with AHI values (r = 0.336, P < 0.001). Conclusion: Our study showed that in OSA patients the most common comorbidities related to OSA were arterial hypertension, GERD and diabetes mellitus type 2. The prevalence of arterial hypertension and diabetes mellitus type 2 in OSA patients increased with the severity of OSA. STOP questionnaire application among population of patients who seek help because of sleep related breathing disorders implies to higher prelavence of related comorbidities in patients with higher risk for OSA. Therefore, it is important to use STOP questionnaire as a screening tool which can help us recognize, diagnose and treat patients with OSA on time and in that way affect the outcome of treating the most important chronic diseases of today’s, which are arterial hypertension and diabetes mellitus type 2