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Obstructive Sleep Apnea Screened by Overnight Pulse Oximetry and Higher Risk of Serious Cardiovascular Events: Prospective Cohort Study in the Primary Care

Received: 21 March 2022    Accepted: 11 April 2022    Published: 20 April 2022
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Abstract

Introduction: Obstructive sleep apnea (OSA) is a condition characterized by sleep disordered breathing which results in health impairment and other related injuries. Cardiovascular and neurocognitive morbidities and increased risk of motor vehicle accidents have been demonstrated in patients with untreated OSA. Overnight pulse oximetry is a good screening tool for OSA. There is no study to examine the prospective outcome of patients with screening positive OSA in the primary care setting. Methodology: This is a prospective cohort study involving consecutive patients whom had performed OSA screening by overnight pulse oximetry in a primary care clinic of Hong Kong from year 2011 to year 2012. One hundred and eighty consecutive OSA screening positive patients were the cohort group while 180 consecutive OSA screening negative patients were the control group. The five year incidence of serious cardiovascular complications and associated predictive factors were examined. Results: Both of cohort and control group patients were followed prospectively for 5 years. There was higher proportion of male (68.3% versus 45.0%, p<0.001) and obesity (58.3% versus 41.1%, p=0.001) patients in the cohort group. There was no statistical difference in concomitant chronic disease or difference in mean blood pressure and Epworth Sleepiness Scale (ESS) score among two groups. At five year follow up, there was no cardiovascular related mortality among two groups. The five year relative risk (RR) of screening positive OSA versus screening negative for serious cardiovascular event is 3.03 (95% CI, 1.16-7.86; p=0.018). By stratification, the relative risk for stroke is 1.69 (95% CI, 0.40-7.16; p=0.475), while for coronary artery disease (CAD) is 4.24 (95%CI, 1.18-15.29; p=0.017). Conclusion: Overnight pulse oximetry screening positive obstructive sleep apnea is the independent risk factor for coronary artery disease.

Published in Journal of Family Medicine and Health Care (Volume 8, Issue 2)
DOI 10.11648/j.jfmhc.20220802.11
Page(s) 32-36
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Obstructive Sleep Apnea, Overnight Pulse Oximetry, Stroke, Coronary Artery Disease

References
[1] Ip MSM, Lam B, Lauder IJ, Tsang KWT, Chung KF, Mok YW et al. A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong, Chest 2001; 119 (1): 62-9.
[2] Ip MSM, Lam B, Tang LCH, Lauder IJ, Ip TY, Lam WK. A community Study of Sleep-Disordered Breathing in Middle-Aged Chinese Women in Hong Kong. Chest 2004; 125: 127-134.
[3] Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002; 165: 1217-39.
[4] Dement WC, Netzer NC. Primary care: is it the setting to address sleep disorders? Sleep Breath 2000; 4: 1-6.
[5] Netzer NC, Stoohs RA, Netzer CM, et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999; 131: 485-491.
[6] Netzer NC, Hoegel JJ, Loube D, Netzer CM, Hay B, Alvarez-Sala R, and Strohl KP. Prevalence of Symptoms and Risk of Sleep Apnea in Primary Care. Chest 2003; 124: 1406-1414.
[7] Marin J. M., Carrizo S. J., Vicente E., Agusti A. G. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365: 1046-53.
[8] Young T., Peppard P., Palta M., Hla K. M., Finn L., Morgan B., Skatrud J. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 1997; 157 (15): 1746-52.
[9] Yaggi H. K., Concato J., Kernan W. N., Lichtman J. H., Brass L. M., Mohsenin V.. Obstructive sleep apnea as a risk factor for stroke and death. New Engl. J. Med., 2005 Nov 10: 353 (19): 2034-2041.
[10] Engleman HM, Martin SE, Deary IJ, Douglas NJ. Effect of continuous positive airway pressure treatment on daytime function in sleep apnea/hypopnoea syndrome. Lancet 1994; 343: 572-5.
[11] Young T, et al. Sleep-disordered breathing and motor vehicle accidents in a population based sample of employed adults. Sleep 1997; 20: 608-613.
[12] Barbe, Pericas J, Munoz A, Findley L., Anto J. M., Agusti A. G. Automobile accidents in patients with sleep apnea syndrome. An epidemiological and mechanistic study. Am J Respir Crit Care Med. 1998 Jul; 158 (1): 18-22.
[13] Marshall NS, Wong KK, Cullen SR, Knuiman MW; Crunstein RR. Sleep apnea and 20-year follow-up for all-cause mortality, stoke, and cancer incidence and mortality in the Busselton health study cohort. J Clin Sleep Med 2014; 10 (4): 355-62.
[14] Loke YK, Brown WL, Kowk CS, Niruban A, Myint PK. Association of obstructive sleep apnea with risk of serious cardiovascular events: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2012; 5: 720-8.
[15] Scottish Intercollegiate Guidelines Network. Management of Obstructive Sleep Apnea/Hypopnea Syndrome in Adults. A national clinical guideline. June 2003.
[16] Nikolaus N, Eliasson AH, Cordula N, Kristo DA. Overnight pulse oximetry for sleep-disordered breathing in adults: a review. Chest 2001; vol 120 (2), pp. 625-633.
[17] Chiang LK, Ng PTK, Kam CW, Ng VL, Wong CY, Yee KS, Tse HN, Lee A. Usefulness in using portable overnight pulse oximeter for screening obstructive sleep apnea in adult patients in primary health care setting. HK Pract. Dec 2011; 33: 146-152.
[18] Kapur VK. Obstructive sleep apnea: diagnosis, epidemiology and economics. Respir Care 2010; 55: 1155-67.
[19] Mohsenin V. Obstructive sleep apnea: a new preventive and therapeutic target for stroke. The American Journal of Medicine 2015; 128: 811-6.
[20] Kendzerska T, Gershon AS, Hawker G, Leung RS, Tomlinson G. Obstructive sleep apnea and risk of cardiovascular events and all-cuase mortality: a decade-long historical cohort study. PloS Med 2014; 11 (2): e1001599.
[21] Gottlieb DJ, Craig SE, Loreni-Filho G, Heeley E, Redline S, McEvoy RD, et al. Sleep apnea cardiovascular clinical trials-current status and steps forward: the international collaboration of sleep apnea cardiovascular trialists. Sleep 2013; 36 (7): 975-80.
[22] Epstein LJ, Kristo D, Strollo JR, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5 (3): 263-76.
[23] Task force members: Lawrence JE, et al. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. Journal of Clinical Sleep Medicine 2009: Vol 5 (3): 263-76.
Cite This Article
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    Lapkin Chiang, Cheukwai Kam, Lorna Ventura Ng, Catherine Xiaorui Chen, Yimchu Li. (2022). Obstructive Sleep Apnea Screened by Overnight Pulse Oximetry and Higher Risk of Serious Cardiovascular Events: Prospective Cohort Study in the Primary Care. Journal of Family Medicine and Health Care, 8(2), 32-36. https://doi.org/10.11648/j.jfmhc.20220802.11

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    ACS Style

    Lapkin Chiang; Cheukwai Kam; Lorna Ventura Ng; Catherine Xiaorui Chen; Yimchu Li. Obstructive Sleep Apnea Screened by Overnight Pulse Oximetry and Higher Risk of Serious Cardiovascular Events: Prospective Cohort Study in the Primary Care. J. Fam. Med. Health Care 2022, 8(2), 32-36. doi: 10.11648/j.jfmhc.20220802.11

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    AMA Style

    Lapkin Chiang, Cheukwai Kam, Lorna Ventura Ng, Catherine Xiaorui Chen, Yimchu Li. Obstructive Sleep Apnea Screened by Overnight Pulse Oximetry and Higher Risk of Serious Cardiovascular Events: Prospective Cohort Study in the Primary Care. J Fam Med Health Care. 2022;8(2):32-36. doi: 10.11648/j.jfmhc.20220802.11

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  • @article{10.11648/j.jfmhc.20220802.11,
      author = {Lapkin Chiang and Cheukwai Kam and Lorna Ventura Ng and Catherine Xiaorui Chen and Yimchu Li},
      title = {Obstructive Sleep Apnea Screened by Overnight Pulse Oximetry and Higher Risk of Serious Cardiovascular Events: Prospective Cohort Study in the Primary Care},
      journal = {Journal of Family Medicine and Health Care},
      volume = {8},
      number = {2},
      pages = {32-36},
      doi = {10.11648/j.jfmhc.20220802.11},
      url = {https://doi.org/10.11648/j.jfmhc.20220802.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jfmhc.20220802.11},
      abstract = {Introduction: Obstructive sleep apnea (OSA) is a condition characterized by sleep disordered breathing which results in health impairment and other related injuries. Cardiovascular and neurocognitive morbidities and increased risk of motor vehicle accidents have been demonstrated in patients with untreated OSA. Overnight pulse oximetry is a good screening tool for OSA. There is no study to examine the prospective outcome of patients with screening positive OSA in the primary care setting. Methodology: This is a prospective cohort study involving consecutive patients whom had performed OSA screening by overnight pulse oximetry in a primary care clinic of Hong Kong from year 2011 to year 2012. One hundred and eighty consecutive OSA screening positive patients were the cohort group while 180 consecutive OSA screening negative patients were the control group. The five year incidence of serious cardiovascular complications and associated predictive factors were examined. Results: Both of cohort and control group patients were followed prospectively for 5 years. There was higher proportion of male (68.3% versus 45.0%, p<0.001) and obesity (58.3% versus 41.1%, p=0.001) patients in the cohort group. There was no statistical difference in concomitant chronic disease or difference in mean blood pressure and Epworth Sleepiness Scale (ESS) score among two groups. At five year follow up, there was no cardiovascular related mortality among two groups. The five year relative risk (RR) of screening positive OSA versus screening negative for serious cardiovascular event is 3.03 (95% CI, 1.16-7.86; p=0.018). By stratification, the relative risk for stroke is 1.69 (95% CI, 0.40-7.16; p=0.475), while for coronary artery disease (CAD) is 4.24 (95%CI, 1.18-15.29; p=0.017). Conclusion: Overnight pulse oximetry screening positive obstructive sleep apnea is the independent risk factor for coronary artery disease.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Obstructive Sleep Apnea Screened by Overnight Pulse Oximetry and Higher Risk of Serious Cardiovascular Events: Prospective Cohort Study in the Primary Care
    AU  - Lapkin Chiang
    AU  - Cheukwai Kam
    AU  - Lorna Ventura Ng
    AU  - Catherine Xiaorui Chen
    AU  - Yimchu Li
    Y1  - 2022/04/20
    PY  - 2022
    N1  - https://doi.org/10.11648/j.jfmhc.20220802.11
    DO  - 10.11648/j.jfmhc.20220802.11
    T2  - Journal of Family Medicine and Health Care
    JF  - Journal of Family Medicine and Health Care
    JO  - Journal of Family Medicine and Health Care
    SP  - 32
    EP  - 36
    PB  - Science Publishing Group
    SN  - 2469-8342
    UR  - https://doi.org/10.11648/j.jfmhc.20220802.11
    AB  - Introduction: Obstructive sleep apnea (OSA) is a condition characterized by sleep disordered breathing which results in health impairment and other related injuries. Cardiovascular and neurocognitive morbidities and increased risk of motor vehicle accidents have been demonstrated in patients with untreated OSA. Overnight pulse oximetry is a good screening tool for OSA. There is no study to examine the prospective outcome of patients with screening positive OSA in the primary care setting. Methodology: This is a prospective cohort study involving consecutive patients whom had performed OSA screening by overnight pulse oximetry in a primary care clinic of Hong Kong from year 2011 to year 2012. One hundred and eighty consecutive OSA screening positive patients were the cohort group while 180 consecutive OSA screening negative patients were the control group. The five year incidence of serious cardiovascular complications and associated predictive factors were examined. Results: Both of cohort and control group patients were followed prospectively for 5 years. There was higher proportion of male (68.3% versus 45.0%, p<0.001) and obesity (58.3% versus 41.1%, p=0.001) patients in the cohort group. There was no statistical difference in concomitant chronic disease or difference in mean blood pressure and Epworth Sleepiness Scale (ESS) score among two groups. At five year follow up, there was no cardiovascular related mortality among two groups. The five year relative risk (RR) of screening positive OSA versus screening negative for serious cardiovascular event is 3.03 (95% CI, 1.16-7.86; p=0.018). By stratification, the relative risk for stroke is 1.69 (95% CI, 0.40-7.16; p=0.475), while for coronary artery disease (CAD) is 4.24 (95%CI, 1.18-15.29; p=0.017). Conclusion: Overnight pulse oximetry screening positive obstructive sleep apnea is the independent risk factor for coronary artery disease.
    VL  - 8
    IS  - 2
    ER  - 

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Author Information
  • Department of Family Medicine and General Outpatient Clinics, Kowloon Central Cluster, Hospital Authority, Hong Kong

  • Department of Family Medicine and General Outpatient Clinics, Kowloon Central Cluster, Hospital Authority, Hong Kong

  • Department of Family Medicine and General Outpatient Clinics, Kowloon Central Cluster, Hospital Authority, Hong Kong

  • Department of Family Medicine and General Outpatient Clinics, Kowloon Central Cluster, Hospital Authority, Hong Kong

  • Department of Family Medicine and General Outpatient Clinics, Kowloon Central Cluster, Hospital Authority, Hong Kong

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