Does apnea hypopnea index alone reflect obstructive sleep apnea severity?

Does apnea hypopnea index alone reflect obstructive sleep apnea severity?

Aim: We aimed to assess whether there was a correlation between the apnea hypopnea index (AHI), desaturation time under 90% (DTU-90), and mean saturation (MS) levels and the parameters associated with tissue hypoxia. Materials and methods: A total of 144 subjects were included in the study. Blood C-reactive protein levels, blood uric acid levels, and urine microalbumin levels were measured and the urine uric acid/creatinine ratio and urine microalbumin/creatinine ratio were calculated. Results: Our study results suggest that MS and DTU-90, as well as the AHI, are correlated with the parameters reflecting hypoxemia and the other events secondary to hypoxia. Conclusion: MS and DTU-90 may reflect the severity of disease and may be used in the first evaluation of a patient with suspicion of obstructive sleep apnea before full polysomnography monitorization. Because they were not much better correlated with the parameters than the AHI, it is difficult to make a claim for their use as the only tool, or their replacement of the AHI, in the evaluation of patients with suspected obstructive sleep apnea.

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  • 1.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.
  • 2.Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med 2005; 352: 1206–14.
  • 3.Marin JM, Carrizo SJ, Vicente E, Agusti AG. 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.
  • 4.Bayram NA, Çiftçi B, Güven SF, Bayram H, Diker HE, Durmaz T et al. Prevalence of cardiac arrhythmia in obstructive sleep apnea syndrome. Turk J Med Sci 2010; 40: 843–50.
  • 5.Ruehland WR, Rochford PD, O’Donoghue FJ, Pierce RJ, Singh P, Thornton AT. The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep 2009; 32: 150–7.
  • 6.Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2007; 3: 737–47.
  • 7.McCord JM. The evolution of free radicals and oxidative stress. Am J Med 2000; 108: 652–9.
  • 8.McCord JM. Oxygen-derived free radicals in postischemic tissue injury. N Engl J Med 1985; 312: 159–63.
  • 9.Meier-Ewert HK, Ridker PM, Rifai N, Regan MM,Price NJ,Dinges DF et al. Effect of sleep loss on CRP, an inflammatory marker of cardiovascular risk. J Am Coll Cradiol 2004; 43: 678–83.
  • 10.Shamsuzzaman AS, Winnicki M, Lanfranchi P, Wo l k R,Kara T,Accurso V et al. Elevated CRP in patients with obstructive sleep apnea. Circulation 2002; 105: 2462–4.
  • 11.Braghilori A, Sacco C, Erbetta M, Ruga V,Donner CF.Overnight urinary uric acid/creatinine ratio for detection of sleep hypoxemia. Validation study in chronic obstructive pulmonary disease and obstructive sleep apnea before and after treatment with nasal continuous positive airway pressure. Am Rev Respir Dis 1993; 148: 173–8.
  • 12.Cerasola G, Cottone S, D’lgnoto G, Fulantelli MA,Grasso L,Mangano MT et al. Microalbuminuria, an early marker of renal changes in essential hypertension. Ann Ital Med Int 1990; 5: 180–5.
  • 13.JerumsG, Cooper M, Gilbert R, O’Brien R, Taft J. Microalbuminuria in diabetes. Med J Aust 1994; 161: 265–8.
  • 14.Ursavas A, Karadag M, Gullulu M, Demirdogen E,CoskunF,Onart S et al. Low-grade urinary albumin excretion in normotensive/non-diabetic obstructive sleep apnea patients. Sleep Breath 2008; 12: 217–22.
  • 15.İzci B, Fırat H, Ardıç S, Köktürk O, Gelir E, Altınörs M. Adaptation of functional outcomes of sleep questionnaire (FOSQ) to Turkish population. Tuberk Toraks 2004; 52: 224– 30.
  • 16.Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath 2008; 12: 161–8.
  • 17.National Heart, Lung and Blood Institute: The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Washington DC: National Institutes of Health; 2004. p.26–7.
  • 18.Yi X. Obstructive sleep apnea-syndrome in patients with serum uric acid and lipid levels of correlation. China Mod Med 2010;
  • 17: doi CNKI:SUN:ZGUD.0.2010-04-009 (article in Chinese).
  • 19.Ruiz García A, Sánchez Armengol A, Luque Crespo E, García Aguilar D, Romero Falcón A, Carmona Bernal C et al. Blood uric acid levels in patients with sleep-disordered breathing. Arch Bronconeumol 2006; 42: 492–500.
  • 20.Pływaczewski R, Bednarek M, Jonczak L, Górecka D, Sliwiński P. Hyperuricaemia in females with obstructive sleep apnoea. Pneumonol Alergol Pol 2006; 74: 159–65.
  • 21.Schäfer H, Pauleit D, Sudhop T, Gouni-Berthold I, Ewig S, Berthold HK. Body fat distribution, serum leptin, and cardiovascular risk factors in men with obstructive sleep apnea. Chest 2002; 122: 829–39.
  • 22.Hasday JD, Grum CM. Nocturnal increase of urinary uric acid/ creatinine ratio: a biochemical correlate of sleep-associated hypoxemia. Am Rev Respir Dis 1987; 135: 534–8.
  • 23.Braghiroli A, Sacco C, Erbetta M, Ruga V,Donner CF.Overnight urinary uric acid/creatinine ratio for detection of sleep hypoxemia: validation study in chronic obstructive pulmonary disease and obstructive sleep apnea before and after treatment with nasal continuous positive airway pressure. Am Rev Respir Dis 1993; 148: 173–8.
  • 24.McKeon JL, Saunders NA, Murree-Allen K, Olson LG,GyulayS,Dickeson J et al. Urinary uric acid/creatinine ratio, serum erythropoietin, and blood 2,3-diphosphoglycerate in patients with obstructive sleep apnea. Am Rev Respir Dis 1990; 142: 8–13
  • 25.Saito H, Nishimura M, Shibuya E, Makita H, Tsujino I, Miyamoto K et al. Tissue hypoxia in sleep apnea syndrome assessed by uric acid and adenosine. Chest 2002; 122: 1686–94.
  • 26.Taheri S,Austin D,Lin L,Nieto FJ,Young T,Mignot E.Correlates of serum C-reactive protein (CRP)--no association with sleep duration or sleep disordered breathing. Sleep 2007; 30: 991–6.
  • 27.Lui MM, Lam JC, Mak HK, Xu A,Ooi C,Lam DC et al.C-reactive protein is associated with obstructive sleep apnea independent of visceral obesity.Chest 2009; 135: 950–6.
  • 28.Guven SF, Turkkani MH, Ciftci B, Ciftci TU, Erdogan Y. The relationship between high-sensitivity C-reactive protein levels and the severity of obstructive sleep apnea. Sleep Breath 2012; 16: 217–1.
  • 29.Tsioufis C,Thomopoulos C,Dimitriadis K,Amfilochiou A,Tsiachris D,Selima M et al. Association of obstructive sleep apnea with urinary albumin excretion in essential hypertension: a cross-sectional study. Am J Kidney Dis 2008; 52: 285–93.
  • 30.Buchner NJ, Henning BF, Hagele KF, Quack IA,Rump LC.Renal function in hypertensive patients with obstructive sleep apnea. Dtsch Med Wochenschr 2004; 129: 305–9.
  • 31.Verhulst SL,Van Hoeck K,Schrauwen N,Haentjens D,Rooman R,Van Gaal L et al. Sleep-disordered breathing and proteinuria in overweight and obese children and adolescents. Horm Res 2008; 4: 224–9.
  • 32.Agrawal V,Vanhecke TE,Rai B,Franklin BA,Sangal RB,McCullough PA. Albuminuria and renal function in obese adults evaluated for obstructive sleep apnea. Nephron Clin Pract 2009; 113: 140–7.
  • 33.Casserly LF,Chow N,Ali S,Gottlieb DJ, Epstein LJ,Kaufman JS. Proteinuria in obstructive sleep apnea. Kidney Int 2001; 60: 1484–9.
  • 34.Odabaş Ö, Ceylan C, Yığman M. Does the treatment of obstructive sleep apnea syndrome improve lower urinary tract symptoms? Turk J Med Sci 2012; 42: 619–22
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
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