Experience of Limited Sleep Study in Diagnosis of Obstructive Sleep Apnea (OSA) among symptomatic patients in Pulmonology Unit Khyber Teaching Hospital, Peshawar
Keywords:
Obstructive Sleep Apnea (OSA), Epworth Sleepiness Scale (ESS), Continuous Positive Air Pressure (CPAP), Automatic Positive Air Pressure (APAP), Apnea Hypo apnea Index (AHI)Abstract
BACKGROUND: Obstructive Sleep Apnea (OSA) is an important medical condition leading to significant mortality and morbidity. Population based studies revealed that 4% of man and 2% of women more than 50 years of age have symptomatic OSA. OSA is suspected by symptoms of snoring, tiredness, observed apnea, hyper-somnolence with high Epworth Sleepiness Scale (ESS) and Body Mass Index (BMI) of more than 30, but polysomnography is the old standard for the diagnosis of OSA. METHODOLOGY: The study was conducted in Pulmonology Unit, Khyber Teaching Hospital (KTH) Peshawar from January 2007 to July 2010. After taking history about snoring, irritability, hypersomnalence, observed apnea, all patients were scored as per ESS tool another measurements. such as BMI, neck circumference; abdominal and hip girth were recorded. Past history about asthma and Ischemic Heart Disease (IHD) was inquired. After optimizing treatmen for asthma and IHD. patients underwent diagnostic study and afterward therapeutic study if the Apnoea and Hypo- apnoea Index (AHI) was higher than 15. We recorded different parameters such as saturation, leak, snoring, minute ventilation, AHI, duration of AHI and positive pressure required to abolish the AHI, Sleep diary was maintained manually by the technician for correlation with study results. RESULT: Thirty-nine patients were subjected to limited polysomnography in Khyber Teaching Hospital (KTH) Peshawar. Out of 39 patients, male were 20 (51.39%) and female were 19 (48.7%). The mean age was 53.2 years (SD\pm9.2). The presenting symptoms were snoring 38 (97.4%), irritability in 25 (64.1%), hypersomnolence in 29 (74.4%), and witnessed apnea in 24 (61%) patients. Mean ESS score 13.1 .1(50\pm5.2) with maximum score of 24 and minimum of 0 score. Only 5 (15.2%) patients had history of asthma and 14 (42.4%) had IHD. The BMI was high with mean of 38 ( (SD\pm8.7) Mean neck circumference of study participants was 43.3 cm (SD4.8), abdominal girth was 123.6 cm (SD\pm13.05) and hip girth was 121.4 cm ( (SD\pm13.6) Diagnostic sleep study revealed that 14(36%) patients had AHI less than 15 per hour and were not subjected to therapeutic sleep study which was conducted only in 27 (64%) patients with average AHI events per hour 50 1 (SD\pm30,1) suggestive of Sleep Apnoea Syndrome. During Diagnostic study in 27 patients mean minute ventilation was 4.4 (SD\pm1,2), and average AHI events per hour 50.1(SD\pm30.1) and during Therapeutic study of the same 27 patients the mean minute ventilation improved to 5.5 (SD\pm1.2) and average AHI event per hour were reduced to 5 (SD\pm3.4) per hour with the mean positive pressure of 10.8 cm of water with minimum of 7 and maximum of 15. CONCLUSION: OSA is a common problem in patients who are obese and suffer from snoring. The limited polysomnography is useful diagnostic tool in making the diagnosis of OSA among high risk patient.References
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