SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science I. Sleep Disorders – Breathing
0350
CLINICAL RECOGNITION OF OBSTRUCTIVE SLEEP
APNEA IN A POPULATION-BASED SAMPLE
Zellmer MR 1 , Rodeheffer RJ 1 , Slusser JP 2 , Caples SM 3 , Gami AS 4 ,
Somers VK 1
1
Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN,
USA, 2 Department of Health Sciences Research, Mayo Clinic,
Rochester, MN, USA, 3 Division of Pulmonary and Critical Care
Medicine, Mayo Clinic, Rochester, MN, USA, 4 Midwest Heart
Specialists, Elmhurst, IL, USA
Introduction: Historically most OSA has been clinically unrecognized
and thus, untreated. Based on 1990s data, 6 - 15% of prevalent
OSA, depending on severity, was clinically recognized in mixed gender
populations. This under-recognition was attributed to limited physician
awareness and limited access to sleep laboratory services, both of which
have increased in the past decade.
Methods: A modified Berlin Questionnaire was completed by participants
in a longitudinal population-based study in Olmsted County,
Minnesota. The Berlin Questionnaire high risk classification was used
as a surrogate for prevalent OSA. Those with clinically recognized
OSA were identified by an electronic search using the resources of the
Rochester Epidemiology Project and subsequent manual record review.
Descriptive, bivariate and multivariate analyses were then used to determine
rates clinical recognition, and factors associated with clinical
recognition.
Results: Analysis in a mixed gender population demonstrated that OSA
clinical recognition among those with prevalent OSA with a mild or
greater severity was 22.7 % (95% CI 19.6 - 25.8%). Among those with
prevalent OSA men are more than twice as likely to be recognized in
bivariate analysis. Multivariate analysis in a mixed gender population
identified length of formal education, and two measures of obesity, body
mass index (BMI) and neck circumference, as significant predictors of
clinical recognition. In gender specific analyses length of education and
waist circumference predicted clinical recognition for men. Only BMI
was predictive for women.
Conclusion: Clinical recognition of OSA has increased since reports
using 1990s data. However, about 75% of prevalent OSA remains unrecognized
and is thus untreated. Markers of obesity and education are
predictive of clinical recognition.
Support (If Any): This study utilized data originally collected in the
Prevalence of Asymptomatic Ventricular Dysfunction (PAVD) Study.
Dr. Rodeheffer received support for that study from the Public Health
Service (NIH HL 55502). This study was also made possible by the
Rochester Epidemiology Project (Grant # R01-AR30582 from the National
Institute of Arthritis and Musculoskeletal and Skin Diseases).
0351
PREVALENCE OF SLEEP DISORDERED BREATHING
IN MIDDLE-AGED GENERAL POPULATION: THE
HYPNOLAUS STUDY
Haba-Rubio J 1 , Andries D 1 , Bastardot F 2 , Tobback N 1 , Vollenweider P 2 ,
Tafti M 1 , Heinzer R 1
1
Center for Investigation and Research in Sleep (CIRS), Lausanne
University Hospital (CHUV), Lausanne, Switzerland, 2 Internal
Medicine Department, Lausanne University Hospital (CHUV),
Lausanne, Switzerland
Introduction: In studies from the 80’s and 90’s, the prevalence of sleep
disordered breathing (SDB) in middle-aged general population is estimated
at 9% in women and 27% in men. Considering the recent improvements
in the sensitivity of recording techniques, our aim was to
reevaluate the prevalence of SDB in the general population.
Methods: 505 subjects (47.1% women, 50.3±5.6 years old, BMI
25.7±4.4 kg/m2) participating in an ongoing population-based cohort
study (HypnoLaus, Lausanne, Switzerland) underwent complete poly-
somnographic recordings at home and had an extensive clinical workup
including Epworth Sleepiness score Score (ESS). Prevalence of SDB
was determined according to apnea-hypopnea index (AHI) using two
different scoring criteria: AASM 2007 and AASM 1999.
Results: With AASM 2007 criteria, prevalence of SDB with AHI
thresholds of 5/h, 15/h and 30/h was 45.7%, 15,7%, and 6.3%, respectively
in men, and 19.3%, 4.2%, and 0.8% respectively in women. Mean
ESS score was 6.9±4.2 in men and 6.4±3.8 in women. 18% of the men
and 12.6% of the women had an ESS >10. The prevalence of ESS>10
and OSA with the same thresholds (5/h, 15/h and 30/h) was 6.3%, 3.4%,
and 0.4%, respectively in men and 2.1%, 1.3%, and 0% in women. With
AASM 1999 criteria, prevalence of OSA with the same thresholds was
77.2%, 37.5%, and 14.6% in men and 51.3%, 15.1%, and 4.6% in women.
Prevalence of OSA and ESS>10 was 12.0%, 6.7%, and 2.6% in men
and 5.5%, 2.1%, and 0.4% in women.
Conclusion: In HypnoLaus population-based study, prevalence of SDB
is much higher than previously reported, especially in middle-aged men.
This appears to be due to differences in scoring criteria and to a higher
sensitivity of nasal pressure sensors compared to thermocouples. These
results warrant a reconsideration of the criteria for the definition of sleep
disordered breathing.
Support (If Any): Lancardis Foundation GSK CIRS fund for research
Swiss Pulmonary Society
0352
DEMOGRAPHIC CHARACTERISTICS IN CHINESE
PATIENTS WITH OBSTRUCTIVE SLEEP APNEA
Li Z 1 , Zhu S 1 , Liu H 1 , Lei F 1 , Zhou G 1 , Wei X 2 , Tang X 1
1
West China Hospital of Sichuan University, Chengdu, China, 2 363
Hospital of China Aviation Industry, Chengdu, China
Introduction: Many studies for data collected in consecutive patients
mentioned that the average age in Caucasian with obstructive sleep apnea
(OSA) is over fifty years old. Through individual clinic observation,
Chinese patients with OSA appear to be younger and less obese, but
possibly more severe, relative to Caucasian. These demographic characteristics
for OSA in Chinese patients have not been emphasized in
literatures.
Methods: We analyzed demographic data of age, sex, body mass index
(BMI), apnea/hypopnea index (AHI) after routine polysomnographic
recording in consecutive 1208 subjects (male 82%) who presented with
suspicion of OSA and in consecutive 559 subjects (male 52%) with the
chief complaint of insomnia.
Results: In OSA group for AHI greater than 30, the means of age,
AHI, BMI and percentage were 44.7±11.6, 57.4±16.4, 28.7±11.2, and
46.9%, respectively; in OSAS with AHI less than 5, those means were
39.6±16.2, 2.3±1.3, 24.0±5.8, 16.4%. In insomnia group for AHI greater
than 30, those values were 44.2±13.9, 50.7±15.0, 26.4±3.5, 8.2%,
respectively, whereas the means for AHI less than 5 were 40.1±12.8,
1.9±1.5, 22.2±3.6, 63.3%.
Conclusion: The data reveal that, for severe OSA (AHI greater than
30), two groups even with different clinic features of OSA (47%) and
insomnia (8%) have similar severity of OSA (AHI 57 vs. 51), age (44.7
vs. 44.2), and BMI (28.7 vs. 26.4). Relative to those values in Caucasian
in some literatures, Chinese OSA patients are possibly younger, not that
obese, and even more severe. Those basic demographic data suggest that
it requires more extensively research for some biological high risk factors
for Chinese OSA (e.g., craniofacial characteristics).
Support (If Any): Chinese National Science Foundation 30870891/
C090302
A123
SLEEP, Volume 34, Abstract Supplement, 2011