Chronic respiratory disease in the regional and remote population of the Northern Territory Top End: A perspective from the specialist respiratory outreach service

Kruavit, Anuk; Fox, Melissa; Pearson, Rebecca; Heraganahally, Subash S.

doi:10.1111/ajr.12349

Cited by 41 publications

(87 citation statements)

References 12 publications

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“…Chronic health conditions are noted to be highly prevalent in Indigenous populations, including Australian Aboriginal people. [40][41][42][43][44][45][46] Under diagnosis or untreated OSA in this population may give rise to adverse health outcome. 47 Ethnic and gender differences need to be considered in the clinical assessment of patients with OSA, which may itself represent a different phenotype.…”

Section: Dovepressmentioning

confidence: 99%

Gender Differences in the Clinical and Polysomnographic Characteristics Among Australian Aboriginal Patients with Obstructive Sleep Apnea

Mehra

Ghimire

Mingi

et al. 2020

NSS

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Background: In this study, we assessed the clinical and polysomnographic (PSG) characteristics according to gender among Australian Aboriginal men and woman diagnosed to have obstructive sleep apnea (OSA). Methods: In this retrospective study, all adult Aboriginal patients over 18 years of age diagnosed to have OSA with an apnea hypopnea index (AHI) > 5/hour over a 5 year period were included. Results: Of the 337 patients (168 females and 169 males), who underwent a diagnostic PSG, 297 (88%) were diagnosed to have OSA (AHI) >5/hour), 154/297 males (52%) and 143/297 females (48%). Amongst male and female patients with OSA, 63% and 37% were in the severe spectrum (AHI>30/hour). The male cohort had higher stage N1 NREM sleep (P<0.001), reduced N3 NREM sleep (P<0.001), higher AHI severity (P<0.001), higher NREM AHI (P<0.001), and high arousal index (P<0.005). REM sleep-related AHI was higher among female patients with all severity of OSA, along with severe oxygen desaturation during REM sleep. Among patients with severe OSA, the female cohort were younger (age 46 years vs 49 years, P=0.030) and had higher BMI with all severity of OSA, while males had larger neck circumference compared to females. Hypertension increased the odds of severe OSA versus the combined odds of mild and moderate OSA for both genders. Conclusion: This study highlights some important differences in the way sleep apnea manifests in Australian Aboriginal males and females and further studies are warranted to explore avenues to look for a physiological basis for these observations and targeted interventions.

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Section: Dovepressmentioning

confidence: 99%

Gender Differences in the Clinical and Polysomnographic Characteristics Among Australian Aboriginal Patients with Obstructive Sleep Apnea

Mehra

Ghimire

Mingi

et al. 2020

NSS

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“…11 Our 2017 study demonstrated that smoking was highly prevalent among Aboriginal people living in remote and regional communities compared to non-Aboriginal people, and higher rates of COPD were noted in Aboriginal patients (56%) compared to non-Aboriginal patients (28%). 12 Furthermore, Aboriginal people living in remote and regional communities are also exposed to a significant amount of environmental smoke due to frequent fires in the surrounding savanna. [13][14][15][16] It is likely that environmental smoke exposure contributes to respiratory illness or gives rise to exacerbations of symptoms secondary to underlying COPD.…”

Section: Introductionmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease In Aboriginal Patients Of The Northern Territory Of Australia: A Landscape Perspective

Heraganahally¹,

Wasgewatta²,

McNamara³

et al. 2019

COPD

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Background: The Aboriginal population of Australia has a higher burden of chronic health conditions than non-Aboriginal Australians. However, there is a paucity of data on clinical and demographic characteristics of chronic obstructive pulmonary disease (COPD) in this population. Method: In this retrospective study we evaluated the clinical, demographic and environmental influences in adult Aboriginal patients with COPD living in the regional and remote communities of the Northern Territory of Australia. Results: There were 380 patients (49%) with a diagnosis of COPD of the 767 patients referred to specialist respiratory outreach clinics. The mean age was 57 years (56% were female) and mean±SD BMI was 24.30±7.01 kg/m 2. Smoking history was noted in 93% of the study cohort. The most common respiratory symptom was shortness of breath in 62%, and inhaled medications (salbutamol, tiotropium, salmeterol/fluticasone) were used by 79%, 44% and 58% of patients, respectively. Spirometry showed obstructive impairment (FEV 1 / FVC <0.7) in 79% (0.56±0.17), with mean FEV 1 42% of predicted, and a bronchodilator response was present in 28.6%. Comorbid bronchiectasis was diagnosed in 49.8% along with COPD. The relationship between COPD and community demography showed a higher proportion of smokers and those with underlying bronchiectasis to have lower FEV 1 /FVC ratios. Communities with a higher proportion of asthma were younger and had higher smoking rates. Mortality increased with increasing number of exacerbations and hospital admissions. Conclusion: The Aboriginal population with COPD has a higher prevalence of smoking, moderate to severe airflow obstruction on spirometry and frequently co-diagnosed bronchiectasis with increased severity of ventilatory impairment.

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“…Previous studies from our centre at the Top End Health Service (TEHS) region of the Northern Territory (NT) of Australia have demonstrated a higher proportion of OSA among both Australian Aboriginal and/or Torres Strait Islander (ATSI) (henceforth represented as Indigenous Australians with respect) and non-Indigenous population. [31][32][33] The population profile of the Top End, NT of Australia is unique and diverse, with a population of about 249,220 people and about 30% of whom are of Indigenous Australian descent living in an area stretched over 245,000 km 2 (94,595.0 sq miles) in the northern, sub-tropical part of Australia. 34 Moreover, 81% of Indigenous Australians and a minor proportion of non-Indigenous people live in remote and regional communities that can be accessed only by seasonal light aircraft.…”

Section: Introductionmentioning

confidence: 99%

Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects

Garg¹,

Er²,

Howarth³

et al. 2020

NSS

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Purpose: To assess the prevalence of positional sleep apnea (POSA) and its predictors in patients diagnosed to have obstructive sleep apnea (OSA) in the regional and remote population of the Northern Territory of Australia over a two-year study period (2018 and 2019). Patients and Methods: Of the total 1463 adult patients who underwent a diagnostic polysomnography (PSG), 946 patients were eligible to be included in the study, of them, 810 consecutive patients with OSA (Apnea-Hypopnea Index (AHI) ≥ 5) who slept >4 h and had ≥30 min sleep in both supine and lateral positions were assessed. Patients were considered to have POSA if supine AHI to lateral AHI ratio ≥2. The likely comparative impact of use of continuous positive airway therapy (CPAP) or positional therapy (PT) on disease severity was evaluated using model simulation. Results: A total of 495/810 (61%) patients had POSA, the majority were males (68% vs 60%, p=0.013) and non-Indigenous Australians (93% vs 87%, p=0.004). POSA patients were younger (mean difference 2.23 years (95% CI 0.27, 4.19)), less obese (BMI mean difference 3.06 (95% CI 2.11, 4.01)), demonstrated less severe OSA (p < 0.001) and a greater proportion reported alcohol consumption (72% vs 62%, p=0.001) as compared to those with non-POSA. Using the simulation model, if patients with POSA use PT two-thirds (323/495, 65%) would obtain significant improvement of their OSA severity, with one in five (92/495, 19%) displaying complete resolution. Comparing this to simulated CPAP therapy, where the majority (444/495, 90%) will show significant improvement, and onethird (162/495, 33%) will display complete resolution. Conclusion: POSA needs to be routinely recognised and positional therapy integrated in practice especially in the remote regions and in the developing world when effective methods are in place to monitor positional therapy.

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Chronic respiratory disease in the regional and remote population of the Northern Territory Top End: A perspective from the specialist respiratory outreach service

Cited by 41 publications

References 12 publications

<p>Gender Differences in the Clinical and Polysomnographic Characteristics Among Australian Aboriginal Patients with Obstructive Sleep Apnea</p>

<p>Gender Differences in the Clinical and Polysomnographic Characteristics Among Australian Aboriginal Patients with Obstructive Sleep Apnea</p>

<p>Chronic Obstructive Pulmonary Disease In Aboriginal Patients Of The Northern Territory Of Australia: A Landscape Perspective</p>

<p>Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects</p>

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