Epworth Sleepiness Scale may be an indicator for blood pressure profile and prevalence of coronary artery disease and cerebrovascular disease in patients with obstructive sleep apnea

Feng, Jing; He, Quan-ying; Zhang, Xilong; Chen, Bao-yuan

doi:10.1007/s11325-011-0481-5

Cited by 64 publications

(55 citation statements)

References 46 publications

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“…Recently, Feng et al 13 found that subjective EDS was an indicator of BP profile in a study of 2297 consecutive Chinese OSA patients. Kapur et al 15 found a significantly elevated OR for hypertension among OSA patients who reported sleepiness ≥5 days per week.…”

Section: Discussionmentioning

confidence: 99%

“…1,12 Many studies have shown that OSA patients with subjective EDS have a higher prevalence of hypertension compared with those without EDS. [13][14][15] Furthermore, a series of clinical trials have suggested that continuous positive airway pressure (CPAP) therapy is less effective in OSA patients without EDS than those with EDS in terms of decreasing blood pressure (BP) and preventing the occurrence of hypertension. [16][17][18][19][20] These findings suggest that subjective EDS is associated with hypertension in OSA.…”

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confidence: 99%

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Obstructive Sleep Apnea With Objective Daytime Sleepiness Is Associated With Hypertension

Ren

Zhang³

et al. 2016

Hypertension

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O bstructive sleep apnea (OSA) is a common disease that affects 2% to 4% of adult men and ≈1% to 2% of adult women, 1 and among adults aged 30 to 70 years, the prevalence of OSA increases to ≈24% to 26% in men and 17% to 28% in women.2 Repetitive asphyxia events in sleep apnea result in brain arousal, intermittent hypoxemia, and increased sympathetic nervous system activity. Both cross-sectional and longitudinal studies have demonstrated that OSA is a risk factor for hypertension that is independent of age, sex, and body mass index.3-5 Furthermore, it has been shown that OSA is an important cause of hypertension. 6,7 Several mechanisms, including increased sympathetic tone, inflammatory response, impaired arterial baroreflex sensitivity, and pleural pressure swings, induced by intermittent hypoxemia of OSA are involved in the relationship between OSA and hypertension. [8][9][10][11] Excessive daytime sleepiness (EDS) is common in patients with OSA and an important criterion for diagnosis and treatment of OSA. EDS has a prevalence of 16% to 22% in OSA in epidemiological samples, and it is the most common complaint in clinical samples. 1,12 Many studies have shown that OSA patients with subjective EDS have a higher prevalence of hypertension compared with those without EDS. [13][14][15] Furthermore, a series of clinical trials have suggested that continuous positive airway pressure (CPAP) therapy is less effective in OSA patients without EDS than those with EDS in terms of decreasing blood pressure (BP) and preventing the occurrence of hypertension. [16][17][18][19][20] These findings suggest that subjective EDS is associated with hypertension in OSA. However, in previous studies, EDS was determined by self-report, with the Epworth Sleepiness Scale (ESS) 21 being most frequently used. Lombardi et al 22 found that EDS determined by the multiple sleep latency test (MSLT) in OSA patients was associated with lower baroreflex sensitivity and higher low-to-high frequency power ratio of heart rate variability during overnight sleep compared with OSA patients without EDS. To our knowledge, this is the only existing study reflecting a possible association between objective EDS and cardiovascular events in OSA. The specific relationship between hypertension and objectively evaluated EDS has not been investigated.Abstract-Subjective daytime sleepiness is considered a significant risk factor of hypertension in patients with obstructive sleep apnea (OSA). In this study, our goal was to examine the joint effect on hypertension of OSA and objective daytime sleepiness measured by the multiple sleep latency test (MSLT). A total of 1338 Chinese patients with OSA and 484 primary snorers were included in the study. All subjects underwent 1 night polysomnography followed by MSLT. The MSLT values were classified into 3 categories: >8 minutes, 5 to 8 minutes, and <5 minutes. Hypertension was defined based either on direct blood pressure measures or on diagnosis by a physician. After controlling for confounders, OSA combined with MSLT o...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Obstructive Sleep Apnea With Objective Daytime Sleepiness Is Associated With Hypertension

Ren

Zhang³

et al. 2016

Hypertension

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“…22 Specifically, it has been established that EDS is a significant public health problem in patients with SDB 39 and is useful to identify individuals with high risk of HTN or RHTN. 13 The observation that patients with controlled BP had less dozing propensity further corroborates this point. 40 Moreover, there is minimal data available examining change in ESS in those with HTN.…”

Section: Discussionmentioning

confidence: 58%

“…For instance, increased risk of HTN observed in OSA may be modulated by daytime somnolence. 13 Moreover, sleepiness is a not an uncommon symptomatic manifestation of depression, the latter representing the second leading cause of common psychiatric problems in adults. 14 While it is fairly well established that SDB serves as a risk for HTN development, depression has also been identified as an independent risk factor for HTN.…”

Section: Impact Of Sleep-disordered Breathing Treatment On Patient Rementioning

confidence: 99%

Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients

Walia

Griffith

Thompson

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: We hypothesized that patient reported outcomes (PROs) improve with positive airway pressure (PAP) in patients with sleep-disordered breathing (SDB) and hypertension (HTN). Methods: Questionnaire-based PROs (sleepiness [Epworth Sleepiness Scale, (ESS)], depression [Patient Health Questionnaire-9 (PHQ-9)], and fatigue [Fatigue Severity Scale (FSS)]) were retrospectively examined in patients with SDB and HTN at baseline and within a year following PAP initiation. PRO changes were estimated using multivariable linear mixed-effect models adjusted for baseline age, sex, race, body mass index, resistant hypertension (RHTN) status, cardiac and diabetes history, and correlation between repeated measurements. Age and race by PAP interaction terms (mean change, 95% CI) were examined. Results: 894 patients with HTN and SDB were examined. 130 (15%) had baseline RHTN (age 58 ± 12 y, 52.9 % male, BMI 36.2 ± 9.1 kg/m 2 ). In multivariable models, a significant improvement in sleepiness ESS (−2.09, 95% CI: −2.37, −1.82), PHQ-9 (−1.91, 95% CI: −2.25, −1.56), and FSS scores (−4.06 95% CI: −4.89, −3.22) was observed. A significant race by PAP effect interaction was observed (p < 0.0001 for all PROs); Caucasians had greater improvements than non-Caucasians. The interaction term of effect of PAP and age was significant for ESS (p = 0.04) and PHQ-9 (p = 0.0003), indicating greater improvement in younger patients. Conclusions: Consistent improvement of broad PRO domains in response to PAP in SDB was observed in this clinic-based hypertensive cohort; Caucasians and younger patients derived greater benefit. Keywords: patient reported outcomes, hypertension, positive airway pressure Citation: Walia HK, Griffith SD, Thompson NR, Moul DE, Foldvary-Schaefer N, Mehra R. Impact of sleep-disordered breathing treatment on patient reported outcomes in a clinic-based cohort of hypertensive patients.

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“…14 A prospective cohort study was performed in 20 hospital sleep centers designed to determine whether ESS scores were associated with prevalence of coronary artery disease in patients with obstructive sleep apnea diagnosed by PSG. 15 Results indicated a positive correlation, further validating the use of this tool among patients with cardiac disease. 15 The use of the ESS in the heart failure population has been controversial, because the clinical manifestations of heart failure can overlap with the symptoms assessed by ESS.…”

Section: Screening and Diagnosis Of Sdbmentioning

confidence: 68%

Use of an Evidence-Based Protocol to Screen for Sleep-Disordered Breathing in a Heart Failure Disease Management Clinic

Garner

Traverse²

2014

Journal of Nursing Care Quality

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Undiagnosed and untreated sleep-disordered breathing can lead to negative health outcomes and increased utilization of health resources among patients with heart failure. The purpose of this evidence-based practice project was to implement and evaluate a new multifaceted sleep-disordered breathing screening protocol in a heart failure disease management clinic. The combined use of a symptoms questionnaire, the Epworth sleepiness scale, and overnight pulse oximetry was significantly more effective in identifying patients with a positive diagnosis of sleep-disordered breathing than using the Epworth sleepiness scale alone (P < .05).

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Epworth Sleepiness Scale may be an indicator for blood pressure profile and prevalence of coronary artery disease and cerebrovascular disease in patients with obstructive sleep apnea

Cited by 64 publications

References 46 publications

Obstructive Sleep Apnea With Objective Daytime Sleepiness Is Associated With Hypertension

Obstructive Sleep Apnea With Objective Daytime Sleepiness Is Associated With Hypertension

Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients

Use of an Evidence-Based Protocol to Screen for Sleep-Disordered Breathing in a Heart Failure Disease Management Clinic

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