Hematological indices as simple, inexpensive and practical severity markers of obstructive sleep apnea syndrome: a meta-analysis

Wu, Mindan; Zhou, Lingren; Zhu, Dingliang; Lai, Tianwen; Chen, Zhihua; Shen, Huahao

doi:10.21037/jtd.2018.10.105

Cited by 38 publications

(34 citation statements)

References 66 publications

(101 reference statements)

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“…Interestingly, the hematocrit level is also correlated with OSA severity. This correlation has been previously identified in individuals in the overall population with OSA[35,36]; however, this finding had not yet been demonstrated in the population of adult individuals with DS. This correlation possibly reflects the presence and greater severity of nocturnal hypoxemia that stimulates increased erythropoietin synthesis, with consequent elevated erythrocyte production and increased hematocrit levels[35,36].…”

Section: Discussionsupporting

confidence: 57%

STOP-Bang questionnaire should be used in all adults with Down Syndrome to screen for moderate to severe obstructive sleep apnea

Carvalho

Amorim

Santana

et al. 2019

Preprint

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Study Objectives To determine the prevalence of obstructive sleep apnea (OSA) in adults with Down syndrome (DS), to investigate factors related to OSA severity and to identify which sleep questionnaire is the most appropriate for the screening of OSA in this population. Methods Cross-sectional study that consecutively included 60 adults with DS. All patients underwent type III polysomnography and clinical and laboratory data were collected; sleep assessment questionnaires were applied. Multiple linear regression models evaluated the associations between OSA severity (measured by the respiratory event index - REI) and clinical and laboratory data and sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, BERLIN and STOP-Bang questionnaires). Results Results show that 60 (100%) adults with DS had OSA, with moderate-severe OSA identified in 49 (81.6%). At the multivariate linear regression, REI significantly correlated with hematocrit levels, BMI and STOP-Bang questionnaire (SBQ) results (P <0.001). The positive STOP-Bang ≥3 points) showed 100% of sensitivity (95%CI: 92.75-100%), 45.45% of specificity (95%CI: 16.75-76.62), positive predictive value of 89.09% (95%CI: 82.64-93.34%), negative predictive value of 100%, accuracy of 90% (95%CI: 79.49-96.24%) and OR of 24.29. Conclusions Adults with DS have a very high prevalence of OSA. Hematocrit levels, BMI and SBQ showed a strong correlation with OSA severity. The SBQ performed well in identifying moderate to severe OSA in this population. Considered together, these results point to the need to perform OSA screening in all adults with DS, and STOP-Bang may play a role in this screening. Keywords Down syndrome; obstructive sleep apnea; self-reported sleep quality; sensitivity and specificity; surveys and questionnaires; polysomnography.

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Section: Discussionsupporting

confidence: 57%

STOP-Bang questionnaire should be used in all adults with Down Syndrome to screen for moderate to severe obstructive sleep apnea

Carvalho

Amorim

Santana

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Interestingly, the hematocrit level is also related with OSA severity (REI). This relation has been previously identified in individuals in the overall population with OSA [36,37]; however, it had not yet been demonstrated in the population of DS adults. This relation possibly reflects the presence and greater severity of nocturnal hypoxemia that stimulates increased erythropoietin synthesis, with consequent elevated erythrocyte production and increased hematocrit levels [36,37].…”

Section: Discussionmentioning

confidence: 56%

STOP-Bang questionnaire should be used in all adults with Down Syndrome to screen for moderate to severe obstructive sleep apnea

et al. 2020

View full text Add to dashboard Cite

Study objectives To determine the prevalence of obstructive sleep apnea (OSA) in adults with Down syndrome (DS), to investigate factors related to OSA severity and to identify which sleep questionnaire is the most appropriate for the screening of OSA in this population. Methods Cross-sectional study that consecutively included 60 adults with DS. All patients underwent type III polysomnography and clinical and laboratory data were collected; sleep assessment questionnaires were applied. Multiple linear regression models evaluated the associations between OSA severity (measured by the respiratory event index-REI) and clinical and laboratory data and sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, BERLIN and STOP-Bang questionnaires). Results Results show that 60 (100%) adults with DS had OSA, with moderate-severe OSA identified in 49 (81.6%). At the multivariate linear regression, REI significantly correlated with hematocrit levels, BMI and STOP-Bang questionnaire (SBQ) results (P <0.001). The positive STOP-Bang �3 points) showed 100% of sensitivity (95%CI: 92.75-100%), 45.45% of specificity (95%CI: 16.75-76.62), positive predictive value of 89.09% (95%CI: 82.64-93.34%), negative predictive value of 100%, accuracy of 90% (95%CI: 79.49-96.24%) and OR of 24.29.

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“…11 To date, only a few studies have examined the association between OSA and erythrocyte measures. [12][13][14][15][16] Choi et al 13 found that patients with severe OSA had higher hematocrit and hemoglobin than patients without OSA and patients with mild-to-moderate OSA, but red blood cell count was not reported. Conversely, other studies did not find any associations between OSA severity and hematocrit or hemoglobin level, 12,14,15 although 1 study found significant differences in red blood cell count among different OSA severity groups.…”

Section: Introductionmentioning

confidence: 99%

Sex-specific associations between erythrocyte measures and obstructive sleep apnea

Covassin

Tan

et al. 2020

Journal of Clinical Sleep Medicine

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Study Objectives: Hypoxemic effects of obstructive sleep apnea (OSA) have been implicated in changes in erythropoiesis and hence erythrocyte measures. Sex differences are evident in both OSA and erythropoiesis. Whether sex modulates the relationship between severity of OSA and erythrocyte measures has not previously been studied. Methods: We examined a sample of 976 patients (38% women) who underwent overnight polysomnography and measurement of red blood cell count, hemoglobin, and hematocrit. Patients were divided into primary snoring and mild, moderate, and severe OSA groups, separately by sex. Results: In multiple regression models, we found significant interactions between sex and oxygen desaturation index and apnea-hypopnea index on erythrocyte measures. Higher oxygen desaturation index and higher apnea-hypopnea index were independently associated with higher red blood cell count, hemoglobin, and hematocrit in women but not in men. Further ordinal logistic regression analysis showed a significant association between oxygen desaturation index (odds ratio, 2.33; 95% confidence interval, 1.17-4.66) and apnea-hypopnea index (odds ratio, 2.44; 95% confidence interval, 1.23-4.84) and red blood cell count in women only. Correlation analysis also showed that erythrocyte measures and markers of cardiometabolic risk were more closely correlated in women than in men. Conclusions: This study provides novel data suggesting a significant association between erythrocyte measures and OSA severity in women but not in men. Similarly, the relationship between hematologic metrics and cardiometabolic risk markers was more pronounced in women than in men. Our findings suggest a sex-specific impact of OSA on erythrocyte measures and on their relationship with indexes of cardiometabolic risk.

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Hematological indices as simple, inexpensive and practical severity markers of obstructive sleep apnea syndrome: a meta-analysis

Cited by 38 publications

References 66 publications

STOP-Bang questionnaire should be used in all adults with Down Syndrome to screen for moderate to severe obstructive sleep apnea

STOP-Bang questionnaire should be used in all adults with Down Syndrome to screen for moderate to severe obstructive sleep apnea

STOP-Bang questionnaire should be used in all adults with Down Syndrome to screen for moderate to severe obstructive sleep apnea

Sex-specific associations between erythrocyte measures and obstructive sleep apnea

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