Screening obstructive sleep apnea-hypopnea syndrome in hypertensive patients: a comparative study of the efficiency of the Epworth sleepiness scale

Abstract

BackgroundUntreated Obstructive Sleep Apnea Hypnopnea Syndrome (OSAHS) is a known factor contributing to resistant hypertension (HT). Continuous Positive Airways Pressure (CPAP) is effective to decrease blood pressure (BP) in severe OSAHS. In our clinical practice, hypertensive patients seem less symptomatic with regard to severe OSAHS than normotensive patients, leading to a risk of underdiagnosis when OSAHS is screened with Epworth Sleepiness Scale (ESS). We aimed to confirm that severe OSAHS is less symptomatic in HT patients than normotensive patients using ESS.MethodsWe retrospectively compared two age, gender-matched groups - 100 hypertensive patients and 100 normotensive patients - with severe OSAHS defined as an AHI (Apnea Hypopnea Index) ≥30. OSAHS was considered symptomatic when ESS > 10.ResultsThe two groups of patients did not differ significantly with respect to main characteristics including Body Mass Index (BMI), AHI and ODI (Oxygen Desaturation Index). Systolic and Diastolic BP were higher in HT patients (p < 0.01). HT patients were less symptomatic with regard to severe OSAHS with a lower ESS (10.0 vs 11.9, p < 0.01), and a lower number of patients with an ESS > 10 (30% vs 58%, p < 0.01). In multivariable analysis adjusted on age, gender, Obesity, Systolic BP, Diastolic BP, AHI and ADO, normotension was significantly associated with symptomatic OSAHS (OR = 2.83, [1.298–6.192], p < 0.01).ConclusionsIn our study on patients with severe OSAHS, ESS score was lower in hypertensive patients than in normotensive patients. This discrepancy may lead to an underestimation of severe OSAHS in hypertensive patients.

Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review

“…Of the cross-sectional studies, 5 were performed in a hospital or a clinic setting, and 16 were community-based studies. Only one study by Seguro et al, in France [ 48 ] proposed a case–control design by comparing OSA severity measured by AHI scores among 100 cases with hypertension and 100 age- and gender-matched normotensive individuals as controls. In that study, an association was found between resistant hypertension and untreated obstructed sleep apnea.…”

“…Based on the ACC/AHA risk calculator, there was a gradual increase in the risk of cardiovascular events (coronary event or stroke) proportional to the increase in AHI severity categories: 8.7% for patients with normal AHI; and 19.7%, 27.8%, and 30.3% for patients with OSA of 5.1–14.9, 15–29.9, and ≥30, respectively [ 23 ]. The French study by Seguro et al [ 48 ] is the only case–control study reviewed here. It is noteworthy that the authors reported a lower Epworth sleepiness scale (ESS) in hypertensive patients than in normotensive patients with severe OSA, which could be misleading.…”

“…It is noteworthy that the authors reported a lower Epworth sleepiness scale (ESS) in hypertensive patients than in normotensive patients with severe OSA, which could be misleading. The authors, therefore, suggested estimating the OSA severity by polysomnography, even if the ESS score is low in patients with hypertension [ 48 ].…”

“… Score = 4; high; study design, sample size, sample selection and data analyses, each scored 1. Seguro et al, 2018 [ 48 ] France Retrospective case–control study 200; normal blood pressure ( n = 100), high blood pressure ( n = 100). Hypertension; obesity ( n = 126, 63%); asthma ( n = 5, 3%), and COPD ( n = 8, 4%).…”

The Weighted Combination of the Epworth Sleepiness Scale and the STOP-Bang Questionnaire Improved the Predictive Value of for OSAHS in Hypertensive Patients

“…Relative satisfied but far from ideal screening abilities were achieved in predicting OSAHS using ESS and SBQ alone. 10,11 Gong et al found that although the ESS alone has acceptable clinical predictive value for OSAHS patients with hypertension, but the severity of OSAHS could not be precisely predicted from ESS score. 12 Therefore, it is rationale to take the advantages of two or more approaches via combination, and evaluation of the screening ability upon combining these questionnaires is lacking.…”