Undiagnosed obstructive sleep apnea in hypertensive outpatients in primary care—Associations with sleep complaints, depressive symptoms and global perceived health

Abstract

Objective: 1) To describe the prevalence of undiagnosed obstructive sleep apnea (OSA) and depressive symptoms in hypertensive men and women below 65 years of age, and 2) to describe the association of OSA to subjective sleep complaints, depressive symptoms and global perceived health. Design: Cross-sectional design focusing on nursing care outcomes of obstructtive sleep apnea. Setting: Four primary care health centres in Sweden. PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed hypertension (BP > 140/90). Main Outcome Measures: Prevalence of OSA and depressive symptoms, and association of OSA to sleep complaints, depressive symptoms and global perceived health. RESULTS: Mild, moderate and severe OSA was seen among 29%, 16% and 14% of patients, respectively. Depressive symptoms were seen in 16% of the total group, with a higher prevalence among men, compared to women, 21% vs. 12%. No differences were found regarding blood pressure, estimated sleep need, sleep sufficiency index, insomnia symptoms, daytime sleepiness or depressive symptoms with respect to different degrees of OSA. Apnea-hypopnea index was significantly associated to perceived health after adjustment for gender and comorbidities, but when depressive symptoms and non-restorative sleep were added to the model, 33% of the variance in global perceived health was explained. Conclusion: OSA is highly prevalent among patients with hypertension in primary care and does together with sleep complaints and depressive symptoms have a negative impact on global perceived health. Hypertensive patients without subjective sleep complaints or depressive symptoms may still have OSA.

Correlation Between Perceived Stress and BMI Among Obstructive Sleep Apnea Individuals

“…and daytime sleepiness, all of which are linked to OSA among individuals referred to the sleep clinics. 6,7 These factors also contribute to decreases the health perceptions in the general population. 6 Stress is a substantial influence impacting various dimensions of both physical and mental well-being in contemporary society.…”

“…6,7 These factors also contribute to decreases the health perceptions in the general population. 6 Stress is a substantial influence impacting various dimensions of both physical and mental well-being in contemporary society. Specifically, "perceived stress," referring to a person's personal evaluation of their stress levels over a certain timeframe, can be influenced by a person's life experiences, physical and mental health, and social support, among other factors.…”

Improving OSA screening and diagnosis in patients with hypertension in an academic safety net primary care clinic: quality improvement project

“… 19 Broström et al found that undiagnosed mild and moderate/severe OSA was seen among 29% and 30% of patients with HTN, respectively. 20–22 The current guidelines by US Preventive Services Task Force (USPSTF) do not recommend any screening for OSA in asymptomatic patients due to insufficient research and data. 1–4 …”

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“…Not only systemic hypertension, but also pulmonary hypertension, heart failure, arrhythmia, stroke, and myocardial infarction can be observed. All these situations increase morbidity and mortality related to OSAS [4][5].…”