Screening questionnaires for obstructive sleep apnea: an updated systematic review

Obstructive sleep apnea [OSA] is the most common sleep-related breathing disorder and is associated with significant morbidity. We sought to present an updated systematic review of the literature on the accuracy of screening questionnaires for OSA against polysomnography [PSG] as the reference test. Using the main databases [including Medline, Cochrane Database of Systematic Reviews and Scopus] we used a combination of relevant keywords to filter studies published between January 2010 and April 2017. Population-based studies evaluating the accuracy of screening questionnaires for OSA against PSG were included in the review. Thirty-nine studies comprising 18 068 subjects were included. Four screening questionnaires for OSA had been validated in selected studies including the Berlin questionnaire [BQ], STOP-Bang Questionnaire [SBQ], STOP Questionnaire [SQ], and Epworth Sleepiness Scale [ESS]. The sensitivity of SBQ in detecting mild [apnea-hypopnea index [AHI] >/= 5 events/hour] and severe [AHI >/= 30 events/hour] OSA was higher compared to other screening questionnaires [range from 81.08% to 97.55% and 69.2% to 98.7%, respectively]. However, SQ had the highest sensitivity in predicting moderate OSA [AHI >/= 15 events/hour; range = 41.3% to 100%]. SQ and SBQ are reliable tools for screening OSA among sleep clinic patients. Although further validation studies on the screening abilities of these questionnaires on general populations are required

Obstructive sleep apnea and postoperative complications in patients undergoing coronary artery bypass graft surgery: a need for preventive strategies

Obstructive sleep apnea [OSA] is very frequent and often unrecognized in surgical patients. OSA is associated with perioperative complications. We evaluated the effects of OSA on postoperative complications and hospital outcomes in patients undergoing coronary artery bypass graft [CABG] surgery. Candidates of elective CABG were evaluated by the Berlin questionnaire for OSA. After surgery, patients were assessed for postoperative complications, re-admission to the Intensive Care Unit [ICU], duration of intubation, re-intubation, days spent in the ICU and the hospital. We studied 61 patients who underwent CABG from which 25 [40.9%] patients had OSA. Patients with OSA had higher body mass index [29.5 +/- 3.9 vs. 26.0 +/- 3.7 kg/m2, P = 0.003] and higher frequency of hypertension [68.0% vs. 30.5%, P = 0.003], dyslipidemia [36.0% vs. 5.5%, P = 0.004], and pulmonary disease [16.0 vs. 2.7%, P = 0.08]. Regarding the surgical outcomes, OSA patients had longer intubation duration [0.75 +/- 0.60 vs. 0.41 +/- 0.56 days, P = 0.03]. Obstructive sleep apnea is frequent, but unrecognized among patients undergoing CABG. In these patients, OSA is associated with prolonged intubation duration. Preventing these problems may be possible by early diagnosis and management of OSA in cardiac surgery patients. Further studies with larger sample of patients and longer follow-ups are required in this regard

Validation of the Persian version of Berlin sleep questionnaire for diagnosing obstructive sleep apnea

Obstructive sleep apnea [OSA] is a common but usually under-diagnosed sleep disorder. Objective diagnosis is based on polysomnography, which is an expensive test. We assessed the reliability and diagnostic accuracy of the Berlin questionnaire [BQ] in diagnosis of OSA in Iranian sleep clinic patients. A cross-sectional linguistic validation study was conducted on consecutive Iranian patients with Persian language attending one sleep clinic in Isfahan [Iran] were studied. Patients completed the Persian BQ [contains 10 questions in 3 categories], developed by forward-backward translation method. The patients underwent an overnight polysomnographic study at the clinic. Apneas/hypopnea index of >5/Hour was considered for diagnosis of OSA. One hundred and fifty seven patients [55.4% male, mean age = 52.3 +/- 13.6 years] were evaluated. Sleep study confirmed OSA diagnosis in 91.7% of the studied patients. The reliability analysis of the BQ categories showed alpha Cronbach's as 0.70 and 0.50 for category 1 and category 2, respectively. BQ categories 1-3 were positive respectively in 88.5%, 67.5%, and 66.9% of the patients. The BQ and sleep study were in agreement for 82.1% of the cases. The sensitivity, specificity, positive and negative predictive values, and positive, and negative likelihood ratio of the BQ were calculated as 84.0%, 61.5%, 96.0%, 25.8%, 2.18%, and 0.26% respectively. BQ is useful as a screening test for diagnosing OSA in Iranian patients with sleep complaints; however, the test cannot be used for rolling out the OSA. Further studies on editing, modifying, and applying the BQ in a larger sample of patients are warranted in our society

Sleep quality in patients on maintenance hemodialysis and peritoneal dialysis

Sleep disturbances are common among uremic patients; however, limited data are available on predictors of sleep quality in this population. We assessed sleep quality in patients on hemodialysis [HD] and peritoneal dialysis [PD] and investigated predictors related to sleep quality. Patients on maintenance HD and PD were consecutively included from two medical centers in Isfahan city [Iran]. They completed the Pittsburgh sleep quality index [PSQI] and hospital anxiety and depression scale. Laboratory tests were done for iron state, kidney function, and electrolytes. Univariate and multivariate analyses were performed to find predictors of sleep quality. About 90 patients were evaluated [53 males, age = 54.2 +/- 15.2 years, disease duration = 5.3 +/- 4.5 years]. Poor sleep quality was frequent in 86.6% of the cases in each group of HD and PD patients. Patients on HD had poorer sleep quality in terms of total PSQI scores and two dimensions of sleep latency and sleep efficiency [P < 0.05]. Anxiety [beta = 0.232, P = 0.027], depression [beta = 0.317, P = 0.004], and being on HD [beta = 2.095, P = 0.009] were independent predictors of overall poor sleep quality. Poor sleep quality is highly frequent in patients on maintenance dialysis and mood disorders and being on HD are predictive factors. Further studies are required for better understanding of risk factors associated with poor sleep quality and thus possible treatments in these patients

Sleep apnea symptoms in diabetics and their first degree relatives

Sleep apnea is associated with increased risk of diabetes mellitus. However, no studies have compared sleep apnea symptoms in diabetic patients and their first degree relatives. The purpose of our study was to investigate high risk for sleep apnea syndrome, in diabetics and their first degree relatives for prevention of diabetes in family. As a part of a cohort study, all of diabetic and their first degree relatives who came for glucose control in diabetes clinic were invited to take part in the survey. Two thousand, four hundred and sixty two individuals [82% of invited] agreed to fill out the Berlin and Epworth sleep questionnaire. Participants consisted of 2462 subjects of 15-70 years of age, both males and females with diabetes and family history of type 2 diabetes mellitus. A total of 1234 participants had diabetes and 11,231 were relatives of diabetic patients. High risk for sleep apnea regarding Berlin questionnaire and Epworth sleepiness scale, diabetic and relative were analyzed. Prevalence's of high risk for sleep apnea were higher among diabetics than relatives [P value<0.001]. In a multiple regression analysis, ''age, body mass index, education, high blood pressure'' were risk factor for sleep apnea symptoms while isolated blood glucose level was not by Berlin questionnaire. By Epworth sleep scale only education level was a risk factor for sleep apnea symptoms while isolated blood glucose level was not risk factor. Sleep apnea symptoms may not have significant difference between diabetics and their relatives. We need more study on sleep apnea in the family of diabetic patients. We hope that more studies on mentioned field may help prevention of diabetes in their family

Comparison of impulse osillometry system and spirometry for diagnosis of obstructive lung disorders

Obstructive lung disease is a growing health problem, especially in developed countries. This study aimed to compare Impulse Osillometry System [IOS] and Spirometry for evaluation of Chronic Obstructive Pulmonary Disease and asthma. The study groups contained 87 healthy people, 87 asthmatic patients and 56 COPD patients. Spirometry [FVC, FEV1, FEV1/FVC] and IOS [R5, R20, X5] measurements were performed for all the healthy subjects and patients. The results of IOS were compared with spirometric results. Significant differences were detected among the 3 groups [control, COPD and asthma] in terms of all the spirometric parameters [FVC, FEV1, FEV1/FVC] and some parameters of IOS [R5,R20,X5] measurements [p<0.05]. Among COPD patients, sensitivity for X5 [the best value of IOS measurements in the COPD group] was 76%. Also, in asthmatic patients, sensitivity for R20 [the best value of IOS measurements in the asthma group] was 77%. We found a correlation between R5, R20 and X5 with FEV1 in asthmatic patients, but only R5 had this correlation with FEV1 in COPD patients. We concluded that IOS can be an alternative for spirometry in the diagnosis of obstructive lung disease in patients with minimal cooperation. R5 can represent COPD severity

Sample survey of chronic obstructive pulmonary disease and associated risk factors in Isfahan, Iran

The purpose of this cross-sectional study was to estimate the number of individuals with chronic bronchitis and/or chronic obstructive pulmonary disease in Isfahan. Our study results were compared with those of previous studies in Iran and similar studies in other countries. As a part of a population-based, cross-sectional study, 2,200 randomly selected individuals aged 40 years or older were asked to take part in the survey; among whom, 1308 individuals [59.45%] agreed to fill out the respiratory questionnaire. This group consisted of 636 [48.6%] males and 672 [51.4%] females. Spirometric measurements were performed in 279 cases. COPD was defined by the "Global Initiative for Obstructive Lung Disease" criteria. One hundred-seven individuals [8.1%] fulfilled the clinical criteria for chronic bronchitis as the main sign of COPD. Multivariate analysis revealed that age and smoking were independent predictors for chronic obstructive pulmonary disease. It is concluded that the prevalence of chronic bronchitis symptoms is approximately the same in our population as compared with western countries. The frequency of clinical chronic bronchitis has risen in comparison to a previous study in Isfahan

effect of opium on polysomnographic findings in patients with sleep apnea

Many reports are available about the increasing rate of mortality due to overuse of opioids. It has been suggested that sleep apnea can be a cause of mortality because of overuse of opioids. Opium use is common in Iran. This study aimed to assess the effect of opium on polysomnographic findings in opium addicts with sleep apnea syndrome. In this prospective case-control study, 50 opium addicts with sleep apnea were compared and matched for age, sex and body mass index with 50 non-addict patients with sleep apnea to determine the effect of opium on sleep disorders and polysomnographic findings. Sleep stages, apneas, hypopneas and desaturation were evaluated and recorded for participants in both groups. Data were analyzed and compared using SPSS version 15 software. There were significant differences between the two groups in sleep efficiency [P-value=0.00], apnea/hypopnea index [0.02], hypopnea [P-value=0.00], desaturation [P-value=0.01], sleep latency to stage 1[P-value=0.00] and central apnea [P-value=0.00] but no difference was detected for obstructive apnea [P-value=0.48]. Opium can increase central apnea, apnea-hypopnea index and desaturation in opium addicts compared with non-addicts

Endothelial dysfunction in patients with obstructive sleep apnoea independent of metabolic syndrome

<p><b>INTRODUCTION</b>Obstructive sleep apnoea syndrome (OSAS), characterised by intermittent hypoxia/re-oxygenation, has been identified as an independent risk factor for cardiovascular diseases and endothelial dysfunction. Our aim was to investigate flow-mediated dilatation (FMD) in patients with obstructive sleep apnoea with and without metabolic syndrome.</p><p><b>MATERIALS AND METHODS</b>Fifty-two subjects with OSAS diagnosed by polysomnography were classified into 2 groups according to the presence and absence of the metabolic syndrome and also according to the severity: mild to moderate OSAS group and severe OSAS group. Endothelial function of the brachial artery was evaluated by using high-resolution vascular ultrasound. Endothelial-dependent dilatation (EDD) was assessed by establishing reactive hyperaemia and endothelial-independent dilatation (EID) was determined by using sublingual isosorbide dinitrate. Spearman correlation and regression analysis were performed.</p><p><b>RESULTS</b>EDD was not significantly different in patients with OSAS and metabolic syndrome as compared with OSAS without metabolic syndrome (4.62 +/- 0.69 versus 4.49 +/- 0.93, P >0.05).</p><p><b>CONCLUSIONS</b>Endothelial dysfunction in OSA may be independent of metabolic syndrome.</p>

Respiratory resistance by impulse oscillometry in healthy Iranian children aged 5-19 years

The impulse oscillation system [IOS] measures respiratory impedance [Zrs] in terms of resistance [Rrs] and reactance [Xrs] at multiples of 5 Hz. These measurements can be used clinically to help diagnose and monitor respiratory disorders, independent of effort. There is, as yet, no information on reference values for IOS in Iranian adolescents. The predictive equation for resistance and impedance at 5 and 15 and 25 Hz, for the first time, in 509 Iranian adolescent subjects [265 boys [aged 6-19 years] and 253 girls [aged 5-19 years] were determined. Gender-specific linear prediction equations were developed by multiple regression analysis; with measuring [R5, R15, R25, X5, X15, X 25] as dependent variables regressed against age [A] and height [H]. For both genders, age and height had negative effects on resistance, while age and height had a positive effect on reactance. The prediction equations for R5 and X5 are as follows: R5: -1.35x10[-5] x agex2.823 - 0.001 x height x1.022 + 0.547 for girls X5: 1.78x10[-7] x age x1.08 + 0.002 height x4.150 - 0.539, for girls R5: -6.19x10[-7] x age x 3.820 - 6.78E-005 xheight x1.651 + 0.691 for boys X5: 6.95x10[-23] x age x16.226 + 0.004 height x 0.846- 0.430, for boys, respectively. Our results therefore provide an original frame of reference for R5, R15, R25, X5, X15, X25 in Iranian adolescents population, obtained from a standardized forced oscillation technique

Prevalence of the common cold symptoms and associated risk factors in a large population study

Common cold is the most frequent illness managed in general practice. Data regarding prevalence of the common cold in communities is confounded by the close similarity between allergy and/or asthma related symptoms and common cold. The purpose of this study was to elucidate possible correlations between self-reported common cold episodes and asthma/allergy related symptoms and some evident risk factors. As a part of an ISSAC study in Isfahan, Iran, a randomly selected population of 11666 students aged 6 to 18 years[mean +/- SD =12.96 +/- 2.99] were studied. The children or parents completed in a questionnaire with both ISSAC, and other supplementary questions regarding the common cold and allergy.11666 pupils [88.9%] completed the study. Those pupils reporting more than 3 to five episodes of the common cold exhibited a significantly more asthma and/or allergy related symptoms. Persian people with more than 3 to 5 episodes of cold like symptoms per year should be evaluated for allergic conditions

Respiratory muscle function and spirometry in patients with systemic lupus erythematosus

Systemic lupus erythematosus [SLE] can affect all organ systems including the respiratory tract and skeletal muscles. Some of the respiratory findings can be attributed to respiratory muscle involvement. The purpose of this study was to clarify the characteristics of pulmonary function tests [PFT], especially maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP] in females with systemic lupus erythematosus [SLE]. During a 12-mounth period, forced vital capacity [FVC], FEV1, FEF25-75, MIP, and MEP were measured prospectively in 76 consecutive female patients, suffering active SLE. The measured values were compared to an age-matched group of healthy women. FVC was lower in the patients than in controls [2.81versus 3.64] P=0.000. Maximal inspiratory pressure [PImax] was lower in the female patients than in 78 controls [3.42 versus 7.36]P=0.000. Maximal expiratory pressure [PEmax] was lower in the female patients than in controls [4.14versus 9.68 kPa] P=0.000, There were no correlations between PImax or PEmax and parameters of disease activity. Mouth occlusion pressure within the first 0.1 s of inspiration was higher in SLE patients than in controls [2.43 versus 1.38]; however, the difference was not statistically significant [P=0.16]. This study provides evidence of inspiratory and expiratory muscle weakness in SLE and may cause FVC reduction as well. The pathophysiologic mechanisms and the prognostic significance should be further investigated

Association between asthma and body mass index in children

Obesity has been reported to be associated with an increase in asthma in children. If there is any association, it could be attributed to an effect of obesity on lung volume and thus airway's obstruction. Data from 2413 children aged 7-12 years in Isfahan were analyzed. The subjects were included in this study if data were available for: height, weight, age, lung volume, and any measure of asthma, including history of diagnosed asthma, wheeze, chronic cough, and medication as obtained by questionnaire. Body mass index [BMI] percentiles, divided into quintiles per year age, were used as a measure of standardized weight. After adjusting for, sex, age, smoking and family history, BMI was a significant risk factor for wheeze ever [p = 0.000] and asthma ever [p = 0.000], diagnosed asthma [P=0.000] and current asthma [p = 0.000]. There was no significant correlation between BMI and obstructive spirometry. Increased BMI was significantly associated with an increased airway resistance. Despite the fact that higher BMI is a risk factor for, wheeze ever, wheeze and dyspnea in the last 12 months, and diagnosed asthma, higher BMI is not a risk factor for obstructive pattern in pulmonary function test

Reference values for maximal respiratory pressures

Maximal respiratory pressures are suitable for non -invasive evaluation of respiratory muscle function A variety of methods for subject selection and test procedures have been used for the determination of normal values and reference equations for maximal respiratory pressure [MRP]. we analyzed a well-defined, healthy subgroup of 224 men and 211 women with a wide age range [20 to 82 yr], using multiple linear regression, for the purpose of determining the effect of age, other correlates, normal values, and gender-specific reference equations on MRP. Mean values of maximal inspiratory pressure [MIP] were 9.78 kPa for men and 7.61 kPa for women. Mean values of maximal expiratory pressure [MEP] were 13.11kPa for men and 10.21 kPa for women. Prediction equations and mean value normally resulted from a cohort study of healthy 20-82 yrs subjects are given and are recommended to be used by pulmonary function laboratories in IRAN

[Respiratory symptoms and gastroesophageal reflux in adult population of more than 20 years old in Shahrekord]

Background and Aim: association between gastroesophageal reflux [GER] and respiratory diseases has been known for a long time. There are few epidemiological studies on general population in the world, and little is known about a possible association between respiratory symptoms and reflux in Iran

Method: a sample of 5492 adults [more than 20 years old] was randomly selected for the study, from them 4762 subjects agreed to take part [86.7%]. The medical students interviewed all of the subjects

Results: the prevalence of monthly reflux symptoms and active asthma were 25.5% and 6.7% respectively. The correlation between reflux and asthma had a confidence interval of [2.60-3.43] and an odds ratio of 2.99. The correlation between chronic bronchitis and reflux had a confidence interval of [1.43-2.58] and an odds ratio of 1.92

Conclusion: these findings indicates that epigastric pain in many asthmatic and chronic bronchitis patients may be due to reflux

Risk factors for chronic bronchitis among women in Shahrekord, Iran

Chronic bronchitis is expected to be less prevalent among Iranian women, since smoking is uncommon among them, however, recent reports disagreed this claim. Traditional baking and cooking with biomass fuel [wood fuel being the most commonly used] is still common in our villages and small towns. These seem to be contributive factors for high prevalence rate of chronic bronchitis among women. We conducted a case-control study to identify the possible risk of indoor smoke and biomass combustion. We compared 100 chronic bronchitis cases with 100 age-matched controls. The odds ratio [OR] was used as the basic statistic to evaluate risk. Chronic bronchitis was associated with cigarette smoking [OR=6.10; p=0.009], water-pipe smoking [OR=4.41; p=0.014], household baking [OR=4.90; p=0.002], using wood for baking [OR=3.04; p=0.000], using wood for space heating [OR=2.36; p=0.009], using wood for cooking [OR=7.17; p= 0.000], and using kerosene fuel for cooking [OR= 4.63; p=0.000]. Results have revealed that among women in Chahar- Mahal- Bakhtiari, wood and other biomass fuels used for cooking, baking and heating are associated with chronic bronchitis. Changing to safer alternative fuels for cooking and heating would ameliorate the impacts of chronic bronchitis