Obstructive sleep apnea from symptoms to follow-up
Year: 2013
Type: dissertation
Study design: Observational Study
Abstract: The prevalence of snoring is high and snoring affects one s quality of life. Snoring can also be a symptom of obstructive sleep apnea (OSA). Snoring has traditionally been measured to predict OSA, but it has not been quantified in the same way as sleep disordered breathing events are. The objective diagnosis of snoring requires a sleep study. Simple and cost-effective systems are needed to screen for snoring and OSA. Upper airway symptoms are frequent in snorers and patients with obstructive sleep apnea syndrome (OSAS) already prior any treatment. The treatment of choice for obstructive sleep apnea is continuous positive airway pressure (CPAP). Although CPAP treatment is effective for OSA, the challenge is to improve treatment adherence. To evaluate the value of a Moving Picture Experts Group Layer-3 Audio (MP3) recorder device in screening of snoring, we recorded snoring sounds during polysomnography (PSG) in 200 consecutive patients referred for suspected obstructive sleep apnea (OSA). Snoring was recorded during the PSG with two microphones and with the MP3 device. We compared the results of the MP3 snoring recordings to the snoring recordings in PSG. To investigate the frequency of upper airway symptoms in subjects referred for a sleep study, we enrolled 524 consecutive patients and asked them to complete a questionnaire inquiring about current upper airway symptoms and any history of nasal and pharyngeal disorders prior the sleep study. Moreover, we examined 385 consecutive OSAS patients referred for CPAP initiation and ask the patients to complete questionnaires about upper airway symptoms before beginning CPAP and after two months of CPAP treatment. To evaluate predictors of later CPAP use, we finally followed 580 consecutive OSA patients scheduled for CPAP initiation for one year. Patients completed a self-efficacy questionnaire (5 = low, 25 = high score) before CPAP initiation. Immediately after CPAP initiation, we asked about the patients satisfaction with the CPAP trial as well as their eagerness and willingness to continue CPAP therapy (0 = unsatisfied, uneager or refused CPAP, 100 = satisfied, eager or willing to continue CPAP treatment). MP3 recording was technically successful for 87% of the patients. The Pearson correlation between PSG snoring and MP3 snoring was significant at 0.77 (p PIENEMPI 0.001). More than half of the sleep study subjects suffered from throat, mouth and nose dryness as well as from nasal stuffiness. The patients with moderate or severe OSAS (apnea-hypopnea index ≥ 15 and an Epworth sleepiness scale score ≥ 10) more often experienced mouth dryness (71% vs. 40%, p PIENEMPI 0.01) than did those with mild or no OSAS. In addition, patients with moderate to severe OSAS who were beginning CPAP treatment frequently suffered daily or almost daily from upper airway symptoms: dryness of mouth (61%), throat (54%) and nose (51%), nasal stuffiness (52%), sneezing (30%), mucus in the throat (24%), rhinorrhea (17%), and nose bleeds (6%). In CPAP users there was shown a significant reduction in the number of patients with frequent mouth (37%), throat (34%) and nose (28%) dryness and nasal stuffiness (24%). Finally, of the 580 patients 377 (65%) continued CPAP therapies beyond one year. Altogether 77 patients had a low score (< 50) for willingess to continue CPAP treatment after a brief initiation, and only 7 of them used CPAP > four hours daily after one year, yielding a specificity of 97% in predicting CPAP failure. In conclusion, recording snoring with an MP3 device offers reliable information about the patients snoring. Subjects referred for a sleep study often presented with upper airway symptoms. Nasal stuffiness and airway dryness in particular bothered snorers even before the development of sleep apnea. The most common upper airway symptoms in patients with untreated OSAS were associated with mucosal dryness. These symptoms improved during CPAP treatment. Finally, a low score for willingness to continue CPAP therapy after a short trial predicted CPAP failure and poor CPAP adherence after one year.
Source: Työväentutkimus Vuosikirja
Author: Hanna‐Riikka Kreivi
Language: English
Subfield: Physiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1504996547