Jan 20, 2016
Parisa Adimi
M.D,Pulmonologist ,InternistDirector of sleep disorder medicine of
Massih Daneshvari Hospital
National Research Institute of Lung and Tuberculosis
of IRAN
Obstructive Sleep ApneaSyndrome (OSAS)
OSAS is a common medical condition that is underrecognized and, therefore, undiagnosed in many adults.
Definite risk factors for OSAS include obesity and craniofacial or upper airway soft tissue abnormalities. Potential risk factors include heredity, smoking, and nasal congestion.
A significant number of obese individuals (57%) were at high risk for OSAS.*
The risk of OSAS increased up to age 65 years.
* Prevalence of symptoms and risk of sleep apnea in the US population: Results from the national sleep foundation sleep in America 2005 poll.
First nationwide survey of prevalence of overweight, underweight ,and abdominal
obesity in Iranian adults
• BMI≥25 :42.8% in Men ,57% in women. Age adjusted • BMI≥30 :11.1% in MEN, 25.2% in Woman Age adjusted• Excess body weight is common in Iran.
• More women than men present with overweight and abdominal obesity.
Conclusion
• Accordingly:– Approximately 9-18% of Iranian population
are at risk of OSA .– May be woman are more prone to OSA.– So we need another studies in order to
consider other risk factors in addition to obesity for better estimation.
Palace of Great Kourosh
Ongoing studies in Iran
• Survey of Insomnia and hypersomnia in adult population in Tehran
• Childhood and adolescence Insomnia and Hypersomnia in Tehran
Methodology
• Adult study– Study of a representative sample of
housholds living in Tehran using Cluster random sampling Technique.
• Child and Adolescents– Study of a representative sample of students
in different categories(Primary,Guidence and Highschool) using cluster random sampling.
SECOND PHASE
Following finding abnormality in this population,24 hour pulse oximetry will be done.
Oxygen Saturation base lower than 90% or 4% desaturation were considered abnormal and further investigations will be performed by polysomnography.
Instrument
• A 16-item Insomnia (ASSM 2nd edition 2005) Questionnaire
• Epworth sleep scale Questionnaire
Polysomnography in Massih Daneshvary Hospital
6months Study
Polysomnography report
Descriptive Statistics
N Range Minimum Maximum Mean Std. Deviation Variance
AHI 60 114.00 .00 114.00 20.9750 25.32627 641.420
minsato2 59 91.00 .00 91.00 67.7458 17.67483 312.400
basesato2 59 99.00 .00 99.00 85.9322 12.71418 161.650
sleepduration 56 50.00 1.00 51.00 5.8789 6.36294 40.487
obstructive 59 46.60 .00 46.60 6.0356 9.47836 89.839
mixed 59 21.40 .00 21.40 1.7305 4.58691 21.040
central 59 53.60 .00 53.60 1.9610 7.26593 52.794
hypopenea 59 56.40 .00 56.40 10.4898 12.58248 158.319
AGE 60 72.00 14.00 86.00 55.5333 16.52781 273.168
BMI 57 40.80 19.20 60.00 34.0140 9.03385 81.611
PTT12 349.00 .00 349.00 2.7808E2 132.67010 1.760E4
SYSPRESSURE29 92.00 98.00 190.00 1.4303E2 25.09195 629.606
EPS 52 21.00 3.00 24.00 12.2885 6.23506 38.876
CO2 13 57.00 23.00 80.00 54.6923 18.14472 329.231
PAP 14 90.00 .00 90.00 44.3571 29.68970 881.478
PLM 58 17.00 .00 17.00 2.2931 4.84032 23.429
SNORE24 625.00 .00 625.00 1.3023E2 200.99186 4.040E4
DESATURATION 25 86.00 .00 86.00 24.5200 25.20600 635.343
Valid N (listwise)1
AHIGR2
Frequency Percent Valid PercentCumulative
Percent
Valid <5 18 29.0 30.0 30.0
>=5 42 67.7 70.0 100.0
Total60 96.8 100.0
Missing System2 3.2
Total62 100.0
According to ASSM (American Society of sleep Medicine)
AHIGR1
Frequency Percent Valid Percent Cumulative Percent
Valid <1530 48.4 50.0 50.0
>=1530 48.4 50.0 100.0
Total
60 96.8 100.0
Missing System
2 3.2
Total
62 100.0
AHI>=15 versus AHI<15
SEX
Frequency Percent Valid PercentCumulative
Percent
Valid MALE 34 54.8 54.8 54.8
FEMALE 28 45.2 45.2 100.0
Total
62 100.0 100.0
HTN DM
Valid Percent Valid PercentValid NEGATIVE
65.5 83.1
POSITIVE
34.5 16.9
Total
100.0 100.0
Hypertension and Diabetes Mellitus in All of the patients
BMI
Frequency Percent
Valid Percent Cumulative Percent
Valid <28 16 25.8 28.1 28.1
>=28 41 66.1 71.9 100.0
Total57 91.9 100.0
Missing System
5 8.1
Total
62 100.0
Discussion
• AHI (Mean)=20.9/h• PAP (Pulmonary Arterial Pressure with Doppler
Echocardiography)=45• BMI (mean)=34 Kg/m2 Most of the patients should be treated with
positive airway pressure. patients were diagnosed with delay and
complication. We should prepare screening method in population.