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035 PREVALENCE OF SYMPTOMS AND RISK OF OBSTRUCTIVE SLEEP APNEA (OSA) SYNDROME IN GENERAL POPULATION: A CROSS-SECTIONAL STUDY
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Abstracts of 3rd International Congress of the Association of Sleep Medicine (WASM) / Sleep Medicine 10, Suppl. 2 (2009) S1–S83
cerning sleep patterns, 48.1% reported morning tiredness, 66% had difficulty maintaining sleep, 37.2% frequently took a nap during the day, 36.9% had difficulty initiating sleep, and 32.9% required more than one hour to initiate sleep. When questioned about religion, 72.6% were Catholics, 13.3% were evangelical Protestants and 3.3% were spiritists; 37.3% reported that they went to religious services at least once a week, 53.8% carried out private religious activities daily and 84.7% stated they felt God’s presence in their lives. Logistic regression controlled for sex, family income, employment, education, marital status and race showed no relationship between extrinsic religiosity, intrinsic religiosity and spirituality with any sleep patterns (initiating sleep, maintaining sleep, sleep hours and morning tiredness). Female sex and low family income were associated with less desirable sleep patterns. Conclusion: In the present study, there appeared to be no association between sleep patterns and spirituality/religiosity. However, not all aspects of sleep and spirituality were assessed, so these results should be interpreted with caution. Further studies are needed to explore this issue in more detail.
034
ASSOCIATION OF SLEEPINESS AND ACCIDENTS IN A SAMPLE OF NIGHT WORKERS OF VALLE DE ABURRÁ, COLOMBIA
H.A. Marín. UNiversidad Cooperativa de Colombia The objective of this research was to determine the relationship between excessive daytime sleepiness and accidents in a sample of night workers. A cross-sectional study was carried out with a sample of 145 night workers randomly selected from a list of companies that are headquartered in the city of Medellin. We applied the Epworth sleepiness scale, the index of the Pittsburgh sleep quality, the scale of morning and evening, in addition to questions of sleep habits, sleep disorders and rate of work-related injuries. In general, workers were evaluated between July 2007 and August 2008, were, on average, 41.2 years of age, engaged in multiple offices, with a prevalence of 22.1% in drowsiness during work and activity of about 17.2 hours per day. The sample had a striking early bird profile (62%) and a low sleep efficiency (73%). Our study highlights an accident rate of 2.1% over the last 2 years for workers with drowsiness, with significant differences against those who are not sleepy. We also observed a prevalence of 8.2% for insomnia and 12.5% for snoring in workers with injuries, values that were significantly different to those who had had no accidents. In conclusion, we observed a high association between sleep disorders and bad habits, with injuries in this sample.
035
PREVALENCE OF SYMPTOMS AND RISK OF OBSTRUCTIVE SLEEP APNEA (OSA) SYNDROME IN GENERAL POPULATION: A CROSS-SECTIONAL STUDY
F. Najafi 1 , L. Rezaei 2 , M. Tahmasian 2 , A.A. Sepehry 3 , F.J.F. Herth 4 , H. Khazaie 2 . 1 Department of Biostatistics and Epidemiology, School of Population Health, Kermanshah University of Medical Science (KUMS), Iran; 2 Sleep Research Center, Department of Psychiatry, Kermanshah University of Medical Science (KUMS), Iran; 3 Department of Psychology, University of Victoria, Victoria, Canada; 4 Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany Background: Obstructive Sleep Apnea (OSA) syndrome is one of the most common sleep breathing disorders with significant consequences but there has no published study, which addresses the prevalence of the condition in Iran. Objective: The aim of the present study was to determine prevalence of symptoms and risk of OSA in Kermanshah general population. Methods: From 2007-2008 by random-cluster-sampling, 527 adult subjects were selected from the urban region of Kermanshah. The age range of the sample was from 20 to 87 years. Assessment was performed by Berlin questionnaire, a valid scale, dissecting “high risk” and “low risk” peoples for OSA symptoms. Common symptoms were later defined. Results: From the total of 527 subjects with a mean age of 48.6±16.6 years and BMI of 25.1±3.3, 144 (27.3%) were at high risk for OSA (men 19% and Women 8.3%) and 261 (49.5%) were suffering from snoring with a higher frequency among women (51.5%). From those snoring during sleep, 51 (19.5%) reported a breathing pause more than once per week. Subjects who were considered at high risk had a clinical history of diabetes and heart failure (15.3% and 16.7% respectively). Conclusions: Prevalence of symptoms, risk of OSA and associated factors in Kermanshah are noticeable. Considering the adverse effects of this condition
on quality of life, further research and efforts to allow early diagnosis and treatment are recommended.
036
CLINICAL AND PHYSICAL CHARACTERISTICS OF OBSTRUCTIVE SLEEP APNEA SYNDROME
C. Nogueira, I. Esteves, S. Ferreira. Centro Hospitalar de Vila Nova de Gaia/Espinho Polysomnography is the gold standard test to diagnose obstructive sleep apnea syndrome (OSAS), but it is time-consuming and expensive. The clinical and physical characteristics of patients are important factors for the standardization of a diagnostic test. Methods: The clinical reports of patients who underwent polysomnography in a sleep unit were reviewed. Statistical analyses were performed with the Statistical Package for the Social Sciences program (SPSS). Objectives: The aims of this study were to determine the clinical and physical characteristics, including hypertension (HTA), obesity, snoring intensity, daytime sleepiness (Epworth score) and neck circumference, in a population of OSAS patients and to calculate the sensitivity, specificity and positive predictive value (PPV) of these characteristics with respect to the diagnosis of OSAS. Results: The study included a total of 746 individuals, with females comprising 20.2% of the cohort and males 79.8%. The study cohort included 591 patients (79.2%) with OSAS (18.4% female, 81.6% male). The mean age at diagnosis was 53 years. Several of the measured characteristics showed statistically significant differences between the OSAS group and the non-OSAS group, including the presence of hypertension, obesity (as determined by a BMI > 30 kg/m2 ) and neck circumference. In the OSAS patient group, 55% had hypertension, 62.4% were obese and the average neck circumference was 43 cm. Both BMI and neck circumference had a positive correlation (R=0.35 and R=0.385, respectively) with the apnea-hypopnea index (AHI). In addition, the snoring intensity of the patients was rated on a four-point scale: 1 = slightly louder than heavy breathing, 2 = as loud as talking, 3 = louder than talking and 4 = extremely loud. Seventy-seven percent of the OSAS patients had a rating of four. Daytime sleepiness, as determined by the Epworth score, was not different between two groups (average score = 13 points) and had no correlation with the severity of OSAS. Conclusions: Clinical and physical characteristics are very important with respect to diagnosis. The association of these characteristics with OSAS resulted in a better clinical orientation and helped to validate the diagnostic test. Among these characteristics, daytime sleepiness had the lowest contribution to the accuracy of the diagnosis, as it showed less sensitivity, specificity and PPV. HTA, obesity and neck circumference were all important factors and contributed to the accuracy of the diagnosis.
037
SLEEP DURATION AND CARDIOVASCULAR CONSEQUENCE
T. Risso, F. Cintra, C. Rizzi, E. Mendonça, A. Paola, D. Poyares, S. Tufik. UNIFESP Introduction: Several studies have implicated that insufficient sleep may be a risk factor for cardiovascular disease. Short duration of sleep has been shown to be related to obesity, hypertension, and diabetes mellitus. However, some of these correlations have only been documented in studies where sleep was self-reported, which may be biased or insufficiently accurate. The aim of this study was to evaluate the clinical, polysomnographic and laboratory parameters in healthy individuals, based on sleep duration. Methods: Subjects were consecutively selected between March 2006 and March 2008. Blood was drawn from all subjects, follwed by a physical examination, 12-lead ECG, spirometry, polysomnography and actigraphy during seven consecutive days. Results: Seventy-one patients were divided into three groups using cluster analysis: short sleepers (n=14, total sleep time=5.25±0.15h); intermediate sleepers (n=26, total sleep time=6.67±0.05h); and long sleepers (n=31, total sleep time=7.64±0.07h). Prevalence of hypertension was significantly different between short, intermediate and long sleepers (p<0.01). Intermediate sleepers had larger cervical circumferences than long sleepers (34.39±0.83, 31.72±0.53; respectively, p=0.02). Glycemia was also significantly different between intermediate and long sleepers (106.08±3.19, 96.68±2.01; respectively, p=0.02). Conclusion: Short sleep duration is associated with increased cardiovascular risk in healthy individuals.
Abstracts of 3rd International Congress of the Association of Sleep Medicine (WASM) / Sleep Medicine 10, Suppl. 2 (2009) S1–S83
cerning sleep patterns, 48.1% reported morning tiredness, 66% had difficulty maintaining sleep, 37.2% frequently took a nap during the day, 36.9% had difficulty initiating sleep, and 32.9% required more than one hour to initiate sleep. When questioned about religion, 72.6% were Catholics, 13.3% were evangelical Protestants and 3.3% were spiritists; 37.3% reported that they went to religious services at least once a week, 53.8% carried out private religious activities daily and 84.7% stated they felt God’s presence in their lives. Logistic regression controlled for sex, family income, employment, education, marital status and race showed no relationship between extrinsic religiosity, intrinsic religiosity and spirituality with any sleep patterns (initiating sleep, maintaining sleep, sleep hours and morning tiredness). Female sex and low family income were associated with less desirable sleep patterns. Conclusion: In the present study, there appeared to be no association between sleep patterns and spirituality/religiosity. However, not all aspects of sleep and spirituality were assessed, so these results should be interpreted with caution. Further studies are needed to explore this issue in more detail.
034
ASSOCIATION OF SLEEPINESS AND ACCIDENTS IN A SAMPLE OF NIGHT WORKERS OF VALLE DE ABURRÁ, COLOMBIA
H.A. Marín. UNiversidad Cooperativa de Colombia The objective of this research was to determine the relationship between excessive daytime sleepiness and accidents in a sample of night workers. A cross-sectional study was carried out with a sample of 145 night workers randomly selected from a list of companies that are headquartered in the city of Medellin. We applied the Epworth sleepiness scale, the index of the Pittsburgh sleep quality, the scale of morning and evening, in addition to questions of sleep habits, sleep disorders and rate of work-related injuries. In general, workers were evaluated between July 2007 and August 2008, were, on average, 41.2 years of age, engaged in multiple offices, with a prevalence of 22.1% in drowsiness during work and activity of about 17.2 hours per day. The sample had a striking early bird profile (62%) and a low sleep efficiency (73%). Our study highlights an accident rate of 2.1% over the last 2 years for workers with drowsiness, with significant differences against those who are not sleepy. We also observed a prevalence of 8.2% for insomnia and 12.5% for snoring in workers with injuries, values that were significantly different to those who had had no accidents. In conclusion, we observed a high association between sleep disorders and bad habits, with injuries in this sample.
035
PREVALENCE OF SYMPTOMS AND RISK OF OBSTRUCTIVE SLEEP APNEA (OSA) SYNDROME IN GENERAL POPULATION: A CROSS-SECTIONAL STUDY
F. Najafi 1 , L. Rezaei 2 , M. Tahmasian 2 , A.A. Sepehry 3 , F.J.F. Herth 4 , H. Khazaie 2 . 1 Department of Biostatistics and Epidemiology, School of Population Health, Kermanshah University of Medical Science (KUMS), Iran; 2 Sleep Research Center, Department of Psychiatry, Kermanshah University of Medical Science (KUMS), Iran; 3 Department of Psychology, University of Victoria, Victoria, Canada; 4 Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany Background: Obstructive Sleep Apnea (OSA) syndrome is one of the most common sleep breathing disorders with significant consequences but there has no published study, which addresses the prevalence of the condition in Iran. Objective: The aim of the present study was to determine prevalence of symptoms and risk of OSA in Kermanshah general population. Methods: From 2007-2008 by random-cluster-sampling, 527 adult subjects were selected from the urban region of Kermanshah. The age range of the sample was from 20 to 87 years. Assessment was performed by Berlin questionnaire, a valid scale, dissecting “high risk” and “low risk” peoples for OSA symptoms. Common symptoms were later defined. Results: From the total of 527 subjects with a mean age of 48.6±16.6 years and BMI of 25.1±3.3, 144 (27.3%) were at high risk for OSA (men 19% and Women 8.3%) and 261 (49.5%) were suffering from snoring with a higher frequency among women (51.5%). From those snoring during sleep, 51 (19.5%) reported a breathing pause more than once per week. Subjects who were considered at high risk had a clinical history of diabetes and heart failure (15.3% and 16.7% respectively). Conclusions: Prevalence of symptoms, risk of OSA and associated factors in Kermanshah are noticeable. Considering the adverse effects of this condition
on quality of life, further research and efforts to allow early diagnosis and treatment are recommended.
036
CLINICAL AND PHYSICAL CHARACTERISTICS OF OBSTRUCTIVE SLEEP APNEA SYNDROME
C. Nogueira, I. Esteves, S. Ferreira. Centro Hospitalar de Vila Nova de Gaia/Espinho Polysomnography is the gold standard test to diagnose obstructive sleep apnea syndrome (OSAS), but it is time-consuming and expensive. The clinical and physical characteristics of patients are important factors for the standardization of a diagnostic test. Methods: The clinical reports of patients who underwent polysomnography in a sleep unit were reviewed. Statistical analyses were performed with the Statistical Package for the Social Sciences program (SPSS). Objectives: The aims of this study were to determine the clinical and physical characteristics, including hypertension (HTA), obesity, snoring intensity, daytime sleepiness (Epworth score) and neck circumference, in a population of OSAS patients and to calculate the sensitivity, specificity and positive predictive value (PPV) of these characteristics with respect to the diagnosis of OSAS. Results: The study included a total of 746 individuals, with females comprising 20.2% of the cohort and males 79.8%. The study cohort included 591 patients (79.2%) with OSAS (18.4% female, 81.6% male). The mean age at diagnosis was 53 years. Several of the measured characteristics showed statistically significant differences between the OSAS group and the non-OSAS group, including the presence of hypertension, obesity (as determined by a BMI > 30 kg/m2 ) and neck circumference. In the OSAS patient group, 55% had hypertension, 62.4% were obese and the average neck circumference was 43 cm. Both BMI and neck circumference had a positive correlation (R=0.35 and R=0.385, respectively) with the apnea-hypopnea index (AHI). In addition, the snoring intensity of the patients was rated on a four-point scale: 1 = slightly louder than heavy breathing, 2 = as loud as talking, 3 = louder than talking and 4 = extremely loud. Seventy-seven percent of the OSAS patients had a rating of four. Daytime sleepiness, as determined by the Epworth score, was not different between two groups (average score = 13 points) and had no correlation with the severity of OSAS. Conclusions: Clinical and physical characteristics are very important with respect to diagnosis. The association of these characteristics with OSAS resulted in a better clinical orientation and helped to validate the diagnostic test. Among these characteristics, daytime sleepiness had the lowest contribution to the accuracy of the diagnosis, as it showed less sensitivity, specificity and PPV. HTA, obesity and neck circumference were all important factors and contributed to the accuracy of the diagnosis.
037
SLEEP DURATION AND CARDIOVASCULAR CONSEQUENCE
T. Risso, F. Cintra, C. Rizzi, E. Mendonça, A. Paola, D. Poyares, S. Tufik. UNIFESP Introduction: Several studies have implicated that insufficient sleep may be a risk factor for cardiovascular disease. Short duration of sleep has been shown to be related to obesity, hypertension, and diabetes mellitus. However, some of these correlations have only been documented in studies where sleep was self-reported, which may be biased or insufficiently accurate. The aim of this study was to evaluate the clinical, polysomnographic and laboratory parameters in healthy individuals, based on sleep duration. Methods: Subjects were consecutively selected between March 2006 and March 2008. Blood was drawn from all subjects, follwed by a physical examination, 12-lead ECG, spirometry, polysomnography and actigraphy during seven consecutive days. Results: Seventy-one patients were divided into three groups using cluster analysis: short sleepers (n=14, total sleep time=5.25±0.15h); intermediate sleepers (n=26, total sleep time=6.67±0.05h); and long sleepers (n=31, total sleep time=7.64±0.07h). Prevalence of hypertension was significantly different between short, intermediate and long sleepers (p<0.01). Intermediate sleepers had larger cervical circumferences than long sleepers (34.39±0.83, 31.72±0.53; respectively, p=0.02). Glycemia was also significantly different between intermediate and long sleepers (106.08±3.19, 96.68±2.01; respectively, p=0.02). Conclusion: Short sleep duration is associated with increased cardiovascular risk in healthy individuals.