BACKGROUND: The links between obstructive sleep apnoea and hypertension are well established; obstructive sleep apnoea is reported in up to 30% of patients with hypertension, although it is frequently underdiagnosed. Physicians can assess the degree of sleepiness by administering the Epworth Sleepiness Scale, but the large number of patients with hypertension makes this strategy difficult for busy physicians to implement. Obese patients form a subgroup at higher risk for obstructive sleep apnoea, which can be targeted for screening. AIM: The study carried out a preliminary exploration of the effectiveness of screening patients with hypertension and obesity for obstructive sleep apnoea in general practice using the Epworth Sleepiness Scale. SETTING: One group practice in Italy. DESIGN OF STUDY: 'Good clinical practice' was systematically applied: identification of patients with hypertension and obesity; qualitative interview to identify obstructive sleep apnea; and consequent work-up and therapy. METHOD: Three family physicians, caring for 769 pharmacologically-treated patients with hypertension, identified 220 obese patients without relevant pulmonary or neurological diseases or insomnia; 31 of these 220 patients scored >11 on the Epworth Sleepiness Scale. RESULTS: Polysomnography confirmed obstructive sleep apnoea in 10% of the obese, hypertensive population (95% confidence interval [CI] = 7.03% to 13.63%), and in 3.9% of the whole hypertensive population (95% CI = 2.74% to 5.51%). At baseline, 24-hour blood pressure monitoring showed uncontrolled blood pressure in all these patients. Under continuous positive airway pressure (CPAP), the blood pressure value normalised (P<0.05), and the mean Epworth Sleepiness Scale score decreased significantly: mean 13.68 versus 7.84 (P<0.001). CONCLUSION: In obese patients with hypertension examined in this study, the prevalence of obstructive sleep apnoea prevalence is about 10%. CPAP significantly ameliorates the blood pressure control. This simple screening and treatment strategy may be easily adopted in primary care.
BACKGROUND: The links between obstructive sleep apnoea and hypertension are well established; obstructive sleep apnoea is reported in up to 30% of patients with hypertension, although it is frequently underdiagnosed. Physicians can assess the degree of sleepiness by administering the Epworth Sleepiness Scale, but the large number of patients with hypertension makes this strategy difficult for busy physicians to implement. Obesepatients form a subgroup at higher risk for obstructive sleep apnoea, which can be targeted for screening. AIM: The study carried out a preliminary exploration of the effectiveness of screening patients with hypertension and obesity for obstructive sleep apnoea in general practice using the Epworth Sleepiness Scale. SETTING: One group practice in Italy. DESIGN OF STUDY: 'Good clinical practice' was systematically applied: identification of patients with hypertension and obesity; qualitative interview to identify obstructive sleep apnea; and consequent work-up and therapy. METHOD: Three family physicians, caring for 769 pharmacologically-treated patients with hypertension, identified 220 obesepatients without relevant pulmonary or neurological diseases or insomnia; 31 of these 220 patients scored >11 on the Epworth Sleepiness Scale. RESULTS: Polysomnography confirmed obstructive sleep apnoea in 10% of the obese, hypertensive population (95% confidence interval [CI] = 7.03% to 13.63%), and in 3.9% of the whole hypertensive population (95% CI = 2.74% to 5.51%). At baseline, 24-hour blood pressure monitoring showed uncontrolled blood pressure in all these patients. Under continuous positive airway pressure (CPAP), the blood pressure value normalised (P<0.05), and the mean Epworth Sleepiness Scale score decreased significantly: mean 13.68 versus 7.84 (P<0.001). CONCLUSION: In obesepatients with hypertension examined in this study, the prevalence of obstructive sleep apnoea prevalence is about 10%. CPAP significantly ameliorates the blood pressure control. This simple screening and treatment strategy may be easily adopted in primary care.
Authors: Giuseppe Mancia; Guy De Backer; Anna Dominiczak; Renata Cifkova; Robert Fagard; Giuseppe Germano; Guido Grassi; Anthony M Heagerty; Sverre E Kjeldsen; Stephane Laurent; Krzysztof Narkiewicz; Luis Ruilope; Andrzej Rynkiewicz; Roland E Schmieder; Harry A J Struijker Boudier; Alberto Zanchetti; Alec Vahanian; John Camm; Raffaele De Caterina; Veronica Dean; Kenneth Dickstein; Gerasimos Filippatos; Christian Funck-Brentano; Irene Hellemans; Steen Dalby Kristensen; Keith McGregor; Udo Sechtem; Sigmund Silber; Michal Tendera; Petr Widimsky; José Luis Zamorano; Serap Erdine; Wolfgang Kiowski; Enrico Agabiti-Rosei; Ettore Ambrosioni; Lars H Lindholm; Margus Viigimaa; Stamatis Adamopoulos; Enrico Agabiti-Rosei; Ettore Ambrosioni; Vicente Bertomeu; Denis Clement; Serap Erdine; Csaba Farsang; Dan Gaita; Gregory Lip; Jean-Michel Mallion; Athanasios J Manolis; Peter M Nilsson; Eoin O'Brien; Piotr Ponikowski; Josep Redon; Frank Ruschitzka; Juan Tamargo; Pieter van Zwieten; Bernard Waeber; Bryan Williams Journal: J Hypertens Date: 2007-06 Impact factor: 4.844
Authors: A Kales; E O Bixler; R J Cadieux; D W Schneck; L C Shaw; T W Locke; A Vela-Bueno; C R Soldatos Journal: Lancet Date: 1984-11-03 Impact factor: 79.321
Authors: Bum-Yong Kang; Kathy Park; Jennifer M Kleinhenz; Tamara C Murphy; Roy L Sutliff; David Archer; C Michael Hart Journal: Am J Respir Cell Mol Biol Date: 2017-01 Impact factor: 6.914