Potential underdiagnosis of obstructive sleep apnoea in the cardiology outpatient setting
Potential underdiagnosis of obstructive sleep apnoea in the cardiology outpatient setting
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DOI：
10.1136/heartjnl-2014-307276
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发表时间：
2015-08-01
期刊：
影响因子：
5.7
通讯作者：
Drager, Luciano F.
中科院分区：
文献类型：
--
作者：
Costa, Lucas E.;Uchoa, Carlos Henrique G.;Drager, Luciano F.
一致的证据表明，阻塞性睡眠呼吸暂停（OSA）与心血管风险增加有关。然而，目前尚不清楚OSA是否在心脏病门诊中诊断不足。在本研究中，我们前瞻性地评估了潜在的诊断不足的阻塞性睡眠呼吸暂停在几个亚专科从三级心脏病大学hospital.Methods从五个亚专科（高血压，冠状动脉，心律失常，心力衰竭（HF），心脏瓣膜病）进行了研究。我们进行了人体测量，使用柏林问卷评估了OSA的风险，并评估了OSA的既往诊断和治疗。在随机选择的患者的子集，我们进行便携式睡眠监测，客观地评估存在的OSA（定义为呼吸暂停-呼吸不足指数= 15事件/小时的睡眠）。平均年龄和体重指数（BMI）分别为59 +/- 13岁和28.2 +/- 5.3 kg/m2。我们发现51.6%（258例患者）有OSA的高风险（柏林问卷）。然而，这些患者中只有13例（3.1%）先前诊断为OSA。其中，只有6名患者接受了特定的OSA治疗。50名患者（每个专业10名）参加了睡眠研究。在接受睡眠监测的患者和没有接受睡眠监测的患者中没有发现差异。我们发现阻塞性睡眠呼吸暂停综合症的发生率很高（66%），从50%（高血压组）到80%（心力衰竭组）不等。结论尽管有大量科学证据表明阻塞性睡眠呼吸暂停综合症是一种新的心血管危险因素，但阻塞性睡眠呼吸暂停综合症在几个心脏病学亚专业中仍然诊断不足。
Introduction Consistent evidence suggests that obstructive sleep apnoea (OSA) is associated with increased cardiovascular risk. However, it is unclear whether OSA is underdiagnosed in the cardiology outpatient setting. In the present study, we prospectively evaluated the potential underdiagnosis of OSA in several subspecialties from a tertiary cardiology university hospital.Methods Consecutive outpatients from five subspecialties (hypertension, coronary, arrhythmia, heart failure (HF), valvular heart disease) were studied. We performed anthropometric measurements, assessed the risk of OSA using the Berlin Questionnaire and evaluated the prior diagnosis and treatment for OSA. In a subset of patients randomly selected, we performed portable sleep monitoring to objectively evaluate the presence of OSA (defined by an apnoea-hypopnoea index = 15 events/h of sleep).Results We evaluated 500 patients (100 from each subspecialty). The mean age and body mass index (BMI) were 59 +/- 13 years and 28.2 +/- 5.3 kg/m(2), respectively. We found that 51.6% (258 patients) had a high risk for OSA (Berlin Questionnaire). However, only 13 (3.1%) of these patients had a previous diagnosis of OSA. Of those, only six patients were receiving specific OSA treatment. Fifty patients (10 from each specialty) participated in sleep studies. No differences were found in patients who underwent sleep monitoring and those who did not. We found a high frequency of OSA (66%), varying from 50% (hypertension group) to 80% (HF group).Conclusions Despite significant scientific evidence pointing to OSA as an emerging cardiovascular risk factor, OSA is still underdiagnosed in several cardiology subspecialties.