Study of Prevalence of OSA in VIET NAM EPSASIE STUDY

Transcription

1 Study of Prevalence of OSA in VIET NAM EPSASIE STUDY S. Duong-Quy*, K. Dang Thi Mai, N. Tran-Van, H. Nguyen Xuan Bich, T. Hua-Huy, F. Chalumeau, A.T. Dinh-Xuan, F. Soyez, F. Martin Sy DUONG-QUY, MD, PhD, FCCP Vice-Chair of Viet Nam Respiratory Society - VNRS Ambassador of European Respiratory Society in Viet Nam Director of Lam Dong Medical College - Viet Nam

2 INTRODUCTION Snoring has been considered long time ago as : o A trivial "family or social" nuisance o Evidence of a "good sleep" in Vietnam Snoring is recognized today as : o One of the cardinal symptoms of obstructive sleep apnea syndrome (OSA) Suspicion of OSA : o Snoring o Pauses in breathing during sleep o Excessive daytime sleepiness o Nocturia

3 INTRODUCTION OSA is a serious pathology : o Major cardiovascular risk factor o Crucial cause of metabolism syndrome o Important impacts on daytime tiredness and sleepiness o Impair quality of life, intellectual and professional performance o Responsible for accidents at working place and in traffic

4 INTRODUCTION Problematic for emerging countries : o Estimated prevalence of OSA in general population o High cost of polysomnography or even ventilatory polygraphy in sreening o Low performance of the single channel such as RU sleeping o EPSASIE : Study of Prevalence of Obstructive Sleep Apnea in VIET NAM

5 OBJECTIVE To assess : 1) The prevalence of OSA and its main symptoms in Viet Nam 2) The feasibility of OSA screening by using RU Sleeping 3) The possible differences between the original and the modified Epworth score for Vietnamese people

6 SUBJECTS AND METHOD Subjects : o Adults more than 25 years o Members of hospital staff or their families o Members of families of out-patients Excluded : o People with professional obligations requiring them to work at night o Pregnant women o Severe chronic diseases

7 SUBJECTS AND METHOD Method : o A prospective, multicenter, and descriptive study o Participants completed a self-anonymized questionnaire about the main symptoms of OSA and sleep habits o Usual snoring (> 3 nights/week) were estimated with self confirmation by family members if possible o Tiredness was assessed by Pichot and VAS-1 scores o Sleep quality was determined by VAS-2 score o Daytime sleepiness was assessed by two scales of Epworth: original and "modified" and by VAS-3 score o Depression was assessed by Pichot and HAD scores

8 SUBJECTS AND METHOD Screening by RU Sleeping: was systematically offered for : - usual snorers (> 3 nights/week) - nocturia, Epworth > 10, VAS-1/3> 3, Pichot tiredness > 24 - nocturnal suffocation or impaired sleep quality Nocturnal polygraphy or polysomnography : was systematically practiced for : - REI (respiratory event index)> 10/hour during sleep - REI > 25 over one hour - conducted in hospital or at home overnight - PG/PSG : polygraph Cidelec or polysomnograph Alice

9 RESULTS: Clinical characteristics of study population Group of age (years) Variables (n = 88) (n = 207) (n = 161) (n = 151) > 60 (n = 60) Male/Female ratio 1/ /1 1.6/1 1.3/1 1.5/1 Active smokers (%) 8.0 (9±7PY) 13.1 (9±6 PY) 14.9 (14±10 PY) 19.2 (15±5 PY) 18.3 (19±7 PY) Former-smokers (%) Anthropometric parameters Height 161.0± ± ± ± ±7.0 Weight 58.0± ± ± ± ±8.5 BMI 21.6± ± ± ± ±4.8 Neck circumference 34.5± ± ± ± ±3.6 Abdominal circumference 74.3± ± ± ± ±12.0

10 RESULTS: Clinical characteristics of study population Group of age (years) > 60 Variables (n = 88) (n = 207) (n = 161) (n = 151) (n = 60) Snoring, % < 3 times/week, % > 3 times/week, % Family impact, % Sleep time/24 hours, h 7.3± ± ± ± ±1.7 Taking a nap, % Duration/day, min 62±31 56±37 54±36 48±30 59±28 Sleeping time, h 22±1 22± ±2 22.3±1 22.2±0.8 Wak-up time, h 5.3±1 5.3± ± ± ±1.5 Efficacy sleep time, % Need of ad. sleep time, h 1.8± ± ± ± ±1.0

11 RESULTS: Clinical characteristics of study population Group of age (years) Variables (n = 88) (n = 207) (n = 161) (n = 151) > 60 (n = 60) Insomnia (+), % Insomnia (-/±), % Good quality of sleep Yes, % Nocturia 2 times/night, % Nocturnal nuisance, % Pichot tiredness 10.0± ± ± ± ±7.4 Pichot depression 2.5± ± ± ± ±2.0 Standard Epworth 6.4± ± ± ± ±3.6 Modified Epworth 6.0± ± ± ± ±3.2 VAS-1 2.9± ± ± ± ±1.4 VAS-2 3.7± ± ± ± ±2.2 VAS-3 3.5± ± ± ± ±2.0 HAD - A 6.0± ± ± ± ±3.6 HAD - D 4.8± ± ± ± ±3.1

12 RESULTS: Clinical characteristics of study population Group of age (years) Variables (n = 88) (n = 207) (n = 161) (n = 151) > 60 (n = 60) Pattern of RU Sleeping realization Snoring, % Nocturia, % Epworth > 10, % VAS > 3, % Pichot > 24, % Nocturnal suffocation, %

13 RESULTS: Differences of clinical characteristics NORMAL RU SLEEPING PSG (n=446) (n=221) (n=93) P<0.001 P<0.01 P< P<0.01 P<0.001 P< Age BMI NECK CIR. ABDO.CIR. SNORING IMPACT AGE BMI NECK ABDOMINAL SNORING IMPACT CIRCUMFERENCE OF SNORING

14 RESULTS: Differences of clinical characteristics 16 NORMAL RU SLEEPING PSG (n=446) (n=221) (n=93) 12 P< P>0.05 P>0.05 P<0.001 P< P>0.05 P< Pi.fat Pic. Dép. Epworth Epw.mod HAD A HAD B EVA1 EVA2 EVA3 PICHOT PICHOT EPWORTH EPWORTH HAD A HAD B VAS-1 VAS-2 VAS-3 TIREDNESS DEPRESSION MODIFIED

15 RESULTS: Characteristics of subjects with PSG (n=93) AHI<5 5<AHI<15 15<AHI<30 AHI>30 (n=36) (n=22) (n=19) (n=16) P<0.001 p< P<0.001 p<0.01 p< Age IMC Pi.fat Pichot. Dépres. Epworth Epw.modifié IER IAH Sat<90% AGE BMI PICHOT PICHOT EPWORTH EPWORTH REI AHI SPO2<90% TIREDNESS DEPRESSION MODIFIED (BMI: body mass index; REI: respiratory event index; AHI: apnea-hyponea index)

16 RESULTS: Prevalence of OSA in study population 250 n NORMAL SUBJECTS (n=610) 8.2% 14 SUBJECTS WITH OSA (n=57) Overal prevalence : 8.5% 8.7% 9.3% % % AGE >60

17 RESULTS: Correlation between RU Sleeping and PSG REI (respiratory event index) >10 R = p < AHI (apnea-hyponea index) 5

18 RESULTS: Diagnostic value of RU Sleeping with REI

19 RESULTS: Diagnostic value of RU Sleeping with REI REI cut-off* ,15 17, ,8 Sensitivity, % Specificity. % (REI: respiratory event index)

20 DISCUSSION o The return of questionnaires is good (88.9%) o People who refused to practice RU Sleeping or PSG (19 in total) were excluded from the analysis o The questionnaires are not considered good diagnostic tools for screening of OSA because of poor specificity o Stop-bang questionnaire can be considered as satisfactory Chung F et al. J Clin Sleep Med Chung F. et al. Anesthesiology. 2015

21 DISCUSSION o To improve the specificity of the questionnaire and for feasibility questions, we used a single channel recorder : RU Sleeping o RU Sleeping : the sensitivity was 92%, but the specificity was insufficient 77 % Grover SS, et al. Sleep Breath 2008 o REI > 15/hour during sleep or > 30/h over one hour : a sensitivity of 70% Watkins MR, et al. J Occup Environ Med We intentionally lowered the positivity thresholds to 10 and 25 respectively, for OSA Screening before realizing PG/PSG

22 DISCUSSION o AHI > 5/h : 7.6% - 8.5% of study subjects having OSA and clinical manifestation o OSA severity : - mild : 3.2% - moderate : 2.8% - severe : 2.3% o We can consider that 5.2% of the population has a significant OSA (IAH > 15) o Previous studies : % of the population has an OSA to benefit from a specific treatment Neven AK et al. Thorax 1998

23 CONCLUSION o Our study confirms a high prevalence of OSA in Viet Nam o VAS (visual analogical scale) tiredness and sleepiness, Epworth score, the HAD scale (depression) are relevant and useful for assessing the severity of OSA in vietnamese population o Complaints of sleepiness and tiredness, quality and quantity of sleep are important in the vietnamese general population o Awareness of OSA for medical profession and health authorities in Viet Nam

24 THANK YOU FOR YOUR ATTENTION!