Epidemiology and diagnosis of sleep apnea
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1 Epidemiology and diagnosis of sleep apnea Dr Raphael Heinzer, MD MPH Center for Investigation and research in Sleep Lausanne University Hospital (CHUV) Switzerland Joint annual meeting SSC/SSCS-SSP 2016
2 Wisconsin Sleep Cohort Study Apnea hypopnea index > 5/h Men 27% Women 9% Sleep apnea syndrome Men 4% (AHI>5/h + Sleepiness) Women 2% Young NEJM 1993
3 Lancet Respiratory Medicine subjects aged 40 to 85 yrs have a full polysomnography at home - EEG/EOG/EMG (sleep structure) - Nasal pressure, chest and abdominal movements and SaO2 - Legs EMG - ECG (1 channel)
4
5 HypnoLaus Cohort study Parameters Value n 2162 Age (y) 58.5 ± 11.0 Gender 50.4 % females Body mass index (kg/m 2 ) 26.2 ± 4.4 Epworth score (Mean± SD) 6.2 ± 3.9 Neck circumference (Mean± SD) 36.9 ± 3.9
6 Prevalence of sleep disorderd breathing in the general population HypnoLaus Cohort (N = 2121) aged years old % Men Women 0 >5/h >15/h >30/h Heinzer et al Lancet resp med 2015
7 Prevalence of sleep apnea syndrome (sleep disordered breathing + Epworth >10) HypnoLaus Cohort (N = 2121) % Males Females AHI > 5/h AHI > 15/h AHI > 30 /h Heinzer et al Lancet resp med 2015
8 Wisconsin-HypnoLaus differences Wisconsin 1993 HypnoLaus 2015 Subjects nb Selection State employees 80% snorers Age Range Setting Sleep laboratory Home Hypopnea Discernible reduction in airflow + 4% O 2 desaturation Sleepiness 3 questions Epworth Airflow signal Thermocouple and end-tidal CO 2 General population AASM 2013 (Chicago, AASM 07 rec) Nasal pressure
9 Nasal pressure vs. thermistor Nasal pressure Thermistor
10 JACC ,876 patients with stable chronic heart failure (LVEF < 45%) - Prevalence of Sleep disordered breathing (AHI >15/h) -36% in women (n: 1,448) -49% in men (n: 5,428) NB: No assessment of central vs obstructive sleep apnea
11 Sleep disordered breathing in stable heart failure Arzt et al JACC 2016
12 SDB according to LV ejection fraction Arzt et al JACC 2016
13 Diagnostic of sleep disordered breathing Oximetry/Apnealink Respiratory polygraphy Polysomnography
14 Obstructive apnea Obstructive apnea Nasal pressure Abdomen Thorax X-flow Saturation O2
15 Central apnea
16 Cheyne Stokes
17 Oximetry 100 sec
18 Polygraphy Nasal pressure (Airflow) SaO2 Thorax + abdomen 100 sec
19 Polysomnography Nasal pressure (airflow) SaO2 Thorax + abdomen 100 sec
20 Screening scores for SDB?
21 Berlin questionnaire Category 1: Snoring Category 2: Fatigue Category 3: BMI and HT High risk of OSA If 2 of the 3 categories are positive
22 STOP-BANG S = Snoring T = Tired O = Observed apnea P = Pressure (high blood pressure) B = BMI > 25 kg/m2 A = Age > 50 ans N = Neck circumference > 40 cm G = Gender (men) A score 3 is considered positive (High risk for OSA)
23 STOP BANG score in a clinical population El Sayed EJCDT
24 NoSAS score Lancet Resp Med, June 17th 2016 Neck circumference > 40 cm Obesity 4 points BMI 25 kg/m 2 and < 3 points 30 kg/m 2 BMI 30 kg/m 2 Snoring (self-reported) Age > 55 years Sex Male NoSAS 8 5 points 2 points 4 points 2 points High probability of SDB 24
25 Lancet Resp Med, June 17th 2016 Estimated prevalence AUC Sensitivity Specificity PPV NPV HypnoLaus (40 80 y.o.) NoSAS STOP-Bang Berlin EPISONO (20-80 y.o) NoSAS STOP-Bang Berlin
26 Lancet Resp Med, June 17th 2016 Estimated prevalence AUC Sensitivity Specificity PPV NPV HypnoLaus (40 80 y.o.) NoSAS STOP-Bang Berlin EPISONO (20-80 y.o) NoSAS STOP-Bang Berlin
27 Area under the curve Performance of the scores according to different AHI thresholds NoSAS STOP-Bang Berlin AHI > 5 AHI > 10 AHI > 15 AHI > 20 AHI > 25 AHI > 30 Lancet Resp Med,
28 Free «NoSAS» application available for iphones and Android smartphones 28
29 Conclusion - Sleep disordered breathing is highly prevalent in the middle to older age general population - SDB is frequent in stable heart failure patients (LVEF <45%) - Polygraphy (with respiratory effort channels) is the minimum standard to diagnose SDB - Screening scores/oximetry can help deciding which patients should be sent for PG/PSG
30 HypnoLaus Team José Haba-Rubio Mehdi Tafti Sopharat Vat Nadia Tobback Daniela Andries Helena Marti-Soler Supported by: Leenaards foundation, Fond national suisse, GSK, Ligue pulmonaire vaudoise
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