Clinical Predictor of OSAHS in Adult Bangladeshi Population

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Clinical Predictors of OSAHS in Bangladeshi Adult Population Prof. AKM Mosharraf Hossain FCPS PhD Chairman, Dept of Respiratory Medicine Bangabandhu Sheikh Mujib Medical Universiry

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Population: 152.6 million (UN, 2005) Area: 143,998 sq km Life expectancy: 62 years (men), 63 years (women) (UN) GNI per capita: US $470 (World Bank, 2006)

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Background ۩ Obstructive sleep apnea hypoapnea syndrome (OSAHS) is a common sleep disorder causing daytime dysfunction and cardiovascular diseases. ۩ PSG is the gold standard inevestigation to diagnose OSAHS. But it is expensive, time-consuming and inconvenient. ۩ This study will reveal clinical and anthropometric predictors of OSAHS in Bangladeshi adult population.

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Snoring and Risk of Sleep Disordered Breathing-A pilot study in Bangladesh-Chest congress 2004 A.K.M.M. Hossain, M.A. Hasnat, M.A.J. Chowdhury, S.A. Haq, and M. Hasan The Berlin questionnaire and Epworth sleepiness scale (ESS) were used to identify patients of snoring and SDB. Subjects [N: 96; sex ( male/female): 66/30]; age [( yrs, m ± SD):33 ± 8] were selected from Chest clinic and Medicine OPD of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Snoring, daytime sleepiness, waketime tiredness are not less frequently seen in Bangladeshi population. Snoring and day time sleepiness was observed in 35% and 46% respectively.

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Methodology ۩ Type of study: Cross-sectional,prospective ۩ Sampling: All patients attending JBFH sleep clinic from 1 st Jan ’06 to 30 th June,’06 were included in that study. Structured sleep interview, anthropometric measurement were taken. Patients were advised to undergo overnight Laboratory PSG. ۩ 63 patients were finally included. They were divided in 2 groups OSAHS and non-OSAHS.

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Methodology-contd ۩ Comorbidities like HTN, DM and symptoms like snoring, apneas, EDS, fatigue, awakenings, leg movements, nocturia and ESS, lowest SpO2 were compared between OSAHS and others by Chi-square and Student’s t test. ۩ OSAHS was defined as AHI≥ 5 with EDS. ۩ All analysis were done with SPSS version 12.

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Results ۩ Out of 63 subjects (age:M ±SD, 47 ±11.55 in yrs; sex: m/f,46/17) OSAHS was diagnosed in 30 (47.6%) patients, 33 had primary snoring or normal.

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Results-contd Variables OSAHS(n=30) Others(n=33) P HTN 15 20 NS DM 12 6 .065 BMI(kg/m 2 ) 34.64±6.62 28.86±7.56 <.01 Neck circum 42.30±4.06 40.35±4.30 .07 Snoring 28 25 NS EDS 30 7 <.001 Apneas 24 19 .078

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Results-contd Variables OSAHS(n=30) Others(n=33) P Awakening 19 9 <.05 Unrefresh sleep 15 10 .166 Leg movements 10 12 NS Dry throat 24 6 <.001 Fatigue 20 15 NS Nocturia 3 4 NS ESS(M±SD) 13.70±3.77 9.15±4.90 <.001 Lowest SpO 2 68.75±13.05 85.00±8.07 <.001

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Variables P value Snoring .284 Witness apnea .810 EDS <.001 Freq awakenings .669 Unrefreshed sleep .576 Leg movements <.05 Dry throat .873 Fatigue .704 Nocturia .489 Regrssion analysis for OSAHS

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Relation of OSAHS & BMI OSAHS & BMI (P<.01)

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P=.07 P=.07

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Conclusion ۩ In a referral Sleep disorder centre of Bangladesh, we observed OSAHS in 47%. ۩ OSAHS has significant relation with BMI, EDS, frequent awakening, dry throat & ESS ۩ EDS and leg movements were found to be independent predictor of OSAHS. ۩ Further study with large sample size may reveal the problem in our population

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Thanks ………

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