Obstructive sleep apnoea in patients with obesity and hypertension.
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.


OBJECTIVE
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.


METHODS
One group practice in Italy.


METHODS
'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.


METHODS
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).


CONCLUSIONS
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.
Di Guardo
Antonino
A
Italian College of General Practitioners, Via del Pignoncino 9/11, Florence, Italy.
Profeta
Gaetano
G
Crisafulli
Cristiano
C
Sidoti
Giuseppe
G
Zammataro
Marcello
M
Paolini
Italo
I
Filippi
Alessandro
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000628:therapy; D055815:Young Adult