Clinical and polysomnographic predictors of severe obstructive sleep apnea in the South Indian population.
BACKGROUND
With the emergence of lifestyle diseases in epidemic proportions, obstructive sleep apnea (OSA) is being increasingly recognized in less developed countries as well.


OBJECTIVE
We sought to study the demographic, clinical, and polysomnographic (PSG) predictors of OSA severity in a cohort of South Indian patients.


METHODS
Consecutive patients with PSG proven OSA [apnea hypopnea index (AHI) ≥5/h] were prospectively recruited. The study period was from January 2012 to December 2012. Demographic data, history of vascular risk factors, substance abuse, sleep quality, snoring, and witnessed apneas were collected using a structured pro forma. In addition, PSG variables such as AHI, sleep latency and efficiency, duration of slow wave and rapid eye movement (REM) sleep, and other parameters were collected. Correlations between AHI severity and clinical and PSG parameters were done.


RESULTS
There were 152 (119 males and 33 females) subjects with a mean age of 53.8 years and body mass index (BMI) of 29.31. Mean AHI was 36.2/h (range: 5.1-110) and 66 subjects had severe OSA. Around 12% had the presenting complaint as insomnia, mainly of sleep maintenance. Of the subjects, 35% had witnessed apneas and 67% had excessive daytime sleepiness (EDS); 40% of patients had ≥2 risk factors. PSG parameters showed short sleep onset latency with a high arousal index. Mean apnea duration was 24.92 s. We found that age >55 years, BMI >25 kg/m(2), witnessed apneas, EDS, hypertension, dyslipidemia, reduced slow wave sleep duration, mean apnea duration >20 s, and desaturation index >10/h correlated well with OSA severity while the arousal index, sleep latency and efficiency, and exposure to smoking and alcohol showed no association.


CONCLUSIONS
Older subjects with witnessed apneas are likely to have more severe OSA. Even though overall sleep architecture was similar between the groups, severe OSA had shorter slow wave sleep, longer apneas, and higher nocturnal hypoxemia.
Department of Neurology, Comprehensive Sleep Disorders Center, Trivandrum, Kerala, India.
Sapna Erat
SE
Sreedharan
Department of Neurology, Comprehensive Sleep Disorders Center, Trivandrum, Kerala, India.
Pragati
P
Agrawal
Department of Neurology, Comprehensive Sleep Disorders Center, Trivandrum, Kerala, India.
Ramachandrapillai S
RS
Rajith
Department of Neurology, Comprehensive Sleep Disorders Center, Trivandrum, Kerala, India.
Shana
S
Nair
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Sankara P
SP
Sarma
Department of Neurology, Comprehensive Sleep Disorders Center, Trivandrum, Kerala, India.
Ashalatha
A
Radhakrishnan
Body mass index (BMI); obstructive sleep apnea (OSA); risk factors