Prevalence and Risk Factors of Obstructive Sleep Apnea Among Hypertensive Sudanese Patients Attending Selected Hospital in Khartoum State, Sudan Between February - April 2022


Authors : Hadeel Fathelrahman Ahmed Ali

Volume/Issue : Volume 8 - 2023, Issue 3 - March

Google Scholar : http://tinyurl.com/mpzmu3sh

Scribd : https://bit.ly/441ibuq

DOI : https://doi.org/10.5281/zenodo.10776673

Abstract :  Introduction Obstructive sleep apnea (OSA) is highly relevant to patients with hypertension (HTN). These 2 conditions frequently coexist (an estimated 50% of patients with HTN have concomitant OSA), and recent evidence supports the notion that OSA represents the most prevalent secondary contributor to elevated blood pressure (BP) in patients with resistant HTN.[3] OSA although common and associated with significant cardiovascular morbidity and mortality it still remains widely underdiagnosed, especially in developing countries like Sudan , this is mainly due to the high cost of the gold standard test which is polysomnography and lack of professional sleep study centres. Screening for OSA is essential in order to provide early management and prevent complications, especially with the lack of professional sleep study centres in Sudan.  Objectives To assess the risk of OSA among hypertensive patients using the berlin questionnaire, to determine the risk factors for OSA among Sudanese hypertensive patients and to know the most prevalent risk factor.  Methodology This was a descriptive cross-sectional facility-based study that took place in the out-patient department of Yastabsheroon and Police hospital, in Khartoum city, Sudan . 230 adult hypertensive patients were interviewed using a questionnaire for symptoms and risk factors of obstructive sleep apnea.  Results 230 participants were included in the study. 51.3 % were males and 48.7 were females. Gender was not associated with the risk of OSA in our study. As age increases the risk of obstructive sleep apnea increases with a significant P-value of 0.039. The highest risk was seen among participants aged 60 and above. Body mass index was associated with the risk of OSA among participants with a significant a P-value of 0.019. Neck circumference was not associated with the risk of OSA with a p- value of 0.259. 87.8% of participants were at high risk of OSA ,96.5% were adherent to their medication, and 71.7 % claimed to have a well-controlled blood pressure. 50.9% experienced the symptoms of OSA before being diagnosed with hypertension while 40.1% suffered from OSA symptoms after being diagnosed with hypertension.  Conclusion Risk of OSA was high among Sudanese hypertensive patients. Age, BMI, heart diseases, stroke and chronic lung diseases were associated with increased risk of OSA among hypertensive Sudanese patients, while gender, neck circumference, smoking, diabetes, chronic nasal congestion or allergies, and thyroid disease were not associated with increased risk of OSA among hypertensive Sudanese patients. Heart disease was the most relevant factor associated with high risk of OSA.  Recommendations There is a need to establish sleep study centres and sleep laboratories in Sudan, and to encourage specialization in this field. Until this is achieved doctors should screen suspected patients especially those with hypertension using berlin questionnaire and a trial of C-PAP may be acceptable for high-risk patients. Raising the awareness of sleep apnea among community as well as doctors and the importance of early diagnosis and treatment of obstructive sleep apnea to avoid serious complications. To encourage future researches to study the type of association between hypertensive and OSA among Sudanese.

Keywords : Obstructive Sleep Apnea, Sleep Apnea, Sleep, Apnea, Sudanese, Hypertensive.

 Introduction Obstructive sleep apnea (OSA) is highly relevant to patients with hypertension (HTN). These 2 conditions frequently coexist (an estimated 50% of patients with HTN have concomitant OSA), and recent evidence supports the notion that OSA represents the most prevalent secondary contributor to elevated blood pressure (BP) in patients with resistant HTN.[3] OSA although common and associated with significant cardiovascular morbidity and mortality it still remains widely underdiagnosed, especially in developing countries like Sudan , this is mainly due to the high cost of the gold standard test which is polysomnography and lack of professional sleep study centres. Screening for OSA is essential in order to provide early management and prevent complications, especially with the lack of professional sleep study centres in Sudan.  Objectives To assess the risk of OSA among hypertensive patients using the berlin questionnaire, to determine the risk factors for OSA among Sudanese hypertensive patients and to know the most prevalent risk factor.  Methodology This was a descriptive cross-sectional facility-based study that took place in the out-patient department of Yastabsheroon and Police hospital, in Khartoum city, Sudan . 230 adult hypertensive patients were interviewed using a questionnaire for symptoms and risk factors of obstructive sleep apnea.  Results 230 participants were included in the study. 51.3 % were males and 48.7 were females. Gender was not associated with the risk of OSA in our study. As age increases the risk of obstructive sleep apnea increases with a significant P-value of 0.039. The highest risk was seen among participants aged 60 and above. Body mass index was associated with the risk of OSA among participants with a significant a P-value of 0.019. Neck circumference was not associated with the risk of OSA with a p- value of 0.259. 87.8% of participants were at high risk of OSA ,96.5% were adherent to their medication, and 71.7 % claimed to have a well-controlled blood pressure. 50.9% experienced the symptoms of OSA before being diagnosed with hypertension while 40.1% suffered from OSA symptoms after being diagnosed with hypertension.  Conclusion Risk of OSA was high among Sudanese hypertensive patients. Age, BMI, heart diseases, stroke and chronic lung diseases were associated with increased risk of OSA among hypertensive Sudanese patients, while gender, neck circumference, smoking, diabetes, chronic nasal congestion or allergies, and thyroid disease were not associated with increased risk of OSA among hypertensive Sudanese patients. Heart disease was the most relevant factor associated with high risk of OSA.  Recommendations There is a need to establish sleep study centres and sleep laboratories in Sudan, and to encourage specialization in this field. Until this is achieved doctors should screen suspected patients especially those with hypertension using berlin questionnaire and a trial of C-PAP may be acceptable for high-risk patients. Raising the awareness of sleep apnea among community as well as doctors and the importance of early diagnosis and treatment of obstructive sleep apnea to avoid serious complications. To encourage future researches to study the type of association between hypertensive and OSA among Sudanese.

Keywords : Obstructive Sleep Apnea, Sleep Apnea, Sleep, Apnea, Sudanese, Hypertensive.

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