H0w to Read Spo2 Night Study Report
J Family Med Prim Care. 2018 Sep-Oct; seven(5): 1086–1089.
Overnight pulse oximetry for obstructive sleep apnea screening among patients with snoring in chief intendance setting: Clinical case report
Lap-Kin Chiang
ane Section of Family Medicine and General Outpatient, Kwong Wah Hospital, Mongkok, Hong Kong SAR, China
Abstract
This clinical case report illustrated a typical patient presented with snoring in the principal intendance. He was screened positive for obstructive sleep apnea (OSA) by overnight pulse oximetry and then referred to respiratory specialist care. With early on confirmation and handling of OSA, symptoms and comorbidity associated with OSA can be improved and risk for cardiovascular complication can be prevented. Among 264 cohort patients presented primarily with snoring in one primary care clinic of Hong Kong, 175 patients (66.two%) were screened to have OSA. About 56.0% (98/175), 26.2% (46/175), and 17.8% (31/175) were classified as mild, moderate, and severe OSA, respectively. In view of high prevalence of OSA among snorers, and OSA-related exacerbation in comorbid conditions and increased risk of cardiovascular complexity, in that location is a need to stimulate OSA screening among snoring patients in primary care.
Keywords: Obstructive sleep apnea, overnight pulse oximetry, snoring
Introduction
Snoring is an important characteristic characteristic of obstructive slumber apnea (OSA). Untreated OSA will atomic number 82 to cardiovascular, metabolic and neurocognitive morbidities, and increased take chances of motor vehicle accidents. Overnight pulse oximetry alone is often used and also a good screening tool in the primary intendance setting. This clinical instance and case series reported screening of OSA among snorers in primary care.
Instance History
Mr. South is a 56-twelvemonth-old school workman. He is a not-smoker and social drinker. He has hypertension and hyperlipidemia for more than 10 years. He had been on amlodipine 5 mg daily and lisinopril 5 mg daily for hypertension and diet for lipid control.
Mr. S did dwelling blood pressure (BP) monitoring and reported that home BP was suboptimal sometimes, with systolic BP around 140–150 mmHg, while diastolic BP around xc mmHg. His wife witnessed that Mr. S had astringent snoring all along. He had fragmented sleep usually from eleven pm to half dozen am. He complained of excessive daytime sleepiness and dozed off at work or on travel. There was no forenoon headache and no history of route traffic accident reported.
On concrete examination, the trunk mass index was 30.1 kg/m2. BP was 147/81 mmHg and pulse 78/min regular in rhythm. Cervix circumference was 18.2 inches (46.2 cm). At that place was no obvious craniofacial aberration, no pallor, no ankle edema, no micronathia, and no adenotonsil hypertrophy. Centre sound was dual, no centre murmur, no carotid bruit, and chest examination was unremarkable. Epworth Sleepiness Scale (ESS) score was 23 (total score is 24, with higher score indicating higher sleepiness), which indicated Mr. S suffering excessive daytime sleepiness.
Overnight pulse oximetry for OSA screening was arranged. Oxygen desaturation index (ODI) of ≥4% was 49.2 events/h [Graph one]. Clinical impression was severe OSA. Mr. S was referred to respiratory unit for further management. Polysomnography was arranged, which revealed that Apnea–Hypopnea Index was l.7 events/h, arousal alphabetize was 42.9/h, and full time with snoring was eight.1% of sleep time. Continuous pneumatic airway force per unit area (CPAP) with autotitration was indicated and initiated. Mr. South was compliant and tolerated to application of CPAP. His sleep symptoms improved significantly, and ESS decreased to score 8. On subsequent follow-upwardly, clinic BP of Mr. Southward was stable, that is, 130/75 mmHg and pulse 64/min. His abode BP monitoring had also optimized, the systolic BP was around 110–120 mmHg, and diastolic BP was effectually lxx–80 mmHg.
Summary folio of overnight pulse oximetry
Discussion
Portable overnight pulse oximeter measured and stored oxygen saturation (SaOii) value and pulse charge per unit continuously. Computer-generated report includes SaO2 analysis, pulse rate assay, ODI (number of oxygen desaturation events per 60 minutes of measurement fourth dimension), and pulse disorder index (pulse rises events per hour of measurement time). Oxygen desaturation was defined as a decrease of ≥four% from baseline SaO2.[1] Subjects who had sleep disordered breath events associated with five or more oxygen desaturation events of the peripheral artery of 4% or greater per hour (ODI_4 ≥five events/h) were defined as screening positive. For screening positive patients, the severity of OSA was likewise determined by cut-off equally mild (ODI_4 = 5–14 events/h), moderate (ODI_4 = xv–30 events/h), and severe (ODI_4 >30 events/h).
In all, 264 patients with chief symptom of snoring were arranged for OSA screening. Patient characteristics and screening effect are summarized in Table ane. The patients had a mean age of 52 years, 62.1% were male, and nine.1% were ex- or current smokers. About 53.0% of patients had hypertension, 28.8% had hyperlipidemia, and 54.2% were obese. A full of 175 patients (66.2%) were screening positive to accept OSA. Among them, 56.0% (98/175), 26.2% (46/175), and 17.8% (31/175) were classified as balmy, moderate, and severe OSA, respectively.
Table 1
Summary of patient characteristics
The case of Mr. S illustrates a typical patient presenting with snoring in the primary care. He screened positive for OSA, and then urgent referral to specialist intendance is justified and indicated. With early on confirmation and treatment of OSA, symptoms and comorbidity associated with OSA were improved and take chances for cardiovascular complexity was prevented. Among accomplice patients presented with snoring in one main care dispensary of Hong Kong, 66.2% were screened to have OSA.
Snoring is common in the general population, with a prevalence of 25% in females and 45% in males.[ii,3] By the historic period of 60 years, snoring adversely affects lx% of men and twoscore% of women.[4] The probability of OSA is 3.two times higher in snorers than in nonsnorers.[five] Of the patients with OSA, 70%–95% are habitual snorers.[4,six] Epidemiological studies have concluded that untreated OSA is a large public wellness burden in terms of cardiovascular morbidity and mortality.[seven] Screening for OSA needs to take identify in any adult who reports OSA symptoms, including snoring, witnessed apnea, nocturnal grasping/choking, unexplained daytime sleepiness, large neck size, slumber fragmentation, and unrefreshing sleep.[8] Oximetry alone is often used as the first screening tool for OSA due to the universal availability of cheap recording pulse oximeters.[9] A study conducted in principal care of Hong Kong concludes that overnight pulse oximetry is a good screening tool for OSA screening.[10] Almost 40% of patients with hypertension (HT) were diagnosed comorbid with OSA, and with level every bit high as 71% with drug-resistant hypertensives.[11,12] A meta-analysis of patients' treatment-resistant HT and OSA calculated that CPAP treatment resulted in an average BP reduction of −6.7/five.9 mm Hg.[13] Continuous positive airway pressure (CPAP) functions as a pneumatic splint to maintain upper airway patency through all phases of sleep breathing. CPAP has been established equally the treatment of OSA with the firmest evidence base. American Academy of Slumber Medicine recommended CPAP as the standard treatment of moderate to severe OSA and self-reported sleepiness, while information technology is the optional treatment for mild OSA, improving quality of life or equally an adjunctive therapy to lower BP in hypertensive patients with OSA.[viii]
In view of high prevalence of OSA among snorers, and OSA-related exacerbation in comorbid conditions and increased take a chance of cardiovascular complication, there is a need to stimulate OSA screening among snoring patients in primary care.
Financial back up and sponsorship
Cipher.
Conflicts of involvement
There are no conflicts of interest.
Acknowledgement
The author would like to thank the patient of the reported case for given his consent for the case report to be published.
References
1. Nikolaus Due north, Eliasson AH, Cordula Due north, Kristo DA. Overnight pulse oximetry for sleep-matted breathing in adults: A review. Breast. 2001;120:625–33. [PubMed] [Google Scholar]
ii. Young T, Palta M, Dempsey J, Skatrud J, Weber South, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. Due north EngJ Med. 1993;32:1230–5. [PubMed] [Google Scholar]
3. Ohayon MM, Guilleminault C, Priest RG, Caulet 1000. Snoring and animate pauses during sleep: Telephone interview survey of a United kingdom of great britain and northern ireland population sample. BMJ. 1997;314:860–3. [PMC costless article] [PubMed] [Google Scholar]
4. Hoffstein V, Mateika Southward, Anderson D. Snoring: Is information technology in the ear of the beholder? Sleep. 1994;17:522–6. [PubMed] [Google Scholar]
5. Wilson K, Stoohs RA, Mulrooney TF, Johnson LJ, Guilleminault C, Huang Z. The snoring spectrum. Acoustic cess of snoring audio intensity in 1,139 individuals undergoing polysomnography. Chest. 1999;115:762–seventy. [PubMed] [Google Scholar]
6. Whyte KF, Allen MB, Jeffrey AA, Gould GA, Douglas NJ. Clinical features of the sleep apnea/hypopnea syndrome. Q J Med. 1989;72:659–66. [PubMed] [Google Scholar]
seven. Kendzerska T, Gershon AS, Bell-ringer G, Leung RS, Tomlinson 1000. Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: A decade-long historical accomplice study. PLoS Med. 2014;11:e1001599. [PMC free article] [PubMed] [Google Scholar]
eight. Epstein LJ, Kristo D, Strolio JR, Fredman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive slumber apnea in adults. J Clin Sleep Med. 2009;5:263–76. [PMC costless article] [PubMed] [Google Scholar]
9. Scottish Intercollegiate Guidelines Network. Direction of Obstructive Sleep Apnea/Hypopnea Syndrome in Adults. A national clinical guideline; June. 2003 [Google Scholar]
10. Chiang LK, Kam CW, Ng Lorna. Overnight pulse oximetry for screening of obstructive sleep apnea for at chance adult patients in primary care setting: Prospective instance series. FMCH. 2017;v:215–22. [Google Scholar]
xi. Worsnop CJ, Naughton MT, Castling CE, Morgan TO, Anderson AI, Pierce RJ. The prevalence of obstructive sleep apnea in hypertensives. Am J Respir Crit Care Med. 1998;157:111–5. [PubMed] [Google Scholar]
12. Goncalves SC, Martinez D, Gus M, de Abreu-Silva EO, Bertoluci C, Dutra I, et al. Obstructive sleep apnea and resistant hypertension: A case-control report. Chest. 2007;132:1858–62. [PubMed] [Google Scholar]
13. Iftikhar IH, Valentine CW, Bittencourt LR, Cohen DL, Fedson AC, Gislason T, et al. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive slumber apnea: A meta-analysis. J Hypertens. 2014;32:2341–50. [PMC free article] [PubMed] [Google Scholar]
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259496/
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