Parisa Adimi

M.D,Pulmonologist ,InternistDirector of sleep disorder medicine of

Massih Daneshvari Hospital

National Research Institute of Lung and Tuberculosis

of IRAN

Obstructive Sleep ApneaSyndrome (OSAS)

OSAS is a common medical condition that is underrecognized and, therefore, undiagnosed in many adults.

Definite risk factors for OSAS include obesity and craniofacial or upper airway soft tissue abnormalities. Potential risk factors include heredity, smoking, and nasal congestion.

A significant number of obese individuals (57%) were at high risk for OSAS.*

The risk of OSAS increased up to age 65 years.

* Prevalence of symptoms and risk of sleep apnea in the US population: Results from the national sleep foundation sleep in America 2005 poll.

First nationwide survey of prevalence of overweight, underweight ,and abdominal

obesity in Iranian adults

• BMI≥25 :42.8% in Men ,57% in women. Age adjusted • BMI≥30 :11.1% in MEN, 25.2% in Woman Age adjusted• Excess body weight is common in Iran.

• More women than men present with overweight and abdominal obesity.

Conclusion

• Accordingly:– Approximately 9-18% of Iranian population

are at risk of OSA .– May be woman are more prone to OSA.– So we need another studies in order to

consider other risk factors in addition to obesity for better estimation.

Palace of Great Kourosh

Ongoing studies in Iran

• Survey of Insomnia and hypersomnia in adult population in Tehran

• Childhood and adolescence Insomnia and Hypersomnia in Tehran

Methodology

• Adult study– Study of a representative sample of

housholds living in Tehran using Cluster random sampling Technique.

• Child and Adolescents– Study of a representative sample of students

in different categories(Primary,Guidence and Highschool) using cluster random sampling.

SECOND PHASE

Following finding abnormality in this population,24 hour pulse oximetry will be done.

Oxygen Saturation base lower than 90% or 4% desaturation were considered abnormal and further investigations will be performed by polysomnography.

Instrument

• A 16-item Insomnia (ASSM 2nd edition 2005) Questionnaire

• Epworth sleep scale Questionnaire

Polysomnography in Massih Daneshvary Hospital

6months Study

Polysomnography report

Descriptive Statistics

N Range Minimum Maximum Mean Std. Deviation Variance

AHI 60 114.00 .00 114.00 20.9750 25.32627 641.420

minsato2 59 91.00 .00 91.00 67.7458 17.67483 312.400

basesato2 59 99.00 .00 99.00 85.9322 12.71418 161.650

sleepduration 56 50.00 1.00 51.00 5.8789 6.36294 40.487

obstructive 59 46.60 .00 46.60 6.0356 9.47836 89.839

mixed 59 21.40 .00 21.40 1.7305 4.58691 21.040

central 59 53.60 .00 53.60 1.9610 7.26593 52.794

hypopenea 59 56.40 .00 56.40 10.4898 12.58248 158.319

AGE 60 72.00 14.00 86.00 55.5333 16.52781 273.168

BMI 57 40.80 19.20 60.00 34.0140 9.03385 81.611

PTT12 349.00 .00 349.00 2.7808E2 132.67010 1.760E4

SYSPRESSURE29 92.00 98.00 190.00 1.4303E2 25.09195 629.606

EPS 52 21.00 3.00 24.00 12.2885 6.23506 38.876

CO2 13 57.00 23.00 80.00 54.6923 18.14472 329.231

PAP 14 90.00 .00 90.00 44.3571 29.68970 881.478

PLM 58 17.00 .00 17.00 2.2931 4.84032 23.429

SNORE24 625.00 .00 625.00 1.3023E2 200.99186 4.040E4

DESATURATION 25 86.00 .00 86.00 24.5200 25.20600 635.343

Valid N (listwise)1

AHIGR2

Frequency Percent Valid PercentCumulative

Percent

Valid <5 18 29.0 30.0 30.0

>=5 42 67.7 70.0 100.0

Total60 96.8 100.0

Missing System2 3.2

Total62 100.0

According to ASSM (American Society of sleep Medicine)

AHIGR1

Frequency Percent Valid Percent Cumulative Percent

Valid <1530 48.4 50.0 50.0

>=1530 48.4 50.0 100.0

Total

60 96.8 100.0

Missing System

2 3.2

Total

62 100.0

AHI>=15 versus AHI<15

SEX

Frequency Percent Valid PercentCumulative

Percent

Valid MALE 34 54.8 54.8 54.8

FEMALE 28 45.2 45.2 100.0

Total

62 100.0 100.0

HTN DM

Valid Percent Valid PercentValid NEGATIVE

65.5 83.1

POSITIVE

34.5 16.9

Total

100.0 100.0

Hypertension and Diabetes Mellitus in All of the patients

BMI

Frequency Percent

Valid Percent Cumulative Percent

Valid <28 16 25.8 28.1 28.1

>=28 41 66.1 71.9 100.0

Total57 91.9 100.0

Missing System

5 8.1

Total

62 100.0

Discussion

• AHI (Mean)=20.9/h• PAP (Pulmonary Arterial Pressure with Doppler

Echocardiography)=45• BMI (mean)=34 Kg/m2 Most of the patients should be treated with

positive airway pressure. patients were diagnosed with delay and

complication. We should prepare screening method in population.