Questionnaire-assessed risk of sleep apnea in inpatients with various endocrine disorders

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Abstract

Background: Sleep breathing disorders can be an additional risk factor for the development of cardiovascular disorders in patients with endocrine disorders.

Aim: To assess the sleep apnea risk in patients with various endocrine disorders undergoing inpatient treatment.

Materials and methods: The sleep apnea risk and the severity of daytime sleepiness were evaluated in 282 inpatients with endocrine disorders based on the following questionnaires: the Epworth Sleepiness Scale (ESS), the sleep apnea screening questionnaire (SAS), and the Berlin sleep apnea risk questionnaire (BQ). To identify the real prevalence of sleep respiratory disorders in endocrine patients we performed cardio-respiratory monitoring with Watch-PAT200 (“Itamar Medical”, Israel) device in 81 patients.

Results: A high sleep apnea risk according to the BQ was detected in 59.9% (160/267) of the patients, according to the SAS in 53.53% (144/269), excessive daytime sleepiness (≥ 11 points) was found in 21.66% (60/277) of the patients with the ESS. Among the patients undergoing cardiorespiratory monitoring, sleep apnea was detected in 84% (68/81), including severe apnea in 38.2% (26/68). The highest sleep apnea risk by BQ and SAS was observed in the patients with type 2 diabetes, acromegaly and hypercortisolism. Excessive daytime sleepiness by the ESS was most noticeable in those with hypercortisolism and thyrotoxicosis.

Conclusion: The high risk of sleep apnea in the inpatients with type 2 diabetes mellitus, acromegaly, hypercorticism, and hypothyroidism makes it necessary to include its active screening into the algorithm of their inpatient assessment to rule out any sleep breathing disorder.

About the authors

I. V. Misnikova

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: fake@neicon.ru

Inna V. Misnikova – MD, PhD, Leading Research Fellow, Department of Therapeutic Endocrinology

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

Yu. A. Kovaleva

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

Yulia A. Kovaleva – MD, PhD, Senior Research Fellow, Department of Therapeutic Endocrinology

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

V. A. Gubkina

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

Valeriya A. Gubkina – MD, PhD, Senior Research Fellow, Department of Therapeutic Endocrinology

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

N. A. Klimina

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

Nataliya A. Klimina – Postgraduate  Student, Chair of Endocrinology, Postgraduate Training Faculty

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

References

  1. Floras JS. Sleep apnea and cardiovascular disease: An enigmatic risk factor. Circ Res. 2018;122(12): 1741–64. doi: 10.1161/CIRCRESAHA.118.310783.
  2. Ceccato F, Bernkopf E, Scaroni C. Sleep apnea syndrome in endocrine clinics. J Endocrinol Invest. 2015;38(8): 827–34. doi: 10.1007/s40618-015-0338-z.
  3. Attal P, Chanson P. Endocrine aspects of obstructive sleep apnea. J Clin Endocrinol Metab. 2010;95(2): 483–95. doi: 10.1210/jc.2009-1912.
  4. Weitzman ED, Zimmerman JC, Czeisler CA, Ronda J. Cortisol secretion is inhibited during sleep in normal man. J Clin Endocrinol Metab. 1983;56(2): 352–8. doi: 10.1210/jcem-56-2-352.
  5. Van Cauter E, Leproult R, Plat L. Age-related changes in slow wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men. JAMA. 2000;284(7): 861–8. doi: 10.1001/jama.284.7.861.
  6. Holl RW, Hartman ML, Veldhuis JD, Taylor WM, Thorner MO. Thirty-second sampling of plasma growth hormone in man: correlation with sleep stages. J Clin Endocrinol Metab. 1991;72(4): 854–61. doi: 10.1210/jcem-72-4-854.
  7. Lindberg E, Theorell-Haglöw J, Svensson M, Gislason T, Berne C, Janson C. Sleep apnea and glucose metabolism: a long-term follow-up in a community-based sample. Chest. 2012;142(4): 935–42. doi: 10.1378/chest.11-1844.
  8. Katz SL, MacLean JE, Hoey L, Horwood L, Barrowman N, Foster B, Hadjiyannakis S, Legault L, Bendiak GN, Kirk VG, Constantin E. Insulin resistance and hypertension in obese youth with sleep-disordered breathing treated with positive airway pressure: A prospective multicenter study. J Clin Sleep Med. 2017;13(9): 1039–47. doi: 10.5664/jcsm.6718.
  9. Peng CS, Cao YA, Tian YH, Zhang WL, Xia J, Yang L. Features of continuous glycemic profile and glycemic variability in patients with obstructive sleep apnea syndrome. Diabetes Res Clin Pract. 2017;134:106–12. doi: 10.1016/j.diabres.2017.08.010.
  10. Зарубина ИВ. Современные представления о патогенезе гипоксии и ее фармакологической коррекции. Обзоры по клинической фармакологии и лекарственной терапии. 2011;9(3): 31–48
  11. Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol (1985). 2005;99(4): 1592–9. doi: 10.1152/japplphysiol.00587.2005.
  12. Цой УА, Коростовцева ЛС, Свиряев ЮВ, Семенов АП, Ваулина ДА, Кравченко СО, Конради АО, Гринева ЕН. Распространенность нарушений дыхания во сне у больных с впервые выявленной акромегалией. Альманах клинической медицины. 2014;(32): 36–42. doi: 10.18786/2072-0505-2014-32-36-42.
  13. Davi' MV, Dalle Carbonare L, Giustina A, Ferrari M, Frigo A, Lo Cascio V, Francia G. Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease. Eur J Endocrinol. 2008;159(5): 533–40. doi: 10.1530/EJE-08-0442.
  14. Pivonello R, Auriemma RS, Grasso LF, Pivonello C, Simeoli C, Patalano R, Galdiero M, Colao A. Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities. Pituitary. 2017;20(1): 46–62. doi: 10.1007/s11102-017-0797-7.
  15. Powlson AS, Gurnell M. Cardiovascular Disease and Sleep-Disordered Breathing in Acromegaly. Neuroendocrinology. 2016;103(1): 75–85. doi: 10.1159/000438903.
  16. Abreu A, Tovar AP, Castellanos R, Valenzuela A, Giraldo CM, Pinedo AC, Guerrero DP, Barrera CA, Franco HI, Ribeiro-Oliveira A Jr, Vilar L, Jallad RS, Duarte FG, Gadelha M, Boguszewski CL, Abucham J, Naves LA, Musolino NR, de Faria ME, Rossato C, Bronstein MD. Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary. 2016;19(4): 448–57. doi: 10.1007/s11102-016-0725-2.
  17. Devdhar M, Ousman YH, Burman KD. Hypothyroidism. Endocrinol Metab Clin North Am. 2007;36(3): 595–615, v. doi: 10.1016/j.ecl.2007.04.008.
  18. Jha A, Sharma SK, Tandon N, Lakshmy R, Kadhiravan T, Handa KK, Gupta R, Pandey RM, Chaturvedi PK. Thyroxine replacement therapy reverses sleep-disordered breathing in patients with primary hypothyroidism. Sleep Med. 2006;7(1): 55–61. doi: 10.1016/j.sleep.2005.05.003.
  19. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7): 485–91. doi: 10.7326/0003-4819-131-7-199910050-00041.
  20. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6): 540–5. doi: 10.1093/sleep/14.6.540.
  21. Горцева АА, Бочкарев МВ, Коростовцева ЛС, Свиряев ЮВ. Определение роли субъективных методов обследования в диагностике нарушений дыхания во сне. Артериальная гипертензия. 2016;22(6): 629–37. doi: 10.18705/1607-419X-2016-22-6-629-637.
  22. Amra B, Rahmati B, Soltaninejad F, Feizi A. Screening questionnaires for obstructive sleep apnea: An updated systematic review. Oman Med J. 2018;33(3): 184–92. doi: 10.5001/omj.2018.36.
  23. Вейн АМ, Елигулашвили ТС, Полуэктов МГ. Синдром апноэ во сне и другие расстройства дыхания, связанные со сном: клиника, диагностика, лечение. М.: Эйдос Медиа; 2002. 310 с.
  24. Netzer N, Stoohs R, Netzer C. Sleep-related symptoms in primary care population. Am J Respir Crit Care Med. 1998;157:A852.
  25. Bar A, Pillar G, Dvir I, Sheffy J, Schnall RP, Lavie P. Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies. Chest. 2003;123(3): 695–703. doi: 10.1378/chest.123.3.695.
  26. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9): 1217–39. doi: 10.1164/rccm.2109080.
  27. Aurora RN, Collop NA, Jacobowitz O, Thomas SM, Quan SF, Aronsky AJ. Quality measures for the care of adult patients with obstructive sleep apnea. J Clin Sleep Med. 2015;11(3): 357–83. doi: 10.5664/jcsm.4556.
  28. Balachandran JS, Patel SR. In the clinic. Obstructive sleep apnea. Ann Intern Med. 2014;161(9):ITC1–15. doi: 10.7326/0003-4819-161-9-201411040-01005.
  29. Myllylä M, Hammais A, Stepanov M, Anttalainen U, Saaresranta T, Laitinen T. Nonfatal and fatal cardiovascular disease events in CPAP compliant obstructive sleep apnea patients. Sleep Breath. 2019 Mar 8. doi: 10.1007/s11325-019-01808-4.
  30. Miller JN, Berger AM. Screening and assessment for obstructive sleep apnea in primary care. Sleep Med Rev. 2016;29:41–51. doi: 10.1016/j.smrv.2015.09.005.
  31. Amin A, Ali A, Altaf QA, Piya MK, Barnett AH, Raymond NT, Tahrani AA. Prevalence and Associations of Obstructive Sleep Apnea in South Asians and White Europeans with Type 2 Diabetes: A Cross-Sectional Study. J Clin Sleep Med. 2017;13(4): 583–9. doi: 10.5664/jcsm.6548.
  32. Tahrani AA. Obstructive sleep apnoea: a diabetologist’s perspective. Br J Diabetes. 2016;16:107–13. doi: 10.15277/bjd.2016.088.
  33. Villa MP, Multari G, Montesano M, Pagani J, Cervoni M, Midulla F, Cerone E, Ronchetti R. Sleep apnoea in children with diabetes mellitus: effect of glycaemic control. Diabetologia. 2000;43(6): 696–702. doi: 10.1007/s001250051365.
  34. Manin G, Pons A, Baltzinger P, Moreau F, Iamandi C, Wilhelm JM, Lenoble P, Kessler L, Kessler R. Obstructive sleep apnoea in people with Type 1 diabetes: prevalence and association with micro- and macrovascular complications. Diabet Med. 2015;32(1): 90–6. doi: 10.1111/dme.12582.
  35. Perks WH, Horrocks PM, Cooper RA, Bradbury S, Allen A, Baldock N, Prowse K, van't Hoff W. Sleep apnoea in acromegaly. Br Med J. 1980;280(6218): 894–7. doi: 10.1136/bmj.280.6218.894.
  36. Herrmann BL, Wessendorf TE, Ajaj W, Kahlke S, Teschler H, Mann K. Effects of octreotide on sleep apnoea and tongue volume (magnetic resonance imaging) in patients with acromegaly. Eur J Endocrinol. 2004;151(3): 309–15.
  37. van Haute FR, Taboada GF, Corrêa LL, Lima GA, Fontes R, Riello AP, Dominici M, Gadelha MR. Prevalence of sleep apnea and metabolic abnormalities in patients with acromegaly and analysis of cephalometric parameters by magnetic resonance imaging. Eur J Endocrinol. 2008;158(4): 459–65. doi: 10.1530/EJE-07-0753.
  38. Sorensen JR, Winther KH, Bonnema SJ, Godballe C, Hegedüs L. Respiratory manifestations of hypothyroidism: A systematic review. Thyroid. 2016;26(11): 1519–27. doi: 10.1089/thy.2015.0642.
  39. Mete T, Yalcin Y, Berker D, Ciftci B, Guven Firat S, Topaloglu O, Cinar Yavuz H, Guler S. Relationship between obstructive sleep apnea syndrome and thyroid diseases. Endocrine. 2013;44(3): 723–8. doi: 10.1007/s12020-013-9927-9.
  40. Millman RP, Bevilacqua J, Peterson DD, Pack AI. Central sleep apnea in hypothyroidism. Am Rev Respir Dis. 1983;127(4): 504–7. doi: 10.1164/arrd.1983.127.4.504.
  41. Milla CE, Zirbes J. Pulmonary complications of endocrine and metabolic disorders. Paediatr Respir Rev. 2012;13(1): 23–8. doi: 10.1016/j.prrv.2011.01.004.
  42. Gokosmanoğlu F, Güzel A, Kan EK, Atmaca H. Increased prevalence of obstructive sleep apnea in patients with Cushing's syndrome compared with weight- and age-matched controls. Eur J Endocrinol. 2017;176(3): 267–72. doi: 10.1530/EJE-16-0815.
  43. Pratt-Ubunama MN, Nishizaka MK, Boedefeld RL, Cofield SS, Harding SM, Calhoun DA. Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension. Chest. 2007;131(2): 453–9. doi: 10.1378/chest.06-1442.
  44. Prejbisz A, Kołodziejczyk-Kruk S, Lenders JWM, Januszewicz A. Primary aldosteronism and obstructive sleep apnea: Is this a bidirectional relationship? Horm Metab Res. 2017;49(12): 969–76. doi: 10.1055/s-0043-122887.

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Copyright (c) 2019 Misnikova I.V., Kovaleva Y.A., Gubkina V.A., Klimina N.A.

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