Uticaj težine sindroma opstruktivne apneje-hipopneje u snu na kvalitet života i toleranciju napora kod obolelih od hipertenzije
Sažetak
Uvod/Cilj. Sindrom opstruktivne apneje-hipopneje u snu (obstructive sleep apnea-hypopnea syndrome – OSAHS) povezan je sa smanjenim kvalitetom života (quality of life – QoL) i smanjenom tolerancijom fizičkog napora. Cilj rada bio je da se utvrdi da li težina OSAHS-a utiče na QoL i toleranciju napora kod bolesnika sa umerenim do teškim OSAHS-om i arterijskom hipertenzijom. Metode. Studija je obuhvatila 115 konsekutivnih bolesnika sa arterijskom hipertentijom koji su imali srednje tažak [40 (34,78%)] ili težak [75 (65,22%)] OSAHS. Tolerancija fizičkog napora procenjivana je korišćenjem testa fizičkim opterećenjem, dok je QoL procenjivan korišćenjem upitnika Short-Form 36 (SF-36). Rezultati. Ispitivane grupe se nisu statistički značajno razlikovale prema starosti (54,80 ± 8,91 vs. 53,55 ± 9,53, p = 0,494) i polu [ženska populacija: 11 (27,50%) vs. 13 (17,33%), p = 0,201]. Uočena je visoka prevalencija kardiovaskularnih faktora rizika. Bolesnici sa teškim OSAHS-om imali su značajno višu vrednost indeksa telesne mase i veći obim vrata. Isto tako, kod bolesnika sa teškim OSAHS-om gojaznost je bila zastupljenija. Pored toga, ova grupa bolesnika imala je značajno više vrednosti indeksa apneje-hipopneje, indeksa desaturacije i trajanje perioda u kome je zabeležena sautracija kiseonika ispod 90%. Nije bilo statistički značajne razlike ni u toleranciji fizičkog napora, niti u parametrima upitnika SF-36 između grupa. Takođe, nije utvrđena značajna korelacija između indeksa apneje-hipopneje, tolerancije fizičkog napora i parametara QoL. Kod dvoje asimptomatskih bolesnika registrovano je postojanje višesudovne koronarne bolesti. Zaključak. Oboleli od OSAHS-a generalno imaju brojne kardiovaskularne faktore rizika, niži QoL i smanjenu toleranciju fizičkog napora. Nije dokazano postojanje značajne korelacije između težine OSAHS-a, tolerancije fizičkog napora i QoL. Otkrivanje višesudovne koronarne bolesti kod asimptomatskih bolesnika u istraživanju naglašava klinički značaj skrininga na koronarnu bolest srca kod obolelih od OSAHS-a.
Reference
Gottlieb DJ. Sleep Apnea and Cardiovascular Disease. Curr Diab Rep 2021; 21(12): 64. DOI: 10.1007/s11892-021-01426-z.
Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019; 7(8): 687–98. DOI: 10.1016/S2213-2600(19)30198-5.
Osman AM, Carter SG, Carberry JC, Eckert DJ. Obstructive sleep apnea: current perspectives. Nat Sci Sleep 2018; 10: 21–34. DOI: 10.2147/NSS.S124657.
Abbasi A, Gupta SS, Sabharwal N, Meghrajani V, Sharma S, Kamholz S, et al. A comprehensive review of obstructive sleep apnea. Sleep Sci 2021; 14(2): 142–54. DOI: 10.5935/1984-0063.20200056.
Peker Y, Akdeniz B, Altay S, Balcan B, Başaran Ö, Baysal E, et al. Obstructive Sleep Apnea and Cardiovascular Disease: Where Do We Stand? Anatol J Cardiol 2023; 27(7): 375–89. DOI: 10.14744/AnatolJCardiol.2023.3307.
Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, et al. Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 144(3): e56–67. DOI: 10.1161/CIR.0000000000000988. Erratum in: Circulation 2022; 145(12): e775. DOI: 10.1161/CIR.0000000000001043.
Seravalle G, Grassi G. Sleep Apnea and Hypertension. High Blood Press Cardiovasc Prev 2022; 29(1): 23–31. DOI: 10.1007/s40292-021-00484-4.
Ahmed AM, Nur SM, Xiaochen Y. Association between obstructive sleep apnea and resistant hypertension: systematic review and meta-analysis. Front Med (Lausanne) 2023; 10: 1200952. DOI: 10.3389/fmed.2023.1200952.
Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens 2023; 41(12): 1874–2071. DOI: 10.1097/HJH.0000000000003480. Erratum in: J Hypertens 2024; 42(1): 194. DOI: 10.1097/HJH.0000000000003621.
Kwon Y, Tzeng WS, Seo J, Logan JG, Tadic M, Lin GM, et al. Obstructive sleep apnea and hypertension; critical overview. Clin Hypertens 2024; 30(1): 19. DOI:10.1186/s40885-024-00276-7.
Shiina K. Obstructive sleep apnea -related hypertension: a review of the literature and clinical management strategy. Hypertens Res 2024; 47(11): 3085–98. DOI: https://doi.org/10.1038/s41440-024-01852-y
Stojanović MM, Deljanin Ilić M, Ristić L, Stamenković Z, Koraćević G, Gojković D, et al. Impact of obstructive sleep apnea–hypopnea syndrome severity on heart rate variability and QTc interval in hypertensive patients. Medicina (Kaunas) 2025; 61(12): 2221. DOI: 10.3390/medicina61122221.
Krishnan S, Chai-Coetzer CL, Grivell N, Lovato N, Mukherjee S, Vakulin A, et al. Comorbidities and quality of life in Australian men and women with diagnosed and undiagnosed high-risk obstructive sleep apnea. J Clin Sleep Med 2022; 18(7): 1757–67. DOI: 10.5664/jcsm.9972.
Stavrou VT, Astara K, Tourlakopoulos KN, Papayianni E, Boutlas S, Vavougios GD, et al. Obstructive Sleep Apnea Syndrome: The Effect of Acute and Chronic Responses of Exercise. Front Med (Lausanne) 2021; 8: 806924. DOI: 10.3389/fmed.2021.806924.
Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13(3): 479–504. DOI: 10.5664/jcsm.6506.
Nikolić A, Biočanin V, Rančić N, Dušpara M, Đurić D. Serbian translation and validation of the SF-36 for the assessment of quality of life in patients with diagnosed arterial hypertension. EABR Exp Appl Biomed Res 2023; 24(3): 227–34. DOI: 10.2478/sjecr-2020-0073
Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest 2010; 137(3): 711–9. DOI: 10.1378/chest.09-0360.
Wahbi Abdalhakim HM, Abdullah HM, Ahmed SF, Fattah FH, Karadakhy KA, Kakamad FH, et al. Correlation between body mass index and apnea-hypopnea index, and the Epworth sleepiness scale: An epidemiological study on sleep. World Acad Sci J 2024; 6(1): 8. DOI: https://doi.org/10.3892/wasj.2024.223
Eldaabousy SA, Awad A, Hassan SAA, Nour MO. Neck circumference as a predictor for the presence and the severity of obstructive sleep apnea in snoring patients. IP Indian J Immunol Respir Med 2021; 6(2): 98–104. DOI: https://doi.org/10.18231/j.ijirm.2021.022
Ibrahim MIS, Mohamad H, Mohamad A, Mohamad I. Association between neck circumference and the severity of obstructive sleep apnea. Pol Ann Med 2020; 27(1): 1–6. DOI:10.29089/2020.20.00097.
Zhao Y, Yan X, Liang C, Wang L, Zhang H, Yu H. Incorporating neck circumference or neck-to-height ratio into the GOAL questionnaire to better detect and describe obstructive sleep apnea with application to clinical decisions. Front Neurosci 2022; 16: 1014948. DOI: 10.3389/fnins.2022.1014948.
Lindberg E, Benediktsdottir B, Franklin KA, Holm M, Johannessen A, Jogi R, et al. Gender differences in sleep disordered breathing. Eur Respir J 2015; 46(suppl 59): PA2377. DOI: 10.1183/13993003.congress-2015.PA2377
Geer JH, Hilbert J. Gender Issues in Obstructive Sleep Apnea. Yale J Biol Med 2021; 94(3): 487–96.
Malhotra A, Huang Y, Fogel RB, Pillar G, Edwards JK, Kikinis R, et al. The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med 2002; 166(10): 1388–95. DOI: 10.1164/rccm.2112072.
Zhang L, Ou X, Zhu T, Lv X. Beneficial effects of estrogens in obstructive sleep apnea hypopnea syndrome. Sleep Breath 2020; 24(1): 7–13. DOI: 10.1007/s11325-019-01896-2.
Mitra AK, Bhuiyan AR, Jones EA. Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review. Diseases 2021; 9(4): 88. DOI: 10.3390/diseases9040088.
Herrscher TE, Overland B, Sandvik L, Westheim AS, Akre H. High cardiovascular risk profile in patients with sleep apnea. Laryngoscope 2014; 124(1): 306–10. DOI: 10.1002/lary.24304.
Stojanović M, Ilić MD, Ristić L, Stamenković Z, Gojković D, Koraćević G. Challenges in assessing cardiovascular risk in obstructive sleep apnea-hypopnea syndrome: applicability of existing tools. Vojnosanit Pregl 2025; 82(8): 481–9. DOI:10.2298/VSP250422053S
Gharsalli H, Harizi C, Zaouche R, Sahnoun I, Saffar F, Maalej S, et al. Prevalence of depression and anxiety in obstructive sleep apnea. Tunis Med 2022; 100(7): 525–33.
Goncalves MA, Paiva T, Ramos E, Guilleminault C. Obstructive sleep apnea syndrome, sleepiness, and quality of life. Chest 2004; 125(6): 2091–6. DOI: 10.1378/chest.125.6.2091.
Caporale M, Palmeri R, Corallo F, Muscarà N, Romeo L, Bramanti A, et al. Cognitive impairment in obstructive sleep apnea syndrome: a descriptive review. Sleep Breath 2021; 25(1): 29–40. DOI: 10.1007/s11325-020-02084-3.
Weaver EM, Woodson BT, Steward DL. Polysomnography indexes are discordant with quality of life, symptoms, and reaction times in sleep apnea patients. Otolaryngol Head Neck Surg 2005; 132(2): 255–62. DOI: 10.1016/j.otohns.2004.11.001.
Kline CE. The bidirectional relationship between exercise and sleep: Implications for exercise adherence and sleep improvement. Am J Lifestyle Med 2014; 8(6): 375–9. DOI: 10.1177/1559827614544437.
Lin CC, Hsieh WY, Chou CS, Liaw SF. Cardiopulmonary exercise testing in obstructive sleep apnea syndrome. Respir Physiol Neurobiol 2006; 150(1): 27–34. DOI: 10.1016/j.resp.2005.01.008.
Cintra F, Poyares D, Rizzi CF, Risso TT, Skomro R, Montuori E, et al. Cardiorespiratory response to exercise in men and women with obstructive sleep apnea. Sleep Med 2009; 10(3): 368–73. DOI: 10.1016/j.sleep.2008.04.006.
Butner KL, Hargens TA, Kaleth AS, Miller LE, Zedalis D, Herbert WG. Association of Obstructive Sleep Apnea Severity with Exercise Capacity and Health-related Quality of Life. N Am J Med Sci 2013; 5(6): 362–6. DOI: 10.4103/1947-2714.114168.
Mei S, Zhou Y, Wu W, Cui X, Cai J, Yuan P, et al. Cross-sectional study on exercise capacity in obese patients with severe obstructive sleep apnea syndrome. Front Physiol 2025; 16: 1580308. DOI: 10.3389/fphys.2025.1580308.
Ooi EL, Rajendran S. Obstructive Sleep Apnea in Coronary Artery Disease. Curr Probl Cardiol 2023; 48(8): 101178. DOI: 10.1016/j.cpcardiol.2022.101178.
Hung CJ, Kang BH, Lin YS, Su HH. Comparison of a home sleep test with in-laboratory polysomnography in the diagnosis of obstructive sleep apnea syndrome. J Chin Med Assoc 2022; 85(7): 788–92. DOI: 10.1097/JCMA.0000000000000741.