Birinci basamağa başvuran hastalarda obstrüktif uyku apne sendromu ve kardiyovasküler hastalık risklerinin belirlenmesi ve aralarındaki ilişkinin değerlendirilmesi

Abstract

Amaç: Bu çalışmanın amacı, birinci basamağa başvuran bireylerin Obstrüktif Uyku Apne Sendromu (OUAS) ve kardiyovasküler hastalık (KVH) risklerini belirlemek ve birbirinin patogenezinde etkili olduğu düşünülen iki durumun risk düzeyleri arasındaki ilişkiyi değerlendirmektir. Gereç ve yöntem: Araştırma tanımlayıcı ve analitik tipte bir çalışma olarak tasarlandı. Çalışmaya Denizli'deki beş farklı aile sağlığı merkezine herhangi bir nedenle başvuran toplam 204 katılımcı dahil edildi. Araştırmada kullanılan veriler, oluşturduğumuz anket sorularından, STOP-BANG ölçeğinden ve SCORE risk hesaplama sisteminden elde edildi. Bulgular: Katılımcıların %25,5'i OUAS açısından yüksek risk grubundadır. Çalışmaya katılanların %33,4'ü KVH açısından yüksek risk taşımaktadır. Katılımcıların OUAS risk düzeyleri ile KVH risk düzeyleri arasında istatistiksel olarak anlamlı bir ilişki vardır. Erkek cinsiyeti, yaş, obezite, sigara kullanımı ve hipertansiyon hem OUAS hem de KVH riskini önemli ölçüde artırır. Sonuç: Herhangi bir nedenle birinci basamağa başvuran hastaların dörtte birinin OUAS riski altında olduğu bulundu. OUAS için yüksek risk grubunda olanların çoğunluğu kardiyovasküler sistem hastalıkları içinde yüksek ve çok yüksek risk gruplarındadır. Yüksek prevalans ve önemli komplikasyonlara sahip iki hastalık olan OUAS ve KVH açısından birinci basamakta taramaların yapılması ile hem bireyin sağlık durumuna hem de toplum sağlığına büyük katkı sağlanabilir.

Keywords

• Obstrüktif uyku apne sendromu
• kardiyovasküler hastalıklar
• birincil basamak
• aile hekimliği
• risk

Identification of obstructive sleep apnea syndrome and cardiovascular diseases risks in patients attending primary care and assessment of their association

Abstract

Purpose: The aim of this study was to determine the risks of Obstructive sleep apnea syndrome (OSAS) and Cardiovascular diseases (CVD) in individuals applying to family health care center and to evaluate the relationship between risk levels of two conditions that are thought to be effective in the pathogenesis of each other. Materials and methods: The research was designed as a descriptive and analytical study. A total of 204 participants who applied to five different family health centers in Denizli for any reason were included in our study. The data used in the research were obtained from the survey questions we created, the STOP-BANG scale and the SCORE risk calculation system. Results: Of the participants, 25.5% are in the high-risk group for OSAS. In total 33.4% of the participants in the study have a high risk of CVD. There is a statistically significant relationship between the OSAS risk levels and CVD risk levels of the participants. Male gender, age, obesity, smoking and hypertension significantly increase both the risk of OSAS and the risk of CVD. Conclusion: One in four patients who applied to primary care for any reason were found to be at risk for OSAS. The majority of those in the high risk group for OSAS are in the high and very high risk groups for the cardiovascular system. Screening in primary care in terms of OSAS and CVD, two diseases with high prevalence and significant complications, can make a great contribution to both the individual's health status and public health.

Keywords

• Obstructive sleep apnea syndrome
• cardiovascular diseases
• primary care
• family medicine
• risk

References

1. Demir A, Ursavaş A, Aslan AT, et al. Turkish thoracic society obstructive sleep apnea syndrome diagnosis and treatment consensus report. Turkish Thoracic Journal. 2012;13:1-66.
2. Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499-521. doi:10.1093/sleep/28.4.499
3. Acar HV, Kaya A, Yücel F, et al. Obstrüktif uyku apnesi tarama testi olarak kullanilan STOP-Bang testinin Türk popülasyonunda geçerliliğinin saptanmasi. Turk J Anaesth Reanim. 2013;41:115-120.
4. World Health Organization. Cardiovascular diseases fact sheet. Available at: http://www.who.int/mediacentre/factsheets/fs317/en/. Accessed April 20, 2025
5. Lavie L. Obstructive sleep apnoea syndrome--an oxidative stress disorder. Sleep Med Rev. 2003;7(1):35-51. doi:10.1053/smrv.2002.0261
6. Silverberg DS, Oksenberg A, Iaina A. Sleep related breathing disorders are common contributing factors to the production of essential hypertension but are neglected, underdiagnosed, and undertreated. Am J Hypertens. 1997;10(12Pt1):1319-1325. doi:10.1016/s0895-7061(97)00322-1
7. Silverberg DS, Iaina A, Oksenberg A. Treating obstructive sleep apnea improves essential hypertension and quality of life. Am Fam Physician. 2002;65(2):229-236.
8. Al Jahdali HH. Obstructive sleep apnea: unjustified diagnostic challenges. Ann Saudi Med. 2000;20(1):24-28. doi:10.5144/0256-4947.2000.24

9. Bailes S, Baltzan M, Rizzo D, et al. Sleep disorder symptoms are common and unspoken in Canadian general practice. Fam Pract. 2009;26(4):294-300. doi:10.1093/fampra/cmp031
10. Bailes S, Baltzan M, Rizzo D, Fichten CS, Amsel R, Libman E. A diagnostic symptom profile for sleep disorder in primary care patients. J Psychosom Res. 2008;64(4):427-433. doi:10.1016/j.jpsychores.2007.10.011
11. Sorscher AJ. How is your sleep: a neglected topic for health care screening. J Am Board Fam Med. 2008;21(2):141-148. doi:10.3122/jabfm.2008.02.070167
12. Demede M, Pandey A, Zizi F, et al. Resistant hypertension and obstructive sleep apnea in the primary-care setting. Int J Hypertens. 2011;2011:340929. doi:10.4061/2011/340929
13. Grover M, Mookadam M, Armas D, et al. Identifying patients at risk for obstructive sleep apnea in a primary care practice. J Am Board Fam Med. 2011;24(2):152-160. doi:10.3122/jabfm.2011.02.100193
14. Labarca G, Cruz N R, Descalzi F. Compromiso multisistémico en apnea obstructiva del sueño [Multisystemic involvement in obstructive sleep apnea]. Rev Med Chil. 2014;142(6):748-757. doi:10.4067/S0034-98872014000600009
15. Go AS, Mozaffarian D, Roger VL, et al. Executive summary: heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation. 2013;127(1):143-152. doi:10.1161/CIR.0b013e318282ab8f
16. Frangopoulos F, Nicolaou I, Zannetos S, et al. Estimating obstructive sleep apnea in Cyprus: a randomised, stratified epidemiological study using STOP-Bang sleep apnea questionnaire. Sleep Med. 2019;61:37-43. doi:10.1016/j.sleep.2019.04.013
17. Ruiz AJ, Sepúlveda MA, Martínez PH, et al. Prevalence of sleep complaints in Colombia at different altitudes. Sleep Sci. 2016;9(2):100-105. doi:10.1016/j.slsci.2016.05.008
18. Khassawneh B, Ghazzawi M, Khader Y, et al. Symptoms and risk of obstructive sleep apnea in primary care patients in Jordan. Sleep Breath. 2009;13(3):227-232. doi:10.1007/s11325-008-0240-4
19. Strange C, Richard CL, Shan S, et al. A population-based estimate of the health care burden of obstructive sleep apnea using a STOP-BAG questionnaire in South Carolina. J Clin Sleep Med. 2021;17(3):367-374. doi:10.5664/jcsm.8860
20. Gümüştakim RŞ, Ayhan Baser D, Cevik M, et al. Evaluation of sleep quality, insomnia severity and OSAS risk in primary care population: A descriptive study. Int J Clin Pract. 2021;75(2):e13786. doi:10.1111/ijcp.13786
21. Wang F, Xiong X, Xu H, et al. The association between obstructive sleep apnea syndrome and metabolic syndrome: a confirmatory factor analysis. Sleep Breath. 2019;23(3):1011-1019. doi:10.1007/s11325-019-01804-8
22. Yılmaz A, Çiledağ A. Systemic Disease in Patients with Obstructive Sleep Apnea Syndrome. J Turk Sleep Med. 2015;2(3):65-68. doi:10.4274/jtsm.93
23. Saraç S, Çetintaş Afşar G, Oruç Ö, Kırbaş G, Görgüner AM. The relationship of obesity and concomitant diseases in the patients with obstructive sleep apnea syndrome. Van Med J. 2015;22(4):246-251.
24. Alenezi MA, Alabdulathim S, Alhejaili SAM, et al. The Association Between Obesity and the Development and Severity of Obstructive Sleep Apnea: A Systematic Review. Cureus. 2024;16(9):e69962. doi:10.7759/cureus.69962
25. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015-3021. doi:10.1001/jama.284.23.3015
26. Başoğlu ÖK, Yürekli BS, Taşkıranlar P, Tunçel Ş, Yılmaz C. Questionnaire survey of Ege Obese Patient School: Relationship between obesity and obstructive sleep apnea syndrome symptoms and daytime sleepiness. Ege J Med. 2011;50(2):111-117.
27. Hiestand DM, Britz P, Goldman M, Phillips B. Prevalence of symptoms and risk of sleep apnea in the US population: Results from the national sleep foundation sleep in America 2005 poll. Chest. 2006;130(3):780-786. doi:10.1378/chest.130.3.780
28. Mahboub B, Afzal S, Alhariri H, Alzaabi A, Vats M, Soans A. Prevalence of symptoms and risk of sleep apnea in Dubai, UAE. Int J Gen Med. 2013;6:109-114. doi:10.2147/IJGM.S40001
29. Selvarajah S, Kaur G, Haniff J, et al. Comparison of the Framingham Risk Score, SCORE and WHO/ISH cardiovascular risk prediction models in an Asian population. Int J Cardiol. 2014;176(1):211-218. doi:10.1016/j.ijcard.2014.07.066
30. Eray A, Set T, Ateş E. Assessment of cardiovascular disease risk in adults. Turk J Fam Pract. 2018;22(1):12-19. doi:10.15511/tahd.18.00112
31. 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
32. Saldías P F, Farcas O K, Reyes S A, Leiva R I. Prevalencia de síndrome metabólico en pacientes adultos con síndrome de apneas obstructivas del sueño [Prevalence of metabolic syndrome in adult patients with obstructive sleep apnea syndrome]. Rev Med Chil. 2024;152(1):49-60. doi:10.4067/s0034-98872024000100049
33. Labarca G, Valdivia G, Oñate A, et al. Prevalence of STOP BANG questionnaire and association with major cardiovascular events in hospitalized population: is it enough with currently used cardiovascular risk measurements? Sleep Med. 2019;61:82-87. doi:10.1016/j.sleep.2019.02.019
34. Yang SH, Xing YS, Wang ZX, et al. Association of Obstructive Sleep Apnea With the Risk of Repeat Adverse Cardiovascular Events in Patients With Newly Diagnosed Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. Ear Nose Throat J. 2021;100(4):260-270. doi:10.1177/0145561321989450
35. Salari N, Khazaie H, Abolfathi M, et al. The effect of obstructive sleep apnea on the increased risk of cardiovascular disease: a systematic review and meta-analysis. Neurol Sci. 2022;43(1):219-231. doi:10.1007/s10072-021-05765-3
36. Köz S. Koroner anjiografi yapılan hastalarda obstrüktif uyku apnesi (OUAS) risk faktörleri ve ouas risk faktörlerine sahip hastalarda koroner arter hastalığı sıklığı. Yüksek Lisans Tezi. Aydın Adnan Menderes Üniversitesi, Sağlık Bilimleri Enstitüsü, İç Hastalıkları Hemşireliği Anabilim Dalı, Aydın, 2015.
37. Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association [published correction appears in Circulation. 2022;145(12):e775. doi:10.1161/CIR.0000000000001043.]. Circulation. 2021;144(3):e56-e67. doi:10.1161/CIR.0000000000000988