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Comparative Study
. 2018 Nov 21;18(1):173.
doi: 10.1186/s12890-018-0737-y.

Screening obstructive sleep apnea-hypopnea syndrome in hypertensive patients: a comparative study of the efficiency of the Epworth sleepiness scale

Florent Seguro  1   2 , Vincent Bard  3 , Kamila Sedkaoui  4 , Maya Riche  3 , Alain Didier  4 , Béatrice Bouhanick  3   5
Affiliations
Comparative Study

Screening obstructive sleep apnea-hypopnea syndrome in hypertensive patients: a comparative study of the efficiency of the Epworth sleepiness scale

Florent Seguro et al. BMC Pulm Med. .

Abstract

Background: Untreated Obstructive Sleep Apnea Hypnopnea Syndrome (OSAHS) is a known factor contributing to resistant hypertension (HT). Continuous Positive Airways Pressure (CPAP) is effective to decrease blood pressure (BP) in severe OSAHS. In our clinical practice, hypertensive patients seem less symptomatic with regard to severe OSAHS than normotensive patients, leading to a risk of underdiagnosis when OSAHS is screened with Epworth Sleepiness Scale (ESS). We aimed to confirm that severe OSAHS is less symptomatic in HT patients than normotensive patients using ESS.

Methods: We retrospectively compared two age, gender-matched groups - 100 hypertensive patients and 100 normotensive patients - with severe OSAHS defined as an AHI (Apnea Hypopnea Index) ≥30. OSAHS was considered symptomatic when ESS > 10.

Results: The two groups of patients did not differ significantly with respect to main characteristics including Body Mass Index (BMI), AHI and ODI (Oxygen Desaturation Index). Systolic and Diastolic BP were higher in HT patients (p < 0.01). HT patients were less symptomatic with regard to severe OSAHS with a lower ESS (10.0 vs 11.9, p < 0.01), and a lower number of patients with an ESS > 10 (30% vs 58%, p < 0.01). In multivariable analysis adjusted on age, gender, Obesity, Systolic BP, Diastolic BP, AHI and ADO, normotension was significantly associated with symptomatic OSAHS (OR = 2.83, [1.298-6.192], p < 0.01).

Conclusions: In our study on patients with severe OSAHS, ESS score was lower in hypertensive patients than in normotensive patients. This discrepancy may lead to an underestimation of severe OSAHS in hypertensive patients.

Keywords: Epworth sleepiness scale; Hypertension; Obstructive sleep apnea Hypnopnea syndrome.

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Conflict of interest statement

Ethics approval and consent to participate

In accordance with European regulation, French retrospective studies from data obtained without monitoring procedure or additional therapy, do not require the approval of ethics committee.

Consent for publication

Not applicable.

Competing interests

None of the authors have any competing interests to declare.

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