Authors: Di Guardo, Antonino¹; Profeta, Gaetano¹; Crisafulli, Cristiano¹; Sidoti, Giuseppe²; Zammataro, Marcello²; Paolini, Italo¹; Filippi, Alessandro¹

Source: British Journal of General Practice, Volume 60, Number 574, May 2010 , pp. 325-328(4)

Publisher: Royal College of General Practitioners

Abstract:

Background:

The links between obstructive sleep apnoea and hypertension are well established; obstructive sleep apnoea is reported in up to 30% of patients with hypertension, although it is frequently underdiagnosed. Physicians can assess the degree of sleepiness by administering the Epworth Sleepiness Scale, but the large number of patients with hypertension makes this strategy difficult for busy physicians to implement. Obese patients form a subgroup at higher risk for obstructive sleep apnoea, which can be targeted for screening.

Aim:

The study carried out a preliminary exploration of the effectiveness of screening patients with hypertension and obesity for obstructive sleep apnoea in general practice using the Epworth Sleepiness Scale.

Setting:

One group practice in Italy.

Design of study:

`Good clinical practice' was systematically applied: identification of patients with hypertension and obesity; qualitative interview to identify obstructive sleep apnea; and consequent work-up and therapy.

Method:

Three family physicians, caring for 769 pharmacologically-treated patients with hypertension, identified 220 obese patients without relevant pulmonary or neurological diseases or insomnia; 31 of these 220 patients scored >11 on the Epworth Sleepiness Scale.

Results:

Polysomnography confirmed obstructive sleep apnoea in 10% of the obese, hypertensive population (95% confidence interval [CI] = 7.03% to 13.63%), and in 3.9% of the whole hypertensive population (95% CI = 2.74% to 5.51%). At baseline, 24-hour blood pressure monitoring showed uncontrolled blood pressure in all these patients. Under continuous positive airway pressure (CPAP), the blood pressure value normalised (P<0.05), and the mean Epworth Sleepiness Scale score decreased significantly: mean 13.68 versus 7.84 (P<0.001).

Conclusion:

In obese patients with hypertension examined in this study, the prevalence of obstructive sleep apnoea prevalence is about 10%. CPAP significantly ameliorates the blood pressure control. This simple screening and treatment strategy may be easily adopted in primary care.

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Keywords: continuous positive airway pressure; diagnosis; hypertension; obesity; obstructive; sleep apnea

Document Type: Research article

DOI: http://dx.doi.org/10.3399/bjgp10X484174

Affiliations: 1: Italian College of General Practitioners, Florence, Italy 2: DEA's Department of Internal Medicine, `Garibaldi' Hospital, Catania, Sicily, Italy

Publication date: 2010-05-01

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• The British Journal of General Practice is an international journal publishing articles of interest to family practitioners and primary care researchers worldwide. The journal's 2010 Impact Factor is 2.07, making it the world's second most highly cited journal of general practice and primary health care.
  
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