What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Arterial hypertension (n=500). Intervention: Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS). Primary outcome: High risk for sleep disorders (Berlin Questionnaire ≥ 2).

What does this research mean for the field?

Screening identifies a high risk for sleep disorders in approximately 25% of hypertensive patients, which significantly correlates with smoking, alcohol consumption, prior traffic accidents, and sleeping pill use. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 26, 2025Open Access

Obstructive Sleep Apnea Screening Among Hypertensive Patients in Low-Resource Settings

Key Result

Screening identified a high risk for sleep disorders in 25% of hypertensive patients, which significantly correlated with smoking, alcohol consumption, prior traffic accidents, and sleeping pill use.

Study Design

Type

Cross-Sectional (n=500)

Multicenter

Structured PICO

What factors correlate with a high risk of obstructive sleep apnea on screening questionnaires in hypertensive patients?

Population

500 patients with arterial hypertension (254 females, 246 males), median age 60 years, median BMI 26.9 kg/m²

Intervention

Screening for obstructive sleep apnea using the Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS) alongside a questionnaire for additional risk factors

Outcome

Identification of high risk for sleep disorders (primarily OSA)patient reported

In hypertensive patients, factors such as smoking, alcohol consumption, history of traffic accidents, and use of sleeping pills correlate with a high risk of obstructive sleep apnea on screening questionnaires.

Limitations

Inability to use polysomnography to confirm OSA diagnosis
Lack of data regarding the history of arterial hypertension (such as the use of antihypertensive medication, average blood pressure level, and the presence of uncontrolled hypertension)

Abstract

INTRODUCTION: In low-resource countries, where sleep medicine centers are limited, screening tools are essential for identifying individuals at risk for obstructive sleep apnea (OSA). This study aimed to identify additional factors that, in combination with the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS), could improve the identification of hypertensive patients requiring further evaluation. SUBJECTS AND METHODS: This cross-sectional study was conducted at the Family Medicine Service of the Public Health Institution "Dr. Mladen Stojanovic" in Laktasi, Bosnia and Herzegovina, which serves approximately 35,000 inhabitants. Using a questionnaire with defined important parameters alongside screening tools - BQ and ESS - the study aimed to present descriptive indicators of the observed population and to determine identifiers of sleep disorders (primarily OSA) using the chi-square test. RESULTS: A total of 500 patients with arterial hypertension (254 females and 246 males; median age 60 years (IQR: 50-68 years) and median body mass index (BMI) 26.9 kg/m² (IQR: 24.8-29.8 kg/m²)) were screened using the BQ and the ESS. High risk for sleep disorders was identified in 25.4% of subjects using the BQ and in 25% using the ESS. Smoking, alcohol consumption, a history of causing a traffic accident, and the use of sleeping pills were correlated with positive results on both screening tests. CONCLUSION: Patients with arterial hypertension who smoke, consume alcohol regularly, have a positive history of causing a traffic accident, and use sleep medications may benefit from screening for OSA and consideration for referral to sleep medicine centers.

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