الفهرس 
Sleep PhysiologyOnly 14 pages are availabe for public view
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Abstract
O
bstructive sleep apnea is one of the most serious prevalent conditions that have significant morbidity and mortality when untreated, current prevalence of OSA pointed that one third of the sleep studies showed some degree of OSA.
Regarding medical complications, studies indicate that obstructive sleep apnea might be a risk factor for both metabolic syndrome and psychiatric illness.
Regarding the metabolic profile, Patients with obstructive sleep apnea appear to suffer from the disorders which characterize the metabolic syndrome, as they have hypertension, high fasting blood glucose levels, increased waist circumference, low HDL cholesterol and high triglycerides and many other characteristics, including sympathetic activation, endothelial dysfunction, systemic inflammation, and hyper coagulation and insulin resistance.
And so the metabolic syndrome might be the final common pathway connecting sleep apnea with cardiovascular diseases.
As for psychiatric profile, many researchers studied the association of sleep apnea (OSA) with psychiatric pathology with higher prevalence of depression, anxiety and nocturnal panic attacks. Psychiatric co-morbidity in OSA may affect patient quality of life and adherence to CPAP.
Based on that, this study was conducted aiming to study the effect of OSA on metabolic and psychiatric profile.
Sample selection:
Selection of cases:
Thirty patients (males and females) were selected from the outpatient sleep clinic in the Institute of Psychiatry, Ain Shams University and approving to participate in this study as the case group.
Their age ranges between 18-55 years. Diagnosed by polysomnogram as having obstructive sleep apnea Patients with Axis I psychiatric disorders according to DSM IV, co morbid major physical illness or history of neurological diseases were excluded from the study.
Control group:
A control group of 30 individuals of volunteers were formed for the case control comparison. They were matched with the patient group for age and sex and with no apparent physical or psychiatric morbidity.
Method:
Procedures and tools:
The study took place from the 1st of august 2013 till 31st of December 2015.
All the outpatients in the sleep clinic were examined to determine eligibility for participation in the study.
Screening was conducted through clinical psychiatric interview according to outpatient psychiatric sheet of Ain Shams University Institute of Psychiatry, which examined demographic data, psychiatric history, sleep history and examination as well as medical history information.
All patients will be offered written informed consent before conducting any procedure.
Patients who will agree on participation will perform Sleep assessment by using Structured Sleep Disorder Questionnaire.
The suspected patients will undergo night polyso-mnography as it will be performed when the participants are medication free for at least 7 days prior to study to exclude the effect of any medication on their polysomnography.
Afterwards, patients who will be diagnosed as obstructive sleep apnea will be assessed by using Structured Clinical Interview for DSM-IV (SCID I) diagnostic tool as well as Hamilton Rating Scale for Depression (HRSD) and Hamilton Anxiety Rating Scale (HAM-A) for anxiety.
Patients who will be diagnosed as obstructive sleep apnea also will perform laboratory investigations in the form of fasting blood sugar, lipid profile (TG and HDL), assessment of arterial blood pressure and waist circumference.
Control group will be subjected also to physical examination, SCID I, HAM-A, HRSD, Sleep questionnaire as well as polysomnographic studying and laboratory investigations.
The results of the study were obtained using the statistical package of the SPSS- 15th version. The statistical processes performed were Spearman Correlation test, ANOVA test as well as Chi Square test.
The Main Findings in the Study were:
As regard Demographic data, baseline and clinical characteristics between cases and control
The current study showed that the socio-demographic characteristics of the sample pointed that the mean age of patients with OSA (case group) was 46.5±5.8 years compared to mean age of 46.1±4.3 years in the other group control group), p value 0.724, more males (80% Vs 20% yet with exactly similar gender distribution between the two groups), higher body weight (102.8±14.10 Vs 72.23±6.21 P value 0.0001), higher BMI (36.96±4.44 Vs 36.43±6.44 P value 0.0001), higher waist circumference (114.10±11.43 Vs97.47± 4.49 P value 0.0001),more dyslipidemic (LDL= 118.3±33.9 Vs 131±3.4 P value 0.046)(HDL=43.1±14 Vs 51.7±2.8 P Value 0.002), more HTN (33.3% Vs 0% P Value 0.001).
Subgroup analysis of patients with OSA divided according to the presence of metabolic syndrome
Within the case group among patients with OSA, 17 had metabolic syndrome while 13 failed to fulfill the criteria for diagnosis of metabolic syndrome.
As regard Clinical and laboratory data in patients with OSA and Ms versus those with OSA alone: we found that the only statistically significant difference was noticed in two parameters only triglycerides (TG) levels with higher levels among patients with both OSA and Mets (mean 185.12±80.37mg/dl) compared to lower levels among those without Mets (mean 127.23±37.96mg/dl), p <0.05 And HTN where About half of the patients with both OSA and MS had systemic hypertension (HTN) 52.9%, while only 1 patient (7.7%) out of those without MS had HTN, p-value of 0.017.
There was no statistical difference between cases divided according to presence of metabolic syndrome as regard PSG data.
As regard Correlations between PSG parameters and different metabolic and clinical parameters of patients with OSA:
There was a statistically significant weak positive correlation between apnea hypopnea index (AHI) and body weight in kg with correlation coefficient of 0.38, p<0.05.
There was a statistically significant positive correlation between rapid eye movement (REM) % and HDL in mg/dl with correlation coefficient of 0.54, p<0.01.
Correlations between PSG parameters and different metabolic and clinical parameters of patients with both OSA and Ms:
There was a statistically significant strong positive correlation between REM latency in minutes and weight in kg with correlation coefficient of 0.64, p<0.05
HDL in mg/dl was positively correlated with stage 3% with correlation coefficient of 0.524, p<0.05 and negatively correlated with stage 1% with correlation coefficient of -0.610, p<0.05.
As regard Correlations between PSG parameters and different metabolic and clinical parameters of patients with OSA alone:
A statistically significant strong positive correlation was noticed between apnea hypopnea index (AHI) and body weight in kg with correlation coefficient of 0.75, p<0.05
A statistically significant strong positive correlation was noticed between arousal index and total cholesterol in mg/dl with correlation coefficient of 0.56, p<0.05
Subgroup analysis of patients with OSA and psychiatric disorders:
Out of the thirty patients with OSA there were eight having psychiatric disorders.
The most prevalent one was depressive disorders (20%) followed by Psychosexual disorder in the form of erectile dysfunction (10%) and adjustment disorder (6%). Then cyclothymic disorder, dysthymia disorder, Panic disorder, obsessive compulsive disorder and hypochondriasis each constitutes 3.3% of the whole cohort.
As regard Comparison between PSG parameters in patients with OSA and psychiatric disorders versus OSA alone:
REM percentage was higher among patients with OSA and psychiatric disorder with mean 9.1763±3.44 Vs 8.43±6.155 P Value 0.0001.
Stage 1%and stage 2% were higher among patients with OSA alone with mean 49.33±18.84 Vs 10.04±2.76 P Value 0.0001, 43.75±15.45 Vs 29.4±8.66 P Value 0.0001 respectively.
Stage 3% and stage 4% were lower among patients with OSA alone with mean 0.01±0.041 Vs 0.65±0.44 P Value 0.0001, 0±0 Vs 0.76±0.85 P Value 0.008 respectively.
AHI and arousal index were higher among patients with OSA alone with mean 56.34±20.24 Vs 37.37±5.46 P Value 0.008, 34.95±17.46 Vs 20.85±5.39 P Value 0.045 respectively.
As regard Association between psychiatric disorders and metabolic syndrome in patients with OSA: we found that there were 3 patients (37.5%) fulfilling the criteria of MS among patients with psychiatric disorder compared to14 patients (63.6%) with MS in those without yet it wasn’t statistically significant with P-value of 0.242.
The study carried some limitations including being conducted on males mostly (80%), number of participants may not be enough to generalize the current results to the population based cases as well as environmental change as a factor affecting sleep.
The study concludes that Patients with obstructive sleep apnea suffer from metabolic disturbance and that the presence of hypertension and hyper-triglyceridemia seemed to be the factors most closely associated with the presence of metabolic syndrome in a patient with OSA, as well as Patients with obstructive sleep apnea were associated with a high prevalence of psychiatric co morbid conditions specifically depression, anxiety and erectile dysfunction.