PURPOSE: The prevalence of obstructive sleep apnea in patients with sickle cell disease (SCD) has been extensively studied in children but not in adult population. Since etiology and treatment of obstructive sleep apnea (OSA) in children is different, it is important to understand the prevalence and characteristics of OSA in adult SSD.
METHODS: The sample was a retrospective study of consecutive adults with SCD referred to ECU sleep disorders center for evaluation of sleep disorders. Demographic, clinical, and polysomnographic data were collected from the ECU electronic medical record following approval by the institutional review boards of the East Carolina University (ECU). Inclusion criteria were 18 years and above with a diagnosis of sickle cell disease (hemoglobin SS disease). 50 patients with sickle cell disease were referred to ECU pulmonary clinic for evaluation of fatigue and day-time hypersomnolence.
RESULTS: Of the 50 patients referred and advised overnight polysomnography 18 patients did not show up for the study. Of the 32 patients 14 (44%) were diagnosed with OSA (AHI>5). Baseline characteristics were not significantly different in OSA versus non-OSA group. Mean age of the group was 40 years.Patients with OSA demonstrated increased REM latency (159 mins Vs 98 mins (P=0.01), increased snore index (16.1 Vs 13.3) with p value = (P=0.04), increased oxygen desaturation index (ODI) of 12.7 Vs 1.6 (p=0.0009) and increased AHI (17.1 Vs 1.6) with p value of 0.0001. We also found that the neck size in patients with OSA was 14.7 inch Vs 13.1 inch in non OSA (p=0.007), OSA patient had BMI of 32.6 Vs 24 of non OSA group (p=0.0003), and Epworth score of 12.7 Vs 8.6 (p=0.01). There was trend towards nocturia (p=0.08) but no significant differences in frequency of pain-crisis or hospital admissions between the two groups were noted.
CONCLUSIONS: We find that adult SSD patients have a high prevalence of OSA (44%). They appear to have changes in sleep architecture. Increased neck size, higher BMI and Epworth score appear to be significant risk factors. Presence of OSA however did not appear to lead to increased crisis or hospitalization though these patient tend to have more daytime sleepiness and trend towards nocturia.
CLINICAL IMPLICATIONS: OSA continues to have high prevalence in adult sickle cell population. The risk factors are similar to those observed in the general population. OSA does not seem to have an impact on SSD as measured by frequency of pain crisis and hospitalization.
DISCLOSURE: The following authors have nothing to disclose: Renuka Kadali, Jimmy Efird, Hadi Chohan, Peter Boettger, Darla Liles, Charles Knupp, Sunil Sharma
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