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216 Obstructive Sleep Apnoea Syndrome
and Cardio Metabolic Risk

Because of the consequences of OSAS, the issue predictor for OSAS.
of screening for OSAS in asymptomatic patients has
been assessed by Shafazand [6] and he concluded The role of ICT
that there is insufficient evidence for this to be rou- New developments in technology have been incor-
tinely done.
porated in the diagnosis and management of OSAS.
Diagnostic tools Koo et.al [14] have investigated the usefulness of re-
cording snoring sounds with the smartphone which
In symptomatic patients, the Epworth sleepiness are then analysed acoustically to determine the site
score has been traditionally used.
of obstruction in OSAS. It was found that retropala-
The STOP-Bang questionnaire [7] tool can also be tal level of obstruction tended to produce sharp and
applied as a reliable, concise and easy-to-use tool. regular peaks while retrolingual obstruction tended to
Snoring, Tiredness, Observed apnoea, high BP, BMI, show peaks with a gradual onset and decay. Acous-
Age, Neck circumference and male Gender are the tic analysis is non-invasive and can be applied at a
parameters assessed. relatively low cost.
Prudon et.al. used a novel postal –based approach to Coma-del-Coral et al [15] have assessed the reliabili-
diagnose OSAS in a high-risk patients. [8]. Patients ty of telemedicine in the diagnosis and treatment of
who interested in participating in the study were sent OSAS. Forty patients were studied from a population
a four-channel device (Apnea Link [AL}, ResMed, UK) 80km away using respiratory polygraphy transmitted
via the post with pictorial and written instructions. in real time. The level of compliance with the resultant
Following a single night study the AL device was re- CPAP treatment in a conventional clinic was 85% and
turned via a freepost service. 75% of the studies could 75% in those seen by teleconsultation suggesting
be analyzed, suggesting that this approach may be that is a useful application.
useful in clinic practice, avoiding clinic attendance.
CPAP is the most commonly used option for OSAS,
Full PSG testing can sometimes be economically and however it is not always clear how compliant is the
logistically difficult and Chai-Coetzer & McEvoy have patient. There was evaluation of the add-on NOWAPI
concluded that simplified cardiorespiratory sleep medical device for remote monitoring of compliance
tests are a reliable, cost-saving option for diagnos- to CPAP and treatment efficacy in OSA [16].
ing OSAS. [9]
The findings suggest that the NOWAPI estimate of
CPAP treatment was clinically accurate and in agree-
Biomarkers in OSAS ment with polygraphy.
Kheerandish-Gazal & Gozal [10] have given a succinct
overview of morbidity biomarkers that have been Phenotyping of OSAS
identified in Paediatric OSAS which would circum- OSAS is a complex disease and Zinchuk et al [17]
vent labour-intensive and onerous steps in diagnos- have made a case for enhanced phenotyping. The
ing OSAS and its morbidities.
OSA phenotype can be defined as “ A category of
Erdim et.al [11] found that the Mean platelet volume patients with OSA distinguished from others by a sin-
(MPV), neutrophil-to-lymphocyte (NLR) and plate- gle or combination of disease features, in relation to
let-to-lymphocyte ratio (PLR) were significantly high- clinically meaningful attributes (symptoms, response
er in children whose AHI was >5 than in children in to therapy, health outcomes, quality of life)”. Better
other groups. phenotyping improve can many aspects of diagnosis,
understanding of the pathophysiology and personal-
Li et al [12] have done a meta-analysis on CRP lev- ization of treatment for OSAS patients.
els and found that the level in the OSAS group was
1.98mmol/l higher than in the control group. This find- The use of Network science and applying it to respi-
ing is consistent with the inflammatory component of ratory medicine can lead to improved OSAS pheno-
OSAS and supports the role of CRP as a biomarker typing and severity prediction according to Mihaicuta
in this disease. et al [18]
Atan et al [13] looked at 336 patients and the Mono-
cyte to HDL Ratio (MHR) was assessed and com- Pathophysiology & Complications of OSAS
pared between the OSAS subjects and controls. It OSAS has a deleterious effect on almost all aspects
was found that MHR was significantly higher in pa- of life, including cardio-metabolic complications
tients with OSAS and can possibly be a new, useful which can be life threatening.

GCDC 2017