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A3968 - Obstructive Sleep Apnea Syndrome Among Subjects with Venous Insufficiency
Author Block: E. Perger1, S. Blaise2, C. Vermorel3, G. Bodge4, J. Pepin5, S. Redolfi6, J. Bosson4; 1Service de Pathologies du Sommeil, Groupe Hospitalier Pitié-Salpêtrière,, Paris, France, 2Service de Médecine Vasculaire, Univ. Grenoble Alpes, Grenoble, France, 3Public Health department, Univ. Grenoble Alpes,, Grenoble, France, 4Association des Médecins Vasculaires Hospitaliers Montpellier, Service de Médecine Vasculaire, Montpellier, France, 5Laboratoire EFCR, CHU DE GRENOBLE, GRENOBLE CEDEX 9, France, 6Pitié-Salpêtrière Hospital, Sorbonne Universités, Paris, France.
Rationale: Obstructive sleep apnea syndrome (OSAS) is highly prevalent in conditions associated with fluid overload. Indeed, an overnight rostral fluid shift from the legs to the neck has been shown to contribute to the pathogenesis of OSAS in various fluid overload conditions, such as heart failure, drug resistant hypertension and end-stage renal disease. Venous insufficiency is a condition characterized by fluid retention and might therefore be associated with OSAS. The aim of this study was to evaluate the prevalence of subjects at risk for OSAS among patients suffering from symptomatic venous insufficiency.
Methods: We performed a multicentric study in patients referred to a vascular doctor in hospital or private practices for symptomatic venous insufficiency (Clinical Etiology Anatomy Pathophysiology - CEAP - classification ≥2). We developed an electronic medical record including the Berlin questionnaire to evaluate the risk to exhibiting OSAS (positive: high risk of OSAS; negative: low risk of OSAS), questions evaluating the symptoms associated to OSAS and 11 questions evaluating symptoms associated to accumulation of excess of fluid in different body regions over the 24 hours (in the lower part of the body at the end of the day: tight shoes, socks mark and heavy legs; in the lungs overnight: orthopnea, sleeping with two pillows or more, sleep in sitting position, paroxysmal nocturnal dyspnea; and in the upper part of the body at night: swollen face, swollen hands, obstructed nose, swollen throat). Patients with already diagnosed OSAS were excluded from the study.
Results: During 12 weeks in 2016 180 subjects (37% males, mean age ± standard deviation 61 ± 15 years, body mass index - BMI - 29 ± 4 kg/m2, 48% with a CEAP = 2) were included. 59 patients (33%) (Confidence Interval 95%: 26-40%) had a positive Berlin score. The risk factors independently associated with a positive Berlin score were sex, age, BMI, CEAP classification and the symptom “socks mark in the evening”.
Conclusions: The risk to have OSAS predicted by the Berlin score is high among subjects with symptomatic venous insufficiency. The predictors of a high risk of OSAS, beside the factors classically associate with the disease such as sex, age and BMI, were the severity of the venous insufficiency and an excess of fluid accumulated in the legs at the end of the day, which suggests the implication of fluid overload and shift.