A Preliminary Report of Medical Comorbidities Associated with Obstructive Sleep Apnea in a Presurgical Cohort
STATEMENT OF PROBLEM: The prevalence of medical conditions in patients with obstructive sleep apnea (OSA) is well known; however, there are few reports detailing the comorbidity profile of OSA patients undergoing maxillomandibular advancement (MMA). The population of patients presenting for MMA may differ significantly from patients followed in Sleep Medicine departments. We hypothesize that patients scheduled for MMA will have a different comorbidity profile than the general OSA population. The purpose of this study was to document the presence of medical comorbidities in surgical patients.
METHODS OF DATA ANALYSIS: This is a retrospective cross-sectional study of patients with OSA evaluated by the Department of Oral and Maxillofacial Surgery at Massachusetts General Hospital from 2000 – present that were subsequently treatment planned for MMA. Patients were included if they had a diagnosis of OSA and were scheduled for surgery. Demographic data (gender, age), clinical findings (outstanding medical problems, BMI, RDI) and habit history (smoking, ethanol, drug use) were recorded. Descriptive statistics for the sample were computed and compared to prevalence data from the OSA literature ("historic" data).1, 2 P-values ≤0.05 were considered significant.
RESULTS OF INVESTIGATION: There were 84 subjects (65 males) with OSA included in this study. The mean age was 39.0 ± 11.9 years( range: 18- 59). The average BMI among this sample was 28.0 (range: 15.8-43.5). BMI categorizations included underweight (1.3%), normal (22.2%), overweight (44.4%), and obese (31.9%). Comorbid conditions identified included psychiatric (N=40, 47.6% subjects), cardiovascular (N=29, 34.5%), neurologic (N=23, 27.4%), gastrointestinal (N=22, 26.2%), musculoskeletal (N=22, 26.2%), pulmonary (N=14, 16.7%), genitourinary (N=14, 16.7%), and endocrine (N=6, 7.1%) diagnoses. Social history included: history of alcohol use (N=52, 61.9%), history of smoking (N=21, 25.0%) and a history of recreational drug use (N=3, 3.6%). The mean RDI was 56.0± 28.1 (range: 11.0 to 111.0). RDI categorizations consisted of mild (3.3%), moderate (21.6%), and severe (75.0%).
Among patients with moderate sleep apnea (15≤RDI<30), comorbid conditions consisted of: psychiatric (54.5%), neurologic (45.4%), pulmonary (45.4%), cardiovascular (27.2%), genitourinary (27.2%), gastrointestinal (18.1%), endocrine (9.0%), and musculoskeletal (9.0%) diagnoses. For patients with severe sleep apnea, comorbid conditions were: psychiatric (44.4%), cardiovascular (31.1%), musculoskeletal (26.7%), neurologic (24.4%), gastrointestinal (24.4%), pulmonary (11.1%), genitourinary (11.1%), and endocrine (6.7%).
When stratified by disease severity, patients with moderate disease had the following diagnoses: hypertension (10.0%; historic: 41.3%, p=0.012), depression (45.5%; historic: 27.8%, p=0.288), and asthma (27.2%; historic: 14.2%, p=0.374). Patients with severe disease presented with: hypertension (13.3%; historic: 45.3%, p<0.001), depression (28.9%; historic: 22.3%, p=0.340), diabetes (4.4%; historic: 19.8%, p<0.001), and asthma (8.9%; historic: 9.9%, p=0.815).
CONCLUSION: When compared with previously published comorbidity profiles of OSA patients undergoing medical management, in this cohort of surgical patients, those with moderate and severe OSA have significantly lower rates of hypertension, while patients with severe OSA have a significantly lower rate of Type II diabetes. These findings support our hypothesis that patients referred for MMA present with a distinct comorbidity profile compared to OSA patients managed medically. A follow-up study is underway that will review changes in the comorbidity profiles following MMA.
References:
1. Huang QR, Qin Z, Zhang S, Chow CM. Clinical patterns of OSA and its comorbid conditions: a data mining approach. J Clin Sleep Med. 2008 Dec 15;4(6):543-50.
2. Abrams B. Hierarchy of comorbidity indicators for OSA. Chest 2010 Jun; 137(6):1491-2.