Comorbidities associated with obstructive sleep apnea: a retrospective Egyptian study on 244 patients

  • Rania Ahmad SweedEmail author
  • Salma Hassan
  • Nashwa Hassan Abd ElWahab
  • Soha Rashed Aref
  • Mahmoud Ibrahim Mahmoud
Sleep Breathing Physiology and Disorders • Original Article



The aim of the present study was to assess prevalence of associated comorbidities in a group of patients diagnosed with obstructive sleep apnea syndrome (OSAS).


This retrospective study enrolled 244 consecutive patients diagnosed by polysomnogram with OSAS between October 2010 and January 2015 after being referred to our Sleep-Related Breathing Disorders Unit, Chest Diseases Department, in the Alexandria Main University Hospital.


Of 244 patients, 47% were men, mean age was 56.9 years, and mean apnea–hypopnea index was 43.6 events per hour. Patients were categorized into two groups: group 1 (38%), mild and moderate OSAS, and group 2 (62%), severe, very severe, and extreme OSAS. Comorbidities were present in 91% of patients. The most common comorbidities were obesity, hypertension (HTN), and diabetes mellitus (DM). Prevalence of obesity, HTN, DM, congestive heart failure, deep vein thrombosis, pulmonary embolism (PE), and hypothyroidism was significantly higher in severity group 2. PE, bronchial asthma, and chronic obstructive pulmonary disease were significantly higher among men, whereas hypothyroidism was significantly higher among women. During this period of over 4 years, mortality rate was 8%. The majority of deaths occurred at night. Most of the studied patients (60%) either received no treatment or were not adherent to positive airway pressure (PAP) therapy. None of the patients received surgicaltreatment. The majority (50%) gained access to PAP therapy through donations. Associated hypoventilation was the only significant predictor of PAP adherence. Quality of life was significantly better among PAP adherent patients.


Patients suffering from OSAS have very high prevalence of comorbidities indicating a great burden on the healthcare system. Despite this fact, over 50% of the patients studied did not receive any treatment. Charities were the main portal fortreatment.


Sleep apnea Quality of life Morbidity Mortality Comorbidity PAP 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Mohamed-Hussein AAR, Wafy S (2010) Prevalence and risk factors of obstructive sleep apnea syndrome in a population of upper Egypt. Eur Respir J 36: Suppl. 54, XXXsGoogle Scholar
  2. 2.
    Javaheri S, Caref EB, Chen E, Tong KB, Abraham WT (2011) Sleep apnea testing and outcomes in a large cohort of Medicare beneficiaries with newly diagnosed heart failure. Am J Respir Crit Care Med 183(4):539–546CrossRefGoogle Scholar
  3. 3.
    World Health Organization. Division of Mental Health (1996) WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996. World Health Organization, GenevaGoogle Scholar
  4. 4.
    Iber C, Ancoli-Israel S, Chesson AL Jr, Quan SF (2007) The AASMmanual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester, ILGoogle Scholar
  5. 5.
    Yousif M, El-Helbawy R (2013) A six-year sleep lab experience in an Egyptian University hospital. Egyptian Journal of Chest Diseases and Tuberculosis 62:717–722CrossRefGoogle Scholar
  6. 6.
    Peppard PE, Hage EW (2018) The last 25 years of obstructive sleep apnea epidemiology—and the next 25? Am J Respir Crit Care Med 197(3):310–312CrossRefGoogle Scholar
  7. 7.
    Schwab RJ, Pasirstein M, Kaplan L, Pierson R, Mackley A, Hachadoorian R, Arens R, Maislin G, Pack AI (2006) Family aggregation of upper airway soft tissue structures in normal subjects and patients with sleep apnea. Am J Respir Crit Care Med 173:453–463CrossRefGoogle Scholar
  8. 8.
    Basoglu OK, Tasbakan MS (2018) Gender differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2827 patients. Sleep Breath 22(1):241–249CrossRefGoogle Scholar
  9. 9.
    Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A (1994) Sleep apnea and sleep disruption in obese patients. Arch Intern Med 154(15):1705–1711CrossRefGoogle Scholar
  10. 10.
    Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284:3015–3021CrossRefGoogle Scholar
  11. 11.
    Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM et al (2016) American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract 3:1–203CrossRefGoogle Scholar
  12. 12.
    Lavie P, Herer P, Hoffstein V (2000) Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ 320(7233):479–482CrossRefGoogle Scholar
  13. 13.
    Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ et al (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25CrossRefGoogle Scholar
  14. 14.
    Hla KM, Young T, Hagen EW, Stein JH, Finn LA, Nieto FJ, Peppard PE (2015) Coronary heart disease incidence in sleep disordered breathing: the Wisconsin Sleep Cohort Study. Sleep 38(5):677–684CrossRefGoogle Scholar
  15. 15.
    Sanchez-de-la-Torre A, Soler X, Barbe F et al (2018) Cardiac troponin values in patients with acute coronary syndrome and sleep apnea. Chest 153(2):329–338CrossRefGoogle Scholar
  16. 16.
    Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL et al (2006) Association of nocturnal arrhythmias with sleep-disordered breathing: the Sleep Heart Health Study. Am J Respir Crit Care Med 173:910–916CrossRefGoogle Scholar
  17. 17.
    Gami AS, Olson EJ, Shen WK, Wright RS, Ballman KV, Hodge DO, Herges RM, Howard DE, Somers VK (2013) Obstructive sleep apnea and the risk of sudden cardiac death. J Am Coll Cardiol 62(7):610–616CrossRefGoogle Scholar
  18. 18.
    Kent BD, Grote L, Ryan S, Pépin JL, Bonsignore MR, Tkacova R, Saaresranta T, Verbraecken J, Lévy P, Hedner J, McNicholas WT (2014) Diabetes mellitus prevalence and control in sleep-disordered breathing: the European Sleep Apnea Cohort (ESADA) study. Chest 146(4):982–990CrossRefGoogle Scholar
  19. 19.
    Celen YT, Hedner J, Carlson J, Peker Y (2010) Impact of gender on incident diabetes mellitus in obstructive sleep apnea: a 16-year follow-up. J Clin Sleep Med 6(3):244–250Google Scholar
  20. 20.
    Rotenberg BW, Murariu D, Pang KP (2016) Trends in CPAP adherence over twenty years of data collection: a flattened curve. Rotenberg et al. J Otolaryngol Head Neck Surg 45:43CrossRefGoogle Scholar
  21. 21.
    Frost & Sullivan (2016) Hidden health crisis costing America billions. Underdiagnosing and undertreating obstructive sleep apnea draining healthcare system. Darien, IL: American Academy of Sleep Medicine. Available from:
  22. 22.
    Wallace DM, Williams NJ, Sawyer AM, Jean-Louis G, Aloia MS, Vieira DL, Wohlgemuth WK (2018) Adherence to positive airway pressure treatment among minority populations in the US: a scoping review. Sleep Med Rev 38:56–69CrossRefGoogle Scholar
  23. 23.
    May AM, Gharibeh T, Wang L, Hurley A, Walia H, Strohl KP (2018) CPAP adherence predictors in a randomized trial of moderate-to-severe OSA enriched with women and minorities. CHEST 154(3):567–578CrossRefGoogle Scholar
  24. 24.
    Balakrishnan K, James KT, Weaver EM (2016) Predicting CPAP use and treatment outcomes using composite indices of sleep apnea severity. J Clin Sleep Med 12(6):849–854CrossRefGoogle Scholar
  25. 25.
    Jacobsen AR, Eriksen F, Hansen RW, Erlandsen M, Thorup L, Damgård MB, Kirkegaard MG, Hansen KW (2017) Determinants for adherence to continuous positive airway pressure therapy in obstructive sleep apnea. PLoS One 12(12):e0189614CrossRefGoogle Scholar
  26. 26.
    Walter RJ, Hagedorn SI, Lettieri CJ (2017) Impact of diagnosing and treating obstructive sleep apnea on healthcare utilization. Sleep Med 38:73–77CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Chest Diseases, Faculty of MedicineUniversity of AlexandriaAlexandriaEgypt
  2. 2.Department of Public, Preventive and Social Medicine, Faculty of MedicineUniversity of AlexandriaAlexandriaEgypt

Personalised recommendations