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Stepped approach for prediction of syndrome Z in patients attending sleep clinic: a north Indian hospital-based study

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Abstract

Purpose

Syndrome Z is the occurrence of metabolic syndrome (MS) with obstructive sleep apnea. Knowledge of its risk factors is useful to screen patients requiring further evaluation for syndrome Z.

Methods

Consecutive patients referred from sleep clinic undergoing polysomnography in the Sleep Laboratory of AIIMS Hospital, New Delhi were screened between June 2008 and May 2010, and 227 patients were recruited. Anthropometry, body composition analysis, blood pressure, fasting blood sugar, and lipid profile were measured. MS was defined using the National Cholesterol Education Program (adult treatment panel III) criteria, with Asian cutoff values for abdominal obesity.

Results

Prevalence of MS and syndrome Z was 74% and 65%, respectively. Age, percent body fat, excessive daytime sleepiness (EDS), and ΔSaO2 (defined as difference between baseline and minimum SaO2 during polysomnography) were independently associated with syndrome Z. Using a cutoff of 15% for level of desaturation, the stepped predictive score using these risk factors had sensitivity, specificity, positive predictive value, and negative predictive value of 75%, 73%, 84%, and 61%, respectively for the diagnosis of syndrome Z. It correctly characterized presence of syndrome Z 75% of the time and obviated need for detailed evaluation in 42% of the screened subjects.

Conclusions

A large proportion of patients presenting to sleep clinics have MS and syndrome Z. Age, percent body fat, EDS, and ΔSaO2 are independent risk factors for syndrome Z. A stepped predictive score using these parameters is cost-effective and useful in diagnosing syndrome Z in resource-limited settings

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Acknowledgments

We thank sleep technicians Mr. Jitender Sharma, Mr. Jitender Kumar, and Mr. Amit Solomon for performing the polysomnographies and for their assistance in data collection. The authors also thank all the study subjects who voluntarily consented to participate in the study.

Conflict of interest statement

None of the authors have any conflict of interest.

Funding

Pfizer India, Ltd., the sponsors, had no role in the study design, data analysis, and in writing the manuscript.

Author information

Authors and Affiliations

  1. Department of Medicine, All India Institute of Medical Sciences, New Delhi, India, 110029

    Swastik Agrawal, Surendra Kumar Sharma & Hemant K. Mishra

  2. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India, 110029

    Surendra Kumar Sharma

  3. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India, 110029

    Vishnubhatla Sreenivas

  4. Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India, 110029

    Ramakrishnan Lakshmy

Authors
  1. Swastik Agrawal
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  2. Surendra Kumar Sharma
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  3. Vishnubhatla Sreenivas
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  4. Ramakrishnan Lakshmy
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  5. Hemant K. Mishra
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Corresponding author

Correspondence to Surendra Kumar Sharma.

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Agrawal, S., Sharma, S.K., Sreenivas, V. et al. Stepped approach for prediction of syndrome Z in patients attending sleep clinic: a north Indian hospital-based study. Sleep Breath 16, 621–627 (2012). https://doi.org/10.1007/s11325-011-0548-3

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  • DOI: https://doi.org/10.1007/s11325-011-0548-3

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