“TO STUDY SLEEP QUALITY AND

OBSTRUCTIVE SLEEP APNEA IN

HYPERTENSIVE PATIENTS”
PRIMARY INVESTIGATOR
Dr.lay desai jr1
MD(Physiology)
INTRODUCTION:
Obstructive sleep apnea (OSA) and hypertension(HTN) frequently co-exist.
46% of adults with Hypertension is are unaware that they have condition as per WHO.
Obstructive Sleep Apnoea is the major sleep breathing disorder and is characterized by episodes
of a complete (apnea) or partial collapse (hypopnea) of the upper airway with an associated
decrease in oxygen saturation or arousal from sleep.
In our study we will be assessing poor sleep quality and day time sleepiness as a risk factor
for hypertension. It is a questionnaire based study where insomania is assessed using Epworth
sleepiness
score and the STOP BANG questionnaire for assessing OSA.
The polysomnograhy will be conducted to confirm the effect in severe OSA patients with
hypertension.
 REVIEW Of LITERATURE :
1. Doop J M , Reichmuth K J , Morgan V J 2007 Dec ; 9 (6) : 529 – 34 research focuses
on mechanisms , evaluation & management of Obstructive Sleep Apnea &
Hypertension.It was found out that OSA episodes produces surges in systolic &
diastolic blood pressure . CPAP treatment was found to be beneficial as it abolishes
the apneas.
2. Chaudhary SC , Gupta P, Sawalani KK , Gupta KK , Singh A, Usman K , Kumar V ,
Himanshu D , Verma A, Singh A B , CHAUDHARY S C . Obstructive Sleep Apnea in
hypertension . Cureus . 2023 Apr 27 ; 15 (4). Treating obstructive sleep apnea improves essential
hypertension and quality of life.
3. Wolf J , Hering D , Narkiewicz K 2010 Sep ; 33 (9): 867-71 observed Non – dipping pattern of
hypertension & obstructive sleep apnea syndrome . Sleep Apnea may be an important factor in
determining the increased cardiovascular risk in hypertensive non-dippers.Effective treatment of
sleep apnea may attenuate neurohumoral & metabolic abnormalities, improve diurnal BP control
& reduce cardiovascular risk.
AIM:-
TO STUDY SLEEP QUALITY AND OBSTRUCTIVE SLEEP APNEA IN
HYPERTENSIVE PATIENTS
OBJECTIVES
Primary objectives:
1. To assess the sleep quality in the hypertensive patient
2. To asses Daytime sleepiness in hypertensive patients.
3. To assess the risk of OSA in hypertensive patient.
4. To study polysomnography in patients with Hypertension with high risk of OSA
Secondary objectives:
To observe the association of sleep quality, daytime sleepiness with risk of OSA in
hypertensive patients.
Material and Methods –
This is an observational, cross sectional study carried out in the Physiology Department in
collaboration with Medicine, Respiratory medicine department & Sleep lab of MGM hospital,
Kamothe, Navi Mumbai after the approval by Institutional Ethics Committee.
Study Design: This is an observational, cross sectional study
Study Site – MGM Hospital, Kamothe, Navi Mumbai.
Study Duration – From January 2024 to December 2025
Sample size –30
Study Population –Males & females in age group of 18 to 70 years with Hypertension
 Inclusion Criteria – Both Male & Female hypertensive patients with or without
comorbidities in the age group of 18 to 70 years willing to participate in the study

Exclusion criteria –
Participants who are unwilling to participate.
Participants with sleep disorders and on sleep medications and sedatives.
Patients with end stage renal disease (ESRD) and glomerula filteration rate (GFR) <15 ml /min/m2
chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) asthama)
Chronic liver disease
coronary artery disease , congestive heart failure ,
diabetes mellitus
thyroid dysfunction
acquired immune deficiency syndrome (AIDS)
drug abuser , depressive patient , pregnant , alchoholic patients , obvious airway abnormalities or
history of maxillofacial , neck trauma and surgery are excluded from the study.
 Material and Method
1) Mercury Sphygmomanometer for blood pressure recording.
2) Anthropometry ;

a) Height is measured in cms.

b) weight is measured in kgs.
c)BMI is calculated.

Body Mass Index (BMI= kg/m2) is calculated by measuring the weight in kgs and height in
cms.
3) Pittsburgh Sleep Quality Index (PSQI) :
PSQI is developed to measure quality of sleep and to help discriminate between individual who
experience poor sleep versus individual who sleeps well.
The scale has two parts self rated questions , utilized to rate the scale and five questions rated
by bed partner. The scale can also be given by a clinician or research assistant.
0==no difficulty to 3=severe difficulty.
The score ranges from 0 to 21 and score >5 be considered a significant sleep disturbance.
4) EPWORTH SLEEPINESS SCALE
Epworth sleepiness scale is a scale intended to measure day time sleepiness through the following
SCORES
0 -7 it is unlikely that you are abnormally sleepy .
8-9 you are an average amount of daytime sleepiness.
10-15 you may be excessively sleepy depending on the situation.
5)STOP BANG QUESTIONNAIRE
Height ,weight is measured & BMI is calculated.
Neck circumference is measured
.

In females >16 inches In males >17 inches is a risk factor associated with OSA.
STOP BANG SCORES are calculated and based on their responses they are divided into 3 groups , low , moderate and
High risk of OSA.
STOP-BANG SCORES:
0 to 2 low risk of OSA
3 to 4 moderate risk of OSA
>5 High risk of OSA
6)POLYSOMNOGRAPHY
(RES MED Machine) is the standard diagnostic test for the diagnosis of OSA in sleep lab,
MGM Hospital , Kamothe , Navi Mumbai.
HEAD Box – EEG , EMG and EOG nodes.
M-Drive ; interface between computer and HEAD BOX .
Connector : used for HEAD BOX and M-Drive to connect TITRATION Machine.
STATISTICAL ANALYSIS

The qualitative variables with be analysed using frequency and percentage

Data will be organised and analysed in SPSS software.

The Chi-square will be used to compare the variables of participants.
EXPECTED OUTCOMES

Sleep deprivation and OSA are a risk factor for hypertension. Screening the cases by
the physician for sleep deprivation and OSA and timely diagnosis by
polysomnography (PSG) and treatment by CPAP is crucial to prevent many cardio
metabolic disorders.
 Case Record Form
Title: “SLEEP QUALITY AND OBSTRUCTIVE SLEEP APNEA IN A PATIENTS OF HYPERTENSION’
Patients Id entification Number:
Patient`s Details: DATE: .................

Name of Patient: ..........................................................................

Age: ………………………………DOB: …………………

Sex……………………

Ad d ress………………………………………………………………………………………………

……………………………………………………………………………………………………….

Contact no………………………………………………

Weight (in Kg)…………. Height (in CM)……………

BMI…………. Neck circumfertence:……………..

Past history:

Present history:

Family history:

Clinical examination:

1. General examination……………
2. HR & BP record ing:
a. Duration of hypertension
b. Duration of Treatment
c. Number of Med ications
3.
Blood pressure
Heart rate/min
SBP DBP
1st record
2nd record
3rd record
Average

A) Global PSQI score:

B) EPSWORTH score:
C) STOP-BANG score:
apnea-hypopnea ind ex (AHI)
mild (AHI 5-14)
mod erate (AHI 15-30)
severe (AHI >30)
 STOP BANG QUESTIONNAIRE
Date -
Name:
Age :
Gender:
Please answer the following 8 dichotomous (Yes/ No) questions
Sr.No. Questions YesNo
1 Do you Snore loudly
2 Do you often feel tired, fatigued, or sleepy during the daytime?
3 Has anyone observed that you stop breathing or choke or gasp during your sleep
4 Do you have or are you being treated for high blood pressure?
5 Is your body mass index more than 35 kg/m2?
6 Are you older than 50 years?
7 Is your neck circumference greater than 40 cm?
8 Are you male?
STOP-BANG scores-
i. 0-2:- Low risk of OSA
ii. 3-4:- Moderate risk of OSA
iii > 5:- High risk of OSA
PITTSBURGH SLEEP QUALITY INDEX
CONSENT FORM
PATIENT / PARTICIPANT INFORMATION
SHEET
 THANK-YOU
Dr. Lay .D. Desai (MD
physiology)