International Journal of Infertility & Fetal Medicine

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VOLUME 11 , ISSUE 2 ( May-August, 2020 ) > List of Articles

Original Article

Assessing the Likelihood of Obstructive Sleep Apnea among Infertile Population Using STOPBANG and Modified Berlin Questionnaire: A Cross-sectional Study

Meena Andiappan, Narghis Bushra, Damal Chandrasekar Mathangi, Puvithra Thanikachalam

Keywords : Infertility, Modified Berlin questionnaire, Obstructive sleep apnea, STOPBANG

Citation Information : Andiappan M, Bushra N, Mathangi DC, Thanikachalam P. Assessing the Likelihood of Obstructive Sleep Apnea among Infertile Population Using STOPBANG and Modified Berlin Questionnaire: A Cross-sectional Study. Int J Infertil Fetal Med 2020; 11 (2):42-47.

DOI: 10.5005/jp-journals-10016-1204

License: CC BY-NC 4.0

Published Online: 09-03-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim and objective: Obstructive sleep apnea (OSA), a prevalent and mostly underdiagnosed chronic condition, has been investigated for its cardiovascular, metabolic, and neurocognitive consequences in recent times. Intermittent hypoxia, a characteristic feature of OSA, is believed to play a key role in the pathogenesis of these consequences by inducing systemic as well as organ-specific oxidative stress. Indeed, oxidative stress has been recognized as a major causative factor of infertility. Provided that OSA provokes oxidative stress, infertility could be envisaged as a potential consequence in patients with severe OSA. The presence and severity of OSA and its associated risk with systemic comorbidities like diabetes, hypertension, and stroke were well established. Whereas the presence of OSA and its relationship with infertility remains elusive. Hence, the study was initiated to evaluate the prevalence of OSA among infertile people attending a tertiary care hospital compared with the general population of the same age group using two questionnaires—Modified Berlin and STOPBANG. Materials and methods: A sample of 120 subjects in the reproductive age group with a diagnosis of infertility was screened for the presence of OSA using two standard questionnaires—STOPBANG and Modified Berlin questionnaire. Results: The prevalence of high-risk OSA in infertile subjects was 7.5% by Modified Berlin and 15% by STOPBANG questionnaire. Overall predictive values of the employed questionnaire were fair (ROC area under curve) AUC 0.521 for Modified Berlin and 0.516 for STOPBANG. Multivariate logistic regression analysis revealed male gender, snoring, body mass index (BMI) >25 kg/m2, and neck circumference >40 cm as significant risk factors for moderate to severe sleep apnea among infertile subjects. Conclusion: There is increased OSA risk among infertile people and hence the clinical suspicion of OSA should be increased among infertile people with the polycystic ovarian syndrome (PCOS), oligozoospermia, hypertension, diabetes, and obesity. Clinical significance: Identification of OSA risk among infertile people forms a new perspective in the field of reproductive medicine, thereby helping us to achieve a high success rate in infertility treatment.


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  1. Reddy EV, Kadhiravan T, Mishra HK, et al. Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: a community-based study. Sleep Med 2009;10(8):913–918. DOI: 10.1016/j.sleep.2008.08.011.
  2. Prasad CN. Obstructive sleep apnea hypopnea syndrome – Indian scenario. Persp Med Res 2013;1(1):22–25.
  3. Pinto J, Ribeiro D, Cavallini A, et al. Comorbidities associated with obstructive sleep apnea: a retrospective study. Int Arch Otorhinolaryngol 2016;20(2):145–150. DOI: 10.1055/s-0036- 1579546.
  4. Torres M, Laguna-Barraza R, Dalmases M, et al. Male fertility is reduced by chronic intermittent hypoxia mimicking sleep apnea in mice. Sleep [Internet]. 2014 [cited 2016 Mar 15]
  5. Hirotsu C, Tufik S, Levy Andersen M. Sleep apnea as a potential threat to reproduction. Sleep 2014;37(11):1731–1732. DOI: 10.5665/sleep.4158.
  6. Luboshitzky R, Aviv A, Hefetz A, et al. Decreased pituitary-gonadal secretion in men with obstructive sleep apnea. J Clin Endocrinol Metab 2002;87(7):3394–3398. DOI: 10.1210/jcem.87.7.8663.
  7. Hammoud AO, Carrell DT, Gibson M, et al. Updates on the relation of weight excess and reproductive function in men: sleep apnea as a new area of interest. Asian J Androl 2012;14(1):77–81. DOI: 10.1038/aja.2011.64.
  8. Tamanna S, Geraci SA. Major sleep disorders among women: (women's health series). South Med J 2013;106(8):470–478. DOI: 10.1097/SMJ.0b013e3182a15af5.
  9. Petersen M, Kristensen E, Berg S, et al. Sexual function in female patients with obstructive sleep apnea. J Sex Med 2011;8(9):2560–2568. DOI: 10.1111/j.1743-6109.2011.02358.x.
  10. Kapoor S. The close relationship between sleep disorders and reproductive dysfunction in endocrinology. Front Endocrinol (Lausanne) Frontiers Media SA 2012;3:117. DOI: 10.3389/fendo.2012.00117.
  11. Lee EK, Gutcher ST, Douglass AB. Is sleep-disordered breathing associated with miscarriages? An emerging hypothesis. Med Hypotheses 2014;82(4):481–485. DOI: 10.1016/j.mehy.2014.01.031.
  12. Champagne KA, John Kimoff R, Barriga PC, et al. Sleep disordered breathing in women of childbearing age and during pregnancy. Indian J Med Res 2010;131:285–301.
  13. El-Sayed I. Comparison of four sleep questionnaires for screening obstructive sleep apnea. Egypt J Chest Dis Tuberc 2012;61(4):433–441. DOI: 10.1016/j.ejcdt.2012.07.003.
  14. Nagappa M, Liao P, Wong J, et al. Validation of the STOP-bang questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PLoS ONE 2015;10(12):1371. DOI: 10.1371/journal.pone.0143697.
  15. Chung F, Subramanyam R, Liao P, et al. High STOP-bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. Oxford University Press; 2012;108(5):768–775.
  16. Chaudhry P, Shrivastava D, Jaiswal A. To study the prevelance of etiological factors resposible for subfertility and its correlation with clinical profile in rural India. Indian J Appl Res 2016;5(10):731–735.
  17. Goswami R. Endocrine and metabolic aspects of OSA. Ann Natl Acad Med Sci 2013;49(3&4):122–131.
  18. Kloss JD, Perlis ML, Zamzow JA, et al. Sleep, sleep disturbance, and fertility in women. Sleep Med Rev 2015;22:78–87. DOI: 10.1016/j.smrv.2014.10.005.
  19. Buckley TM, Schatzberg AF. On the interactions of the hypothalamic-pituitary-adrenal (HPA) axis and sleep: normal HPA axis activity and circadian rhythm, exemplary sleep disorders. J Clin Endocrinol Metab Endocrine Society 2005;90(5):3106–3114. DOI: 10.1210/jc.2004-1056.
  20. Goldstein CA, Smith YR. Sleep, circadian rhythms, and fertility. Curr Sleep Med Reports, Springer International Publishing 2016;2(4):206–217. DOI: 10.1007/s40675-016-0057-9.
  21. Reishtein JL, Maislin G, Weaver TE. Outcome of CPAP treatment on intimate and sexual relationships in men with obstructive sleep apnea. J Clin Sleep Med Am Acad Sleep Med 2010;6(3):221–226. DOI: 10.5664/jcsm.27817.
  22. Taskin U, Yigit O, Acioglu E, et al. Erectile dysfunction in severe sleep apnea patients and response to CPAP. Int J Impot Res 2009;22(10): 134–139.
  23. Zhang X-B, Jiang X-T, Du Y-P, et al. Efficacy of continuous positive airway pressure on testosterone in men with obstructive sleep apnea: a meta-analysis. PLoS One Pub Libr Sci 2014;9(12):e115033. DOI: 10.1371/journal.pone.0115033.
  24. Nitsche K, Ehrmann DA. Obstructive sleep apnea and metabolic dysfunction in polycystic ovary syndrome. Best Pract Res Clin Endocrinol Metab 2010;24(5):717–730. DOI: 10.1016/j.beem.2010.08.001.
  25. Hammoud AO, Walker JM, Gibson M, et al. Sleep apnea, reproductive hormones and quality of sexual life in severely obese men. Obesity 2011;19(6):1118–1123. DOI: 10.1038/oby.2010.344.
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