Hubungan Indeks Massa Tubuh dan Lingkar Leher dengan Kejadian Obstructive Sleep Apnea pada Strok Iskemik
Abstract
Abstrak
Obstructive sleep apnea (OSA) telah ditunjukkan dapat meningkatkan risiko kematian. Penelitian di Korea menunjukkan terjadi peningkatan tingkat mortalitas seiring dengan peningkatan keparahan OSA. Peningkatan deposit lemak atau obesitas viseral di sekitar faring dapat menjadi salah satu penyebab penyempitan saluran napas atas. Prevalensi strok di Jawa Barat adalah 6,6‰, terjadi peningkatan dari tahun 2007. Prevalensi OSA pada pasien strok adalah 60%, sedangkan prevalensi OSA pada populasi nonstrok adalah 4%. Penelitian ini adalah penelitian kasus-kontrol yang dilakukan dengan subjek penelitian sebanyak 56 orang pasien strok iskemik di poli saraf RSAU dr. M. Salamun periode Maret–Mei 2017. Dilakukan pengukuran berat badan dan tinggi badan untuk pengukuran indeks massa tubuh (IMT) dan lingkar leher, lalu ditentukan derajat risiko kejadian OSA. Derajat risiko kejadian OSA dinilai menggunakan skor STOP-BANG yang terdiri atas delapan pertanyaan. Hasil skor dibagi menjadi tiga kelompok risiko: (1) risiko tinggi (5–8), (2) risiko sedang (3–4), dan (3) risiko rendah (0–2). Kelompok kasus adalah kelompok dengan derajat risiko tinggi. Pada penelitian ini tidak didapatkan hubungan bermakna antara IMT dan derajat risiko kejadian OSA (p=0,866). Ditemukan hubungan bermakna antara lingkar leher dengan derajat risiko tinggi kejadian OSA (p=0,001) dengan 66,7% dari kelompok lingkar leher abnormal. Simpulan, terdapat hubungan bermakna antara lingkar leher dengan OSA baik pada pasien obesitas atau non-obesitas, tetapi tidak ditemukan hubungan bermakna antara IMT dengan kejadian OSA.
Abstract
One of the strongest risk factor for obstructive sleep apnea (OSA) is obesity with body mass index (BMI) more than 30 kg/m2. Stroke prevalence in Jawa Barat is 6,6‰ which incresed since 2007. The OSA prevalence on stroke patient is 60%, compared to OSA prevalence on general adult population for 4%. The study aims to describe the relations between BMI and neck circumferences (NC) with OSA incidence. The study is a case control study comprised of 41 subjects who are stroke ischemic patients in neurology unit at RSAU dr. M. Salamun Bandung on March–May 2017. Body height and body weight was measured for BMI measurement, and NC. Risk degree for OSA is then determinded by using STOP-BANG scoring which consist of eight questions. The interpretation of the scoring then divided to 3 categories: (1) high risk (5–8), (2) intermediate risk (3–4), and (3) low risk (0–2). The cases are those in the high risk categories. In this study, there are no relation found between BMI and OSA incidence (p=0.792, p≤0.05). Meanwhile there is a relation found between NC with OSA incidence (p=0.039, p≤0.05) with 71.4% from normal neck circumference group. In conclusion, there is a significant relation between NC with OSA incidence whether in obese or non-obese patient, meanwhile there are no significant relation found between BMI with OSA incidence.
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Lee W, Nagubadi S, Kryger MH, Mokhlesi B. Epidemiology of obstructive sleep apnea: a population-based perspective. Expert review of respiratory medicine. 2008 Juni 1;2(3):349-364.
Dutt N, Janmeja AK, Mohapatra PR, Singh AK. Quality of life impairment in patients of obstructive sleep apnea and its relation with the severity of disease. Lung India : Official Organ of Indian Chest Society. 2013 Okt-Des; 30(4):289-294.
Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005 Nov 10;353:2034-41.
Parra O, Arboix A, Bechich S, dkk. Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med 2000;161: 375-80.
Departemen Kesehatan RI. Riset Kesehatan Dasar Tahun 2013. [diunduh 2 Februari 2017]. Tersedia dari: http://www.depkes.go.id/resources/download/general/Hasil%20Riskesdas%202013.pdf
Dinas Kesehatan Kota Bandung. Profil Kesehatan Kota Bandung Tahun 2012. [diunduh 2 Februari 2017]. Tersedia dari: http://www.depkes.go.id/resources/download/profil/PROFIL_KAB_KOTA_2012/3273_Jabar_Kota_Bandung_2012.pdf
Blackburn H, Jacobs, Jr. D. Commentary: Origins and evolution of body mass index (BMI): continuing saga. Int J Epidemiol. 2014 Mar 29;43(3):665-669.
Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, De Paula LKG, Amaro ACS, dkk. Obstructive sleep apnea. Hypertention. 2011 Oktober 19;58:811-17.
Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: A practical approach to screen for obstructive sleep apnea. Chest. 2016 Mar;149(3):631-8.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurance of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993 Apr 29;328(17):1230-5.
Young T, Peppard PE, Taheri S. Excess weight and sleep-diordered breathing. J Appl Physiol. 2005 Okt;99:1592-9.
Dempsey JA, Veasey SC, Morgan BJ, O’donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010; 90:47-112.
Kawaguchi Y, Fukumoto S, Inaba M, Koyama H, Shoji T, Shoji S, Nishizawa Y. Different impacts of neck circumference and visceral obesity on the severity of obstructive sleep apnea syndrome. Obesity. 2011 Feb. 19: 276–282. doi:10.1038/oby.2010.170
Stardling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax. 1991 Feb;46(2):85-90.
Carmelli D, Swan GE, Bliwise DL. Relationships of 30-years changes in obesity to sleep-disordered breathing in the western collaborative study group. Obesity Research. 2000 Des;8(9):632-7.
Patil SP, Schneider H, Schwartz AR, Smith PL. Adult Obstructive Sleep Apnea: Pathophysiology and Diagnosis. Chest. 2007 Jul; 132(1):325. doi:10.1378/chest.07-0040.
Greenberg H, Lakticova V, Scharf SM. Obstructive sleep apnea: Clinical features, evaluation, and principle of management. Dalam: Kyger MH, Roth T, Dement WC. Principles and practice of sleep medicine. Philadelphia: Elsavier; 2017. hlm. 1110-26.
Dancey DR, Hanly PJ, Soong C, dkk. Gender differences in sleep apnea: the role of neck circumference. Chest 2003;123:1544–1550.
Irasanti SN, Azis Y, Sukarya WS. Pengaruh inovasi jasa dan harga terhadap nilai yang dirasakan pasien di Stroke Center RS Al-Islam Bandung. GMHC. 2015;3(1):25–31.