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

Abstract

Ab s t r Ac t 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.