Perfil clínico de pacientes con sospecha de apneas del sueño

Ramiro Horacio Rojas Mendiola; Marcela Smurra; Marina Khoury

doi:10.31053/1853.0605.v78.n3.25531

Autores

Ramiro Horacio Rojas Mendiola Hospital Enrique Tornú
Marcela Smurra Hospital Enrique Tornú
Marina Khoury Instituto de Investigaciones Médicas Alfredo Lanari

DOI:

https://doi.org/10.31053/1853.0605.v78.n3.25531

Palavras-chave:

apneia obstrutiva do sono, signos e sintomas, análise multivariada

Resumo

Introdução: A síndrome da Apneia/Hipopneia Obstrutiva do Sono (SAHOS) é uma patologia com prevalência crescente que produz um impacto significativo na qualidade de vida e na morbimortalidade, principalmente cardiovascular.
Objetivos: Descrever sintomas, comorbidades e medidas antropométricas de pacientes avaliados clinicamente e submetidos a estudos do sono para identificar variáveis associadas a um Índice de Distúrbios Respiratórios (IDR) maior ou igual a 15.
Material e métodos: Foram revisados questionários autoadministrados, antropometria, comorbidades e estudos do sono de pacientes consultados no consultório de patologia respiratória do sono entre junho de 2012 e maio de 2016.
Resultados: Entre os 366 pacientes incluídos, 47,5% foram encontrados com IDR> 30, 21,9% com IDR 15 a 29,9, 22,1% com IDR 5 a 14,9 e 8,5% com IDR <5. O modelo multivariado, utilizando a IDR≥15 como variável dependente, mostrou que uma frequência de ronco superior a 3 noites por semana (OR 2,89, IC 95% 1,66 - 5,05), IMC≥35 Kg / m2 (OR 2,53, IC 95% 1,35 - 4,72), apnéias testemunharam quase todas as noites (OR 1,95, IC 95% 1,09 - 3,49), sexo masculino (OR 1,81, IC 95% 1,10 - 2,97) e presença de hipertensão arterial (OR 1,67, 95% IC 1,02 - 2,74) foram os fatores clínicos mais significativos.
Conclusões: Em nossa amostra, os preditores mais significativos da presença de um IPR≥15 foram: frequência de ronco superior a 3 noites por semana, IMC≥35 Kg / m2, apnéia testemunhada durante quase todas as noites, sexo masculino e presença de hipertensão.

Downloads

Os dados de download ainda não estão disponíveis.

Referências

1. Nogueira F, Borsini E, Cambursano H, Smurra M, Dibur E, Franceschini C, Perez-Chada D, Larrateguy L, Nigro C. Guías prácticas de diagnóstico y tratamiento del síndrome de apneas e hipopneas obstructivas del sueño: Actualización 2019. Rev. am. med. Respir. 2019 Mar; 19(1):59-90. http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1852-236X2019000100007

2. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991 Dec;14(6):540-5. doi: 10.1093/sleep/14.6.540.

3. Sala H, Nigro C, Rabec C, Guardia AS, Smurra M. Consenso Argentino de trastornos respiratorios vinculados al sueño [Argentine consensus on sleep-related respiratory disorders]. Medicina (B Aires). 2001;61(3):351-63. Spanish.

4. Berry R, Brooks R, Gamaldo C, Harding S, Lloyd R, Marcus C, Vaughn B. The AASM Manual for the Scoring of Sleep and Associated Events. Rules, terminology and technical specifications. Version 2.2 American Academy of Sleep Medicine. 2015; 18-78

5. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91. doi: 10.7326/0003-4819-131-7-199910050-00002.

6. Chung F, Yang Y, Brown R, Liao P. Alternative scoring models of STOP-bang questionnaire improve specificity to detect undiagnosed obstructive sleep apnea. J Clin Sleep Med. 2014 Sep 15;10(9):951-8. doi: 10.5664/jcsm.4022.

7. Schiavone M, Ernst G, Blanco M, Avaca H, Acosta AL, Nosetto D, Manuale O, Salvado A, Borsini E. Performance of questionnaires aimed at detecting sleep disorders in patients attending a hypertension center. Clin Exp Hypertens. 2019;41(7):687-691. doi: 10.1080/10641963.2018.1539095.

8. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, Walsleben JA, Finn L, Enright P, Samet JM; Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002 Apr 22;162(8):893-900. doi: 10.1001/archinte.162.8.893

9. Maimon N, Hanly PJ. Does snoring intensity correlate with the severity of obstructive sleep apnea? J Clin Sleep Med. 2010 Oct 15;6(5):475-8.

10. Jonas DE, Amick HR, Feltner C, Weber RP, Arvanitis M, Stine A, Lux L, Harris RP. Screening for Obstructive Sleep Apnea in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017 Jan 24;317(4):415-433. doi: 10.1001/jama.2016.19635. Erratum in: JAMA. 2017 Mar 28;317(12 ):1278.

11. Baguet JP, Lévy P, Barone-Rochette G, Tamisier R, Pierre H, Peeters M, Mallion JM, Pépin JL. Masked hypertension in obstructive sleep apnea syndrome. J Hypertens. 2008 May;26(5):885-92. doi: 10.1097/HJH.0b013e3282f55049.

12. Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, Leung RS, Bradley TD. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001 Dec;19(12):2271-7. doi: 10.1097/00004872-200112000-00022.

13. Friedman O, Bradley TD, Chan CT, Parkes R, Logan AG. Relationship between overnight rostral fluid shift and obstructive sleep apnea in drug-resistant hypertension. Hypertension. 2010 Dec;56(6):1077-82. doi: 10.1161/HYPERTENSIONAHA.110.154427.

14. O'Connor GT, Caffo B, Newman AB, Quan SF, Rapoport DM, Redline S, Resnick HE, Samet J, Shahar E. Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2009 Jun 15;179(12):1159-64. doi: 10.1164/rccm.200712-1809OC.

15. Cano-Pumarega I, Durán-Cantolla J, Aizpuru F, Miranda-Serrano E, Rubio R, Martínez-Null C, de Miguel J, Egea C, Cancelo L, Alvarez A, Fernández-Bolaños M, Barbé F. Obstructive sleep apnea and systemic hypertension: longitudinal study in the general population: the Vitoria Sleep Cohort. Am J Respir Crit Care Med. 2011 Dec 1;184(11):1299-304. doi: 10.1164/rccm.201101-0130OC.

16. Soylu AC, Levent E, Sarıman N, Yurtlu S, Alparslan S, Saygı A. Obstructive sleep apnea syndrome and anthropometric obesity indexes. Sleep Breath. 2012 Dec;16(4):1151-8. doi: 10.1007/s11325-011-0623-9.

17. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008 May;108(5):812-21. doi: 10.1097/ALN.0b013e31816d83e4.

18. Caffo B, Diener-West M, Punjabi NM, Samet J. A novel approach to prediction of mild obstructive sleep disordered breathing in a population-based sample: the Sleep Heart Health Study. Sleep. 2010 Dec;33(12):1641-8. doi: 10.1093/sleep/33.12.1641.

19. Lee W, Nagubadi S, Kryger MH, Mokhlesi B. Epidemiology of Obstructive Sleep Apnea: a Population-based Perspective. Expert Rev Respir Med. 2008;2(3):349-364. doi:10.1586/17476348.2.3.349

20. Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, Wadden TA, Kelley D, Wing RR, Sunyer FX, Darcey V, Kuna ST; Sleep AHEAD Research Group. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009 Jun;32(6):1017-9. doi: 10.2337/dc08-1776.

21. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002 Mar 1;165(5):670-6. doi: 10.1164/ajrccm.165.5.2103001

22. Dawson A, Abel SL, Loving RT, Dailey G, Shadan FF, Cronin JW, Kripke DF, Kline LE. CPAP therapy of obstructive sleep apnea in type 2 diabetics improves glycemic control during sleep. J Clin Sleep Med. 2008 Dec 15;4(6):538-42.

23. Hoflstein V. Relationship between smoking and sleep apnea in clinic population. Sleep. 2002 Aug 1;25(5):519-24.

24. C. Balaguer et al. Tabaco y trastornos del sueño. Arch Bronconeumol. 2009;45(9):449–458

25. Nam H, Lim JS, Kim JS, Lee KJ, Koo DL, Lee C. Sleep Perception in Obstructive Sleep Apnea: A Study Using Polysomnography and the Multiple Sleep Latency Test. J Clin Neurol. 2016 Apr;12(2):230-5. doi: 10.3988/jcn.2016.12.2.230

26. Benbadis SR, Mascha E, Perry MC, Wolgamuth BR, Smolley LA, Dinner DS. Association between the Epworth sleepiness scale and the multiple sleep latency test in a clinical population. Ann Intern Med. 1999 Feb 16;130(4 Pt 1):289-92. doi: 10.7326/0003-4819-130-4-199902160-00014.

27. Daurat A, Sarhane M, Tiberge M. Syndrome d'apnées obstructives du sommeil et cognition : une revue [Obstructive sleep apnea syndrome and cognition: A review]. Neurophysiol Clin. 2016 Jun;46(3):201-15. French. doi: 10.1016/j.neucli.2016.04.002.

28. Corral J, Sánchez-Quiroga MÁ, Carmona-Bernal C, Sánchez-Armengol Á, de la Torre AS, Durán-Cantolla J, Egea CJ, Salord N, Monasterio C, Terán J, Alonso-Alvarez ML, Muñoz-Méndez J, Arias EM, Cabello M, Montserrat JM, De la Peña M, Serrano JC, Barbe F, Masa JF; Spanish Sleep Network. Conventional Polysomnography Is Not Necessary for the Management of Most Patients with Suspected Obstructive Sleep Apnea. Noninferiority, Randomized Controlled Trial. Am J Respir Crit Care Med. 2017 Nov 1;196(9):1181-1190. doi: 10.1164/rccm.201612-2497OC