Sonolência e apnéia do sono: uma parceria desastrosa

Abstract

Editoriala cross-sectional study of 300 patients with OSAHS, re-affirmed the repercussions of its morbid relationship with obesity, highlighting body mass index (BMI) as the clinical parameter that has the greatest impact on the severity of OSAHS. In a previous study of 1,595 patients evaluated at a sleep laboratory in Salvador, Brazil, we obtained similar results.(7) Regardless of the BMI, the distribution of body fat, central obesity in particular, is the relevant factor to consider under these circumstances, with special emphasis on waist/hip ratio and neck circumference-the latter being considered the best predictor of OSAHS.(2) A recent study involving magnetic resonance imaging of the upper airways to evaluate obese individuals with and without OSAHS showed that, in isolation, greater deposition of fat at this anatomical level is not a determining factor for the development of OSAHS.(8) Of special note is the fact that the excessive daytime sleepiness caused by OSAHS is correlated with traffic accidents, as is well documented in the Knorst et al. study appearing in this issue. We pulmonologists are increasingly called upon to manage quality-of-life issues, whether through monitoring environmental pollution, attempting to improve aerobic performance, encouraging smoking cessation, or promoting workplace sanitation, and, by extension, reducing the damage and insults that such factors cause in the lives of our patients. Within this context, the identification and appropriate treatment of individuals suffering from OSAHS will undoubtedly lead to a reduction in the number of traffic accidents, a statistic in which Brazil, sadly, is one of the world champions. Knorst et al., in what I consider the greatest contribution of their study, reported that 238 (79.3%) of the 300 patients studied drove cars on a regular basis, and that 106 (44.5%) of those patients admitted to having dozed off while driving. As would be expected, those patients presented high scores on the sleepiness scale. Classically, individuals with OSAHS have two cardinal complaints: snoring and excessive daytime sleepiness.(9,10) The mere presence of OSAHS results in an up to six-fold increase in the risk of having a traffic accident due to falling asleep at the wheel.(1,9,11) The Brazilian National Transportation Council recently adopted a strategy long employed in other countries, recommending polysomnography for individuals clinically suspected of having OSAHS, as determined by physicians performing the Based on current knowledge, sleep-disordered breathing should be considered to consist of a broad spectrum of pathophysiological events, with systemic clinical repercussions, that have long been grouped under the single heading of sleep apnea syndrome. More recent evidence indicates that there is an evolution that tends to be progressive-from primary snoring to the classic presentation of obstructive sleep apnea-hypopnea syndrome (OSAHS).(1,2) This evolution presents distinct stages of the same pathophysiological process rather than one specific ...