Síndrome das apnéias-hipopnéias obstrutivas do sono: associação com gênero e obesidade e fatores relacionados à sonolência

Abstract

Objective: To study the effects that gender and obesity have on excessive daytime sleepiness (EDS) in individuals with obstructive sleep apnea-hypopnea syndrome (OSAHS), as well as to identify factors associated with EDS in such individuals. Methods: A total of 300 consecutive patients who completed the clinical evaluation satisfactorily and whose polysomnography showed an apnea-hypopnea index (AHI) > 10 events/hour of sleep were selected from a sleep clinic population for inclusion in the study. Results: Mean age was 47 ± 11 years, and mean AHI was 52.1 ± 29.2 events/hour of sleep. Females presented higher mean age, lower EDS scores and less time in apnea . Mean EDS score was 14.7 ± 7.2. The EDS score correlated best with body movements (r = 0.43; p < 0.01), respiratory events during sleep (r = 0.40; p < 0.01), duration of apnea (r = 0.40; p < 0.01), peripheral oxygen saturation (SpO 2 ; r = -0.38; p < 0.01) and AHI (r = 0.37; p < 0.01). Mean body mass index (BMI) was 30.2 ± 5.3 kg/m 2 . Overweight, obesity and morbid obesity were observed in 41, 44 and 5.3% of cases, respectively. Disease severity correlated most strongly with BMI (r = 0.51; p < 0.01). Conclusions: Higher mean age, lower EDS scores and less time spent in sleep apnea time in apnea were associated with being female. Fragmented sleep, number/duration of respiratory events during sleep, SpO 2 levels and obesity were associated with sleepiness. The BMI had a significant effect on OSAHS severity.Keywords: Sleep apnea, obstructive; Sleep apnea syndromes; Polysomnography; Sleep stages; Obesity. ResumoObjetivo: Estudar os efeitos de gênero e obesidade e identificar fatores relacionados à sonolência diurna excessiva (SDE) em indivíduos com síndrome das apnéias-hipopnéias obstrutivas do sono (SAHOS). Métodos: Foram selecionados para inclusão no estudo 300 pacientes consecutivos, atendidos em clínica do sono, com índice de apnéia/hipopnéia (IAH) > 10 eventos/hora de sono, que completaram adequadamente a avaliação clínica. Resultados: A média de idade foi de 47 ± 11 anos e o IAH médio foi de 52,1 ± 29,2 eventos/hora de sono. As mulheres apresentaram maior média de idade, menos sonolência e menos tempo em apnéia. O escore médio de SDE foi de 14,7 ± 7,2. O escore de SDE correlacionou-se melhor com movimentos corpóreos (r = 0,43; p < 0,01), eventos respiratórios durante o sono (r = 0,40; p < 0,01), tempo em apnéia (r = 0,40; p < 0,01), valores mínimos da saturação periférica de oxigênio (SpO 2 ; r = -0,38; p < 0,01) e IAH (r = 0,37; p < 0,01). O índice de massa corpórea (IMC) médio foi de 30,2 ± 5,3 kg/m 2 . Sobrepeso, obesidade e obesidade mórbida foram observados em, respectivamente, 41, 44 e 5,3% dos casos. A gravidade da doença correlacionou-se melhor com IMC (r = 0,51; p < 0,01). Conclusões: Maior média de idade, menor escore de SDE e menor tempo em apnéia foram associados ao gênero feminino. Fragmentação do sono, número e duração de eventos respiratórios durante o sono, níveis de SpO 2 e obesidade se associaram à sonolência. O IMC teve efeito significat...

Weak Correlation between Clinical Parameters and Polysomnography Findings

“…Regarding BMI, many studies have considered this to be the most important variable for predicting OSAS [5,7,8], our data, however, did not confirm this, and indeed found that even non-obese men under age 50 years can suffer from OSAS. This finding corroborates the approach recommended by the Brazilian Ministry of Health, which does not include a preoperative PSG examination for bariatric surgery and stresses that the clinical data are superior to laboratory findings.…”

“…The patient profile revealed a higher risk of OSAS in obese males [5], but although men had a 1.5-fold greater chance of presenting with a moderate-to-severe AHI than women, this finding was not consistent statistically; a similar finding was reported by Knorst et al [5], Compared to other studies, in the present study, the large number of women (42%) included is remarkable, which reported a lower prevalence [5,6,8,10]. Thus, the reported tendency towards an OSAS sub-diagnosis in women based on incipient clinical findings [7], might be reduced in our sample.…”

“…Thus, the objective of the present study was to retrospectively compare the request of the sleep exam and the diagnosis of the sleep apnea and other sleep disorders and also to test the correlations between clinical parameters such as body mass index (BMI) [2,5,6], neck circumference [7][8][9], age [10] and the presence or severity of OSAS.…”

High risk for sleep apnea in the Berlin questionnaire and coronary artery disease

“…Obesity [20,21], advanced age [22], and gender [23,24] are involved in OSA pathophysiology [25,26]. These factors are similar to the ones implicated in coronary artery disease (CAD) [27].…”

Fonoaudiologia e apneia do sono: uma revisão

“…A síndrome das apneias obstrutivas do sono envolve respiração e é de grande valia clínica 46 . O exame objetivo tem seus méritos, e inclui a avaliação geral do individuo para detecção de obesidade e da distribuição da gordura corporal.…”