Obstructive sleep apnea: from the beginnings, to the risk factors and to occupational medicine assessment

Abstract

Over the last thirty years, the pathogenesis of obstructive sleep apnea syndrome (OSAS) has begun to be elucidated worldwide due to the presence of standardized diagnostic and treatment. In adults, the clinical diagnosis may be suggestive of OSAS when symptoms like fatigue, lack of concentration, poor work performance, absenteeism, daytime sleepiness, insomnia, snoring, nocturnal respiratory distress or apnea episodes witnessed by others are present. Some medical conditions found in employees’ personal history such as craniofacial abnormalities, some endocrine diseases, arterial hypertension, especially resistant arterial hypertension, coronary artery disease, atrial fibrillation, congestive heart failure, stroke, obesity, diabetes mellitus, cognitive dysfunction or mental disorders may be the alarm signal for OSAS. The assessment of all risk factors, clinical presentation and diagnosis must become an important part of occupational medical examinations and performed in all workers due to its major public health potential and impact on survival. The early identification of OSAS among workers performed by the occupational physician can potentially reduce the risk of work injuries and fatalities. In conclusion, OSAS is a complex entity and an important public health problem. The delay in diagnosis and treatment contributes to the increase of healthcare services demand and implicitly to general mortality.

The Triad Nocturia, Smoking and Obstructive Sleep APnea

“…Despite these, the intervention by continuous positive airway pressure (CPAP) in reducing the number of the nocturnal voiding [9] is a strong argument for an independent existing relation between nocturia and OSA. Sometimes more efficient measures and therapies have to be associated in OSA patients as smoking cessation, losing weight by exercise and hypocaloric diet, or even dental interocclusal thermoformed appliances for preventing other risk factors of sleep disturbances [13,14]. We also found a significant incidence of comorbidities, as previously reported in other OSA studies [15], some of them having a direct effect on the nocturnal, intermittent obstruction, while others only sharing common pathogenic pathways [16] or being therapy related [17].…”

Relationship Between Obstructive Sleep Apnoea, Oxygen Desaturation and Cardiovascular Risk

“…Recent studies demonstrate that OSA is a common treatable cause of drug-resistant hypertension, risk factor for paroxysmal supraventricular tachycardia and atrial fibrillation, is an independent risk factor for ischemic stroke [15,16]. OSAS comorbidities are not fully identified, but cardiovascular diseases (treatmentresistant hypertension, arrhythmias, myocardial infarction, even sudden death), metabolic diseases (obesity and diabetes), obstructive lung diseases (COPD and asthma), neurological diseases, psychiatric disorders are considered pathological consequences, that can be prevented [17][18][19][20] in order to preserve the social integration and professional activity [8]. The education of patients to recognize the symptoms of sleep apnea and to apply the available effective treatments is a stringent necessity [17,18].…”

“…OSAS comorbidities are not fully identified, but cardiovascular diseases (treatmentresistant hypertension, arrhythmias, myocardial infarction, even sudden death), metabolic diseases (obesity and diabetes), obstructive lung diseases (COPD and asthma), neurological diseases, psychiatric disorders are considered pathological consequences, that can be prevented [17][18][19][20] in order to preserve the social integration and professional activity [8]. The education of patients to recognize the symptoms of sleep apnea and to apply the available effective treatments is a stringent necessity [17,18]. The limitation of the present study was the absence of a control population, but this was not regarded as important since the study did not seek to identify any separate cardiovascular risk related to OSAS.…”