Commercial vehicle drivers are required to maintain Department Of Transportation medical certification which entails a Commercial Driver Medical Examination (CDME) and optimally leads to a two-year certification. The examination must be performed by a licensed "medical examiner" administered by a variety of health care providers including physicians, advanced registered nurse practitioners, physician assistants and doctors of chiropractic. Unfavorable findings in the examination can yield either a shortened medical certification period or denial of certification. Sleep disorders including sleep apnea are assessed by a single question located in the health history portion of the CDME form which is filled-out by the examinee. A positive response to this single item often prompts the medical examiner to further supplement this question using a subjective questionnaire, such as the Epworth Sleepiness Scale. This particular questionnaire generates a total score based on the examinee's subjective responses to eight items regarding the propensity to doze-off or fall asleep in different scenarios, thus indicating daytime sleepiness. Commercial drivers depend on the medical certification for their livelihood and it is hypothesized that subjective responses regarding daytime sleepiness are distorted in an effort to attain optimal DOT certification.

Nowadays, sleep disorders e.g. sleep apnea —the cessation of airflow at the nose and mouth lasting at least 10 second— are a broadly problem around the world. Direct and indirect costs associated to sleep problems are outsize and the quality of patient life is deteriorated because of it. In addition, Sleep is a fundamental part of everyday life, the lack of it or the poor quality of sleep may lead into the development of important diseases. Sleep studies are usually carried out by specialists by means of polysomnography. Polysomnography is a type of sleep study which is consisting of EEG, EOG, EMG, ECG, respiratory signals and/or many other biosignals which together can be used to determine the state of patient’s sleep and any other issue. Nowadays, visual inspection of these signals forms the “gold standard” in sleep clinics. The cost of monitoring a person overnight, the scarcity of beds available and the uncertainty of whether the results are representative of a normal nights’ sleep means that a move to home diagnostics is likely to be advantageous. Therefore, a necessity for home recorders systems capable of perform this kind of analysis has come out. A state machine based automatic scorer is developed and evaluated in Matlab by using 12 recordings of apnoeic patients from sleep heart health study (SHHS) database. By the analysis of EEG, EOG, EMG, Oxygen saturation (Sao2) and respiratory movements signals, the implemented algorithm is trained and evaluated to detect the five stages of subject’s sleep (Wake, N1, N2, N3, or REM) as well as apnoeic episodes according to guidelines from American Academy of Sleep Medicine (AASM). In the final evaluation of algorithms, the automatic scorer achieved 74±5.27% accuracy for all five stages and Cohen’s kappa of 0.5 for the overall set of 12 patients, being the accuracy better for healthier subjects and reaching in this case 78±4.05%. The analysis of the sleep apnea concluded with a sensitivity of 47.08%, a specificity of 83.38%, and an accuracy of 78.1%. Differences in the performance among patients according to their apnea/hypopnea index were significant.   Key Words: Polysomnography, AASM, Sleep apnea/hypopnea.

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Introduktion: Sömn är en erkänt viktig del för idrottslig prestation. Intresset och möjligheterna att övervaka den har ökat betänkligt till följd av antalet tillgängliga sömnmonitorerande bärbara verktyg (SBV) idag. Denna utrustning bidrar med en möjlighet att kontinuerligt samla in data, men till följd av den snabba utvecklingen av dessa verktyg finns det ett ständigt behov av mer valideringsarbete.   Syfte: Syftet med litteraturöversikten var att undersöka och redogöra hur väl olika sömnmonitorerande bärbara verktyg kan monitorera sömn i relation till polysomnografi (PSG), nivå I bland friska individer.   Metod: En strukturerad litteratursökning utfördes i databaserna SPORTdiscus och PubMed under tidsperioden 2023-03-15 till och med 2023-04-06 med syftet att identifiera artiklar som jämförde kommersiellt tillgängliga SBV mot PSG, nivå I bland friska individer. Vi utvärderade kvaliteten och risken för bias för de inkluderade studierna genom en modifierad checklista av Downs & Black (1998).  Resultat: Efter en granskning av 213 artiklar inkluderades 11 av dem, innehållandes totalt 368 deltagare. Resultatet visade att SBV har svårigheter att korrekt estimera tid spenderad i respektive sömnfas i jämförelse mot PSG. Förmågan att uppskatta Total Sleep Time (TST) och Wake After Sleep Onset (WASO) varierade stort mellan de olika modellerna. Gällande Sleep Onset Latency (SOL), hjärtfrekvensen (HR) och hjärtfrekvensvariabiliteten (HRV) var det få statistiskt signifikanta resultat samt antal studier som undersökte dessa tre variabler.  Konklusion: I dagsläget har SBV problem att uppmäta tiden spenderad i respektive sömnfas, och uppvisar varierande resultat i fråga om estimeringen av TST och WASO. Gällande SOL, HR och HRV fanns det inte tillräckligt med underlag i de inkluderande studierna för att dra slutsatser om förmågan hos SBV att uppskatta dessa variabler. Individer bör vara försiktiga vid appliceringen av data från verktygen, samt medvetna om de eventuella risker som kan tillkomma när denna data introduceras inom den atletiska populationen. / Introduction: Sleep is widely recognized as an important factor for athletic performance. The interest and possibility of measuring it has increased dramatically following the number of available wearable devices today. These wearables provide an opportunity to continuously collect data in a home environment, but because of the rapid increase of commercial availability, there remains a constant need for more validation of the most recent models.   Purpose: The purpose of this review was to examine the capability of different wearables to monitor sleep in comparison to polysomnography (PSG), level I in healthy individuals.  Method: A structured literature review was performed in the databases SPORTDiscus and PubMed under the period 2023-03-15 until 2023-04-06 with the aim of identifying relevant articles that compared commercially available wearables to PSG level I in healthy individuals. We assessed the quality and risk of bias of the included studies with a modified questionnaire from Downs & Black (1998).  Results: After screening 213 articles, 11 of them were included, which in total amounted to 368 participants. The result showed that wearables struggle to correctly estimate the time spent in each sleep-stage in comparison with PSG. The capability to assess Total Sleep Time (TST) and Wake After Sleep Onset (WASO) varied between the different models. There were few statistically significant results of the ability to measure Sleep Onset Latency (SOL), Heart Rate (HR) and Heart Rate Variability (HRV).  Conclusion: Wearables have, at present time, a difficult time correctly estimating time spent in each sleep-stage and show varied results in monitoring TST and WASO. Too few studies analyzed SOL, HR and HRV to draw conclusions regarding these variables. Individuals should be cautious when implementing the data from these devices, and aware of the potential risks when it is used with athletes.

<p>Poremećaji disanja tokom spavanja (Sleep disordered breathing &ndash; SDB) obuhvataju spektar bolesti koje nastaju usled povećanog otpora u gornjem disajnom putu i reflektuje se na spavanje. Najveća podgrupa SDB su prekidi disanja tokom spavanja ili sleep apnea sindrom (Sleep Apnea Syndrome &ndash; SAS). SDB su prisutni kod 20% op&scaron;te populacije, dok je 82% mu&scaron;karaca i 93% žena koje imaju umerenu i te&scaron;ku OSA nedijagnostikovano. Kako osnovna dijagnostička metoda, polisomnografija, zahteva stručan kadar i adekvatnu laboratorijsku opermu nameće se potreba za brzom, efikasnom i jeftinom skrining metodom pri dijagnostici SAS. Cilj ove studije jeste da se uradi validacija i prevođenje &ldquo;STOP BANG&ldquo; upitnika sa engleskog na srpski jezik i utvrdi njegova specifičnost i senzitivnost u odnosu na vrednosti AHI indeksa kod odraslih ispitanika pri dijagnostikovanju SAS i da se utvrdi senzitivnost i specifičnost &ldquo;STOP BANG&ldquo; upitnika i Epfortove skale pospanosti zajedno. Istraživanje je u potpunosti sprovedeno u Centru za patofiziologiju disanja sa medicinom sna Instituta za plućne bolesti Vojvodine, Sremska Kamenica. Studijsku grupa se sastojala od 102 ispitanika koji su popunjavali oba upitnika, a potom je svima urađena polisomnografija. Testiranje &bdquo;STOP BANG&ldquo; upitnikom, kao i retest nakon mesec dana uradilo 30 ispitanika. Rezultati istraživanja pokazuju da su u uzorku dominirale osobe mu&scaron;kog pola 69,6%. Prosečna starost je iznosila 50,1&plusmn;13,8 godina. Najveći broj ispitanika je imao poremećaj disanja tokom spavanja (73,5%). Prema stepenu težine najveći broj ispitanika (30,4%) je bolovao od te&scaron;kog oblika (apnea/hipopnea indeks- AHI&gt;30), a prema tipu poremećaja dominirali su opstruktivni poremećaji sa 66,7% u ukupnom uzorku. Prekomerna dnevna pospanost, merena Epfortovom skalom pospanosti, bila je prisutna kod 58,8% ispitanika i korelirala je sa stepenom težine poremećaja (r=0,43). Dobijena senzitivnost i specifičnost za &bdquo;STOP BANG&ldquo; upitnik je iznosila 62,7% i 51,9% respektivno. &bdquo;STOP BANG&ldquo; upitnik je preveden na srpski jezik, a zatim je urađen test i retest upitika gde nije bilo razlike u odgovorima. Dobijena je granična vrednost za &bdquo;STOP BANG&ldquo; upitnik koja iznosi 4.5, a senzitivnost i specifičnost testa za različit stepen težine SAS je zadovoljavajuća i iznosila je 70,7%/66,7% za laku, 78,6% /60,9% za umerenu i 87,4%/ 50,7% za te&scaron;ku sleep apneu. Pri poređenju oba upitnika zajedno dobijena je bolja specifičnost 85,2%, 76,1%, 69,0% ali lo&scaron;ija senzitivnost 53,3%, 58,9% ,71,0% za laku , umerenu i te&scaron;ku sleep apneu respektivno u grupi ispitanika koji su imali vrednosti oba upitnika iznad graničnih vrednosti. U grupi ispitanika gde je jedan od upitnika imao vrednosti iznad granične vrednosti dobijena je bolja senzitivnost ali lo&scaron;ija specifičnost u odnosu na samo &bdquo;STOP BANG&ldquo; upitnik. Istraživanjem je utvrđen skrining metod -&ldquo;STOP BANG&ldquo; upitnik, koji stratifikuje pacijente na osnovu kliničkih simptoma, fizičkog pregleda i prisustva faktora rizika, na one pacijente sa visokim rizikom kojima treba hitno uraditi polisomnografiju i uputiti ih dalje na lečenje i na one kojima polisomnografija nije potrebna.</p> / <p>Sleep disordered breathing (SDB) includes a spectrum of diseases occurring due to an increased resistance in the upper airway, which affects sleeping. The major SDB subgroup is sleep apnea syndrome (SAS). SDB is present in 20% of the general population, and among the subjects with a moderate or severe SAS, 82% of males and 93% of females remain undiagnosed. Since polysomnography - the basic diagnostic method, requires a well-trained staff and adequate laboratory equipment, the need for a fast, efficient and cheap screening method in the diagnosis of SAS has breen imposed. Objectives of the study are to evaluate and translate the &ldquo;STOP BANG&ldquo; questionnaire from English to Serbian, establish its specificity and sensitivity in relation to the apnea hypopnea index (AHI) values while diagnosing SAS in adults, and to assess the cumulative sensitivity and specificity of the &ldquo;STOP BANG&ldquo; questionnaire and Epworth Sleepiness Scale. The investigation has been entirely carried out in the Lung Function and Sleep Medicine Centre of the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica. The study cohort included 102 subjects who were all, having answered both questionnaires first, submitted to polysomnography. Thirty subjects were tested by the &bdquo;STOP BANG&ldquo; questionnaire, and retested a month later. Results of the investigation show the male sex predominated in the study sample (69.6%). The subjects&#39; mean age was 50.1&plusmn;13.8 years. Most subjects had SDB (73.5%). The majority of ther subjects (30.4%) had a serious SDB form (AHI&gt;30). Obstuctive disorders prevailed, registered in 66.7% of the study population. Excessive daily sleepiness, measured by the Epworth sleepiness scale, was registered in 58.8% of the examined subjects, correlating well to the disorder severity level (r=0.43). Sensitivity and specificity obtained for the &bdquo;STOP BANG&ldquo; questionnaire amounted to 62.7% and 51.9% respectively. The &bdquo;STOP BANG&ldquo; questionnaire was translated to Serbian first, followed by testing an retesting using the questionairre, providing no differences in the obtained answeres. The obtained cut-off value for the &bdquo;STOP BANG&ldquo; questionnaire was 4.5, and the test sensitivity and apecificity for different SAS severity levels were satisfactory, amounting to 70.7%/66.7% for mild, 78.6% /60,9% for moderate, and 87.4%/50.7% for severe sleep apnea. The cumulative comparation of the two questionnaires has disclosed a better specificity of 85.2%, 76.1%, and 69.0%, but a worse sensitivity of 53.3%, 58.9%, and 71.0% for a mild, moderate and severe sleep apnea respectively in the group of subjects whose values for both questionnaires exceeded the cutoffs. In the group of subjects with one of the questionnaire values exceeding the cutoffs, a better sensitivity but a worse specificity were obtained related to only the &bdquo;STOP BANG&ldquo; questionnaire. The investigation has established the screening method &ndash; the &ldquo;STOP BANG&ldquo; questionnaire which (on the basis of the clinical symptoms, physical examination and present risk factors) stratifies the patients into the high risk group requiring urgent polysomnography and referral for further treatment, and to those requiring no polysomnography.</p>

A linfangioleiomiomatose pulmonar é uma enfermidade cística progressiva que afeta mulheres jovens e cuja sobrevida média estimada em algumas casuísticas é de cerca de dez anos após o diagnóstico. A deterioração da função pulmonar é uma de suas principais características e resulta em dispnéia progressiva e hipoxemia grave nos casos avançados. O esforço físico é um desencadeador de dessaturação e correlaciona-se com a progressão funcional da doença. Assim como o esforço, o sono é um importante momento fisiológico durante o qual o sistema cardiorrespiratório dessas pacientes pode ser estressado. A partir da ocorrência de hipoxemia durante o sono ao longo dos anos pode surgir elevação progressiva da pressão na circulação pulmonar, resultando em cor pulmonale. Com o intuito de estudar o comportamento da saturação de oxigênio durante o sono e sua correlação com variáveis funcionais respiratórias estáticas e dinâmicas e de qualidade de vida, foram avaliadas consecutivamente 21 pacientes com diagnóstico de linfangioleiomiomatose pulmonar (LAM) atendidas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no período de março de 2005 a dezembro de 2007. Todas as pacientes realizaram polissonografia completa (PSG), prova de função pulmonar (PFP), teste de caminhada de 6 minutos (TC6M) e responderam aos questionários de Berlim, Epworth e SF-36, após assinatura de termo de consentimento livre e esclarecido. Verificou-se que a idade média das pacientes foi de 38 8 anos ao início dos sintomas, 41 10 ao diagnóstico e 45 11 anos à realização dos testes. O sintoma clínico mais freqüente foi dispnéia aos esforços, presente em 20 das 21 pacientes. Funcionalmente as pacientes apresentavam um padrão obstrutivo leve (%VEF1 72% e VEF1/CVF 0,68) com redução moderada da DLCO (48% predito). Das 21 pacientes, 14 apresentaram queda da saturação de hemoglobina abaixo de 90% durante a PSG. O tempo médio de queda da saturação foi de 2 horas e 25 minutos, com os principais períodos de dessaturação ocorrendo durante o sono REM e de ondas lentas. Estes caracterizaram-se por períodos de hipoventilação, sem aumento do índice de apnéia-hipopnéia (mediana IAH = 1,7). As principais variáveis que se correlacionaram através do teste de Pearson com a dessaturação abaixo de 90% durante o sono foram o delta de dessaturação durante o TC6M (r = 0,57), o %VEF1 (r = -0,80), %CVF (r = -0,80) e %DLCO (r = - 0,64) em relação ao predito, todas com p < 0,01. A partir da estratificação pela ocorrência de SpO2 < 90% durante a PSG e análise pelo teste de Wilcoxon, evidenciou-se que além das variáveis acima a relação VR/CPT mostrou-se significativamente diferente do ponto de vista estatístico (p = 0,04) nos grupos com e sem hipoxemia noturna. Em relação à qualidade de vida observou-se redução em todos os domínios particularmente quanto aos aspectos emocionais nas pacientes com hipoxemia noturna. O ecocardiograma evidenciou ocorrência de hipertensão pulmonar em cinco pacientes. Verificou-se com esse estudo pela primeira vez a ocorrência de hipoxemia durante o sono em pacientes com LAM. A hipoxemia noturna, apesar de não rotineiramente avaliada nessa população de pacientes, correlacionou-se com aspectos corriqueiramente avaliados no seguimento ambulatorial dessas pacientes como parâmetros da PFP e do TC6M, além de indicar uma tendência a prejuízo da qualidade de vida avaliada pelo SF-36. / Pulmonary lymphangioleiomyomatosis (LAM) is a progressive cistic lung disease of unknown etiology and no established medical treatment. It basically occurs in child bearing age women and its mean survival is about 10 years in some case series. LAM is caractherized by pulmonary function deterioration: obstructive pattern on espirometry and progressive impairment on DLCO capacity which results in rest dyspnea and hypoxemia in advanced cases. Exercise is an important factor that causes hypoxemia in this set of patients and correlates with progressive functional impaiment. Sleep is also another important physiologic moment when cardiorespiratory system may be stressed in these patients, leading to chronic hypoxemia though the years. This phenomenum may be responsible by cor pulmonale observed in advanced stages of LAM. In order to study hemoglobin saturation by oxygen during sleep and its correlation with lung function test (LFT), six minute walk test (6MWT), ecocardiography and SF-36 quality of life variables, 21 consecutive patients with LAM from Hospital das Clínicas University of São Paulo Medical School were evaluated from march 2005 to december 2007. All patients performed full polysomnography (PSG), lung function test, 6MWT and answered Berlim, Epworth and SF-36 quality of life questionnaire. Mean age at beginning of symptoms was 38 8 years, 41 10 years at diagnosis and 45 11 years by the time of the protocol. Dyspnea during routine daily activities was the most frequent symptom (20 / 21). LFT yielded mild obstruction (% FEV1 = 72%; FEV1/FVC = 0,68) and moderate impairment in DLCO (48%). Fourteen patients presented desaturation with SpO2 lower than 90% on PSG. Mean time with SpO2 lower than 90% was 2 hours and 25 minutes (mainly during REM and S3 and S4). Median apnea-hipopnea index (AHI) was 1,7 (normal). Pearson and Spearman correlations yielded that the main variables related to desaturation below 90% on PSG with p < 0.01 were: Desaturation on TC6M rs = 0,57 Spearman %FEV1 r = -0,80 Pearson %FVC r = -0,80 Pearson %DLCO rs = -0,64 Spearman After that, functional variables were stratified by SpO2 < 90% during PSG. Wilcoxon test showed that besides all 4 previous variables RV/TLC (p=0.04) was also statistically different between patients who did and did not desaturate. SF-36 yielded impairments in all domains, particularly in emotional aspects among patients who desaturated on PSG. Heart ecocardiography detected pulmonary hypertension in 5 patients. Our study found out for the first time that patients with LAM desaturate during sleep. Although pulmonary function variables are related to sleep desaturation, desaturation occured even in patients with mild or no impairments in lung function. 6MWT desaturation ,but not distance walked, correlated to sleep desaturation. SF-36 analysis yielded impairments in all domains of quality of life, particularly in emotional aspects in patients who desaturated.

Made available in DSpace on 2016-04-04T18:28:16Z (GMT). No. of bitstreams: 1 Micheli Aparecida Gomes dos Santos.pdf: 4751573 bytes, checksum: 7ca8f16261c512805eef4512cc814ae4 (MD5) Previous issue date: 2014-02-18 / Pontif?cia Universidade Cat?lica de Campinas / The aim of this study was to evaluate and compare the level of stress and anxiety in a sample of patients with obstructive sleep apnea syndrome (OSAS) before and after a month of medical or surgical treatment. To collect the data were used the ISSL - Inventory of Stress Symptoms for Adults Lipp, the Beck Anxiety Scale (BAI), answered twice, once before the start of treatment and another, one month after the start of the treatment, and a sociodemographic questionnaire. The sample consisted of 18 patients, 13 men and 5 women, aged between 26 and 74 years (Mean=51,83, SD=13,46). The assessment showed that 77,8% (n=14) of patients had stress on the first evaluation, and such amount was reduced to 16,7% (n=3) in the second evaluation after treatment. Thus, patients showed a significant decrease in mean stress symptoms after treatment (z=-3,53, p<0,000). In relation to anxiety , 44,4% of participants had a minimum degree of anxiety symptoms at the first assessment, although were present mild, moderate and severe degrees. In the second assessment serious cases disappear and there was a significant decrease in moderate cases. Patients showed a significant decrease in mean anxiety symptoms of post-treatment (z=-3,51, p<0,000). Patients with moderate apnea showed a significant decrease in mean stress (z=-2,971, p<0,003) and anxiety symptoms (z=-2,032, p<0,042) of post-treatment. The same occurred in relation to stress (z=-2,023, p<0,043) and anxiety (z=-2,944, p<0,003) in patients with severe apnea. Furthermore, women showed no significant improvement in the symptoms of post-treatment in stress (z=-1,633; p=0,102) and anxiety (z=-1,625; p=0,104) symptoms, while men had reduced the symptoms of stress (z=-3,184; p=0,001) and anxiety (z=-3,062; p=0,001). The research of the type of treatment showed significant improvement in stress (z=- 3,21, p=0,001) and anxiety symptoms (z= -3,17, p=0,001) in patients who were treated with CPAP . Already in the surgical group, no significant differences in any of the constructs assessed were noted. Thus it was possible to see that the patients showed significant improvement in symptoms of stress and anxiety in the second evaluation, in order to be able to say to this group of individuals, that treatment had the desired effect, being effective in improving symptoms of stress and anxiety for the general sample for the two levels (moderate and severe) illness, for males and for patients who were treated with CPAP. / O objetivo deste estudo foi avaliar e comparar o n?vel de stress e de ansiedade em uma amostra de portadores da S?ndrome da Apneia Obstrutiva do Sono (SAOS), antes e ap?s um m?s de tratamento cl?nico ou cir?rgico. Para a coleta dos dados foram utilizados o ISSL -Invent?rio de Sintomas de Stress para Adultos de Lipp, a Escala de Ansiedade de Beck (BAI), respondidos duas vezes, uma antes do in?cio do tratamento e outra, um m?s ap?s o in?cio do mesmo, al?m de um question?rio sociodemogr?fico. A amostra foi composta por 18 pacientes, sendo 13 homens e 5 mulheres, com idade entre 26 e 74 anos (M?dia=51,83; DP=13,46). A avalia??o demonstrou que 77,8% (n=14) dos pacientes apresentavam stress na primeira avalia??o, sendo que tal valor foi reduzido para 16,7% (n=3) na segunda avalia??o, ap?s tratamento. Assim, pacientes apresentaram uma diminui??o significativa na m?dia de sintomas de stress p?s-tratamento (z=-3,53, p<0,000). Em rela??o ? ansiedade, 44,4% dos participantes apresentavam grau m?nimo de sintomas de ansiedade na primeira avalia??o, embora se fizessem presentes graus leve, moderado e grave. Na segunda avalia??o os casos graves desaparecem e houve uma importante diminui??o nos casos moderados. Os pacientes apresentaram uma diminui??o significativa na m?dia de sintomas de ansiedade p?s-tratamento (z=-3,51, p<0,000). Pacientes com SAOS moderada apresentaram uma diminui??o significativa na m?dia de sintomas de stress (z=-2,971, p<0,003) e sintomas de ansiedade (z=-2,032, p<0,042) p?s-tratamento. O mesmo ocorreu em rela??o em rela??o ao stress (z=-2,023, p<0,043) e ansiedade (z=-2,944, p<0,003) dos pacientes com SAOS grave. Por outro lado, mulheres n?o apresentaram melhora significativa nos sintomas de stress p?s-tratamento (z=-1,633; p=0,102) e nem na ansiedade (z=-1,625; p=0,104), ao passo que os homens obtiveram diminui??o dos sintomas de stress (z=-3,184; p=0,001) e ansiedade (z=-3,062; p=0,001). A investiga??o do tipo de tratamento indicou melhora significativa nos sintomas de stress (z=-3,21, p=0,001) e ansiedade (z= -3,17, p=0,001) nos pacientes que fizeram tratamento com CPAP. J? no grupo cir?rgico n?o foram notadas diferen?as significativas em nenhum dos construtos avaliados. Desse modo foi poss?vel visualizar que os pacientes demonstraram melhora significativa nos sintomas de stress e ansiedade na segunda avalia??o, de modo a se poder afirmar, para esse grupo de indiv?duos, que o tratamento teve o efeito desejado, sendo eficaz na melhora dos sintomas de stress e ansiedade para a amostra geral, para os dois n?veis da doen?a (moderada e grave), para o sexo masculino e para os pacientes que fizeram tratamento com CPAP.

INTRODUÇÃO: A apnéia obstrutiva do sono é uma doença altamente prevalente na população adulta e associada à morbidade significante. A polissonografia noturna é o método padrão ouro para o diagnóstico de apnéia obstrutiva do sono. Entretanto seu custo é elevado e a disponibilidade de leitos para polissonografia é muito inferior a demanda. Por esta razão, estratégias para otimizar o diagnóstico de apnéia obstrutiva do sono são urgentes e necessárias. O objetivo deste estudo foi o de comparar um exame diurno de polissonografia, de curta duração e através de sono induzido por benzodiazepínico com a polissonografia noturna para o diagnóstico de apnéia obstrutiva do sono. MÉTODOS: Foram estudamos 40 pacientes divididos em dois grupos baseados no resultado da polissonografia noturna (Índice de Apnéia e Hipopnéia = 15 eventos/hora). Os dezoito Indivíduos portadores de apnéia obstrutiva do sono (id= 46 + 9 anos) e os vinte e dois controles (id= 38 + 10 anos) foram submetidos a uma polissonografia diurna, de curta duração, com indução de sono através de infusão intravenosa lenta de midazolam. RESULTADOS: O sono induzido foi obtido em todos indivíduos. O tempo total de sono foi de 41,5 + 18,9 minutos. A maioria dos eventos respiratórios durante o sono induzido forma obstrutivos e similares aos observados durante a polissonografia noturna. Não houve diferença estatisticamente significativa entre o índice de apnéia e hipopnéia bem como com a saturação mínima de oxigênio obtido pela polissonografia noturna e com sono induzido nos grupos estudados (p>0,05). Reunindo os dois grupos, o índice de apnéia e hipopnéia e a menor saturação de oxigênio obtidos pelos dois métodos tiveram correlação significativa (r=0,67 e r=0,77, respectivamente). A sensibilidade e especificidade para o diagnóstico de apnéia obstrutiva do sono através do sono induzido foi 0,83 e 0,72 respectivamente. Nenhuma complicação foi observada durante o sono induzido. CONCLUSÃO: A polissonografia com sono induzido é um método rápido e seguro que pode ser uma alternativa a polissonografia noturna para o diagnóstico de apnéia obstrutiva do sono. / Polysomnography is the gold standard method for diagnosing obstructive sleep apnea. However, the gap between demand and capacity in performig polysomnography is a major healthcare problem. We sought to compare a short day-time induced sleep with full overnight standard PSG (full PSG) monitoring for the diagnosis of obstructive sleep apnea. We studied 40 patients classified into subjects with obstructive sleep apnea (n=18, age= 46.8 + 9.1yr) and controls (n=22, age= 38.5 + 10,7yr) groups, based on the results of a full polysomnography (apnea-hypopnea index >= 15 events/hour). All subjects underwent a short day-time polysomnography. Sleep was induced by slow intravenous drip infusion of midazolam and achived in all subjects. Total time of induced sleep was 41.5 ± 18.9 min. The majority of the respiratory events during induced sleep were obstructive and similar to that observed during full polysomnography. There was no difference between apnea-hypopnea index obtained by full and short polysomnography in obstructive sleep apnea and control groups (p>0,05). The same occured to lowest O2 saturation. Taken all together, apnea-hypopnea index and lowest O2 saturation during short polysomnography correlated well with full polysomnography (r=0,67 and r=0,77, respectively). Sensitivity and specificity for the diagnosis of obstructive sleep apnea by induced sleep was 0,83 and 0,72, respectively. No complications were observed. Induced sleep PSG by midazolan is a short and safe study that may represent an alternative for full polysomnography in the diagnosis of obstructive sleep apnea.

Objetivos: Determinar o tempo de espera para o diagnóstico e início do tratamento da síndrome da apneia obstrutiva do sono (SAOS) em hospital público brasileiro. Desenho do estudo: Estudo transversal. Métodos: Foi avaliada, com um questionário específico, uma amostra de conveniência composta por 68 pacientes com síndrome da apneia obstrutiva do sono (SAOS), com indicação de tratamento com pressão positiva em vias aéreas (PAP) e que utilizaram o aparelho durante acompanhamento ambulatorial, no período de janeiro de 2005 a dezembro de 2009. Foram excluídos os pacientes menores de 18 anos, incapazes de responder ao questionário ou que se negaram a participar. Resultados: Dos pacientes avaliados, a maioria era de homens (62%), com média de idade de 54,4 (+ 10,7) anos e obesos (IMC médio 33,7 + 7,1 Kg/m2); 76% eram hipertensos, 22% portadores de diabete melito e igual número de doença arterial coronariana; 10% destes apresentavam hipoventilação associada. A mediana do tempo entre a primeira consulta médica e a realização da PSG diagnóstica foi de 8,3 (intervalos interquartis [IQ] 3,3-14,3) meses e a mediana do tempo da indicação da PAP até a aquisição do aparelho foi de 10,5 (IQ 3,1-16,7) meses. Sessenta e quatro pacientes (94%) eram usuários de CPAP e 4 usuários de bilevel (6%). A maioria dos aparelhos (57%) foi obtida de forma gratuita por meio da rede pública de saúde. Conclusão: O presente estudo evidenciou a demora excessiva para diagnóstico e tratamento dos pacientes portadores de SAOS em atendimento em um hospital público de referência no Brasil. / Objectives: To determine the waiting time for the diagnosis and beginning of treatment of syndrome of obstructive sleep apnea (OSA) in Brazilian public hospital. Study design: cross-sectional study Methods: A convenience sample composed of 68 patients with syndrome of obstructive sleep apnea (OSA) was assessed through a specific questionnaire. All patients were indicated a treatment with positive airway pressure (PAP) and that used the unit during de period between January 2005 and December 2009. Patients who were under 18 years old, who were uncapable of answering the questionnaire or who refused to answer were excluded. Results: Among the patients, the majority were men (62%), with an average age of 54.4 (+10.7) years and obese (mean BMI 33.7 + 7.1 kg/m2); 76% were hypertensive, 22% diabetes mellitus patients and an equal number with coronary artery disease, 10% of them had associated hypoventilation. The average time between the first medical consultation and the implementation of diagnostic PSG was 8.3 (interquartile range [IQ] 3.3 to 14.3) months and the average time indication of the PAP until the purchase of the equipment was 10,5 (CI 3.1 to 16.7) months. Sixty-four patients (94%) were users of CPAP and 4 were users of bilevel (6%). Most appliances (57%) were obtained free of charge through the public health system. Conclusion: The present study demonstrated the excessive delay to diagnosis and treatment of patients with OSAS in attendance at a public hospital of reference in Brazil.

INTRODUÇÃO: A apnéia obstrutiva do sono é uma doença altamente prevalente na população adulta e associada à morbidade significante. A polissonografia noturna é o método padrão ouro para o diagnóstico de apnéia obstrutiva do sono. Entretanto seu custo é elevado e a disponibilidade de leitos para polissonografia é muito inferior a demanda. Por esta razão, estratégias para otimizar o diagnóstico de apnéia obstrutiva do sono são urgentes e necessárias. O objetivo deste estudo foi o de comparar um exame diurno de polissonografia, de curta duração e através de sono induzido por benzodiazepínico com a polissonografia noturna para o diagnóstico de apnéia obstrutiva do sono. MÉTODOS: Foram estudamos 40 pacientes divididos em dois grupos baseados no resultado da polissonografia noturna (Índice de Apnéia e Hipopnéia = 15 eventos/hora). Os dezoito Indivíduos portadores de apnéia obstrutiva do sono (id= 46 + 9 anos) e os vinte e dois controles (id= 38 + 10 anos) foram submetidos a uma polissonografia diurna, de curta duração, com indução de sono através de infusão intravenosa lenta de midazolam. RESULTADOS: O sono induzido foi obtido em todos indivíduos. O tempo total de sono foi de 41,5 + 18,9 minutos. A maioria dos eventos respiratórios durante o sono induzido forma obstrutivos e similares aos observados durante a polissonografia noturna. Não houve diferença estatisticamente significativa entre o índice de apnéia e hipopnéia bem como com a saturação mínima de oxigênio obtido pela polissonografia noturna e com sono induzido nos grupos estudados (p>0,05). Reunindo os dois grupos, o índice de apnéia e hipopnéia e a menor saturação de oxigênio obtidos pelos dois métodos tiveram correlação significativa (r=0,67 e r=0,77, respectivamente). A sensibilidade e especificidade para o diagnóstico de apnéia obstrutiva do sono através do sono induzido foi 0,83 e 0,72 respectivamente. Nenhuma complicação foi observada durante o sono induzido. CONCLUSÃO: A polissonografia com sono induzido é um método rápido e seguro que pode ser uma alternativa a polissonografia noturna para o diagnóstico de apnéia obstrutiva do sono. / Polysomnography is the gold standard method for diagnosing obstructive sleep apnea. However, the gap between demand and capacity in performig polysomnography is a major healthcare problem. We sought to compare a short day-time induced sleep with full overnight standard PSG (full PSG) monitoring for the diagnosis of obstructive sleep apnea. We studied 40 patients classified into subjects with obstructive sleep apnea (n=18, age= 46.8 + 9.1yr) and controls (n=22, age= 38.5 + 10,7yr) groups, based on the results of a full polysomnography (apnea-hypopnea index >= 15 events/hour). All subjects underwent a short day-time polysomnography. Sleep was induced by slow intravenous drip infusion of midazolam and achived in all subjects. Total time of induced sleep was 41.5 ± 18.9 min. The majority of the respiratory events during induced sleep were obstructive and similar to that observed during full polysomnography. There was no difference between apnea-hypopnea index obtained by full and short polysomnography in obstructive sleep apnea and control groups (p>0,05). The same occured to lowest O2 saturation. Taken all together, apnea-hypopnea index and lowest O2 saturation during short polysomnography correlated well with full polysomnography (r=0,67 and r=0,77, respectively). Sensitivity and specificity for the diagnosis of obstructive sleep apnea by induced sleep was 0,83 and 0,72, respectively. No complications were observed. Induced sleep PSG by midazolan is a short and safe study that may represent an alternative for full polysomnography in the diagnosis of obstructive sleep apnea.