Clinical Evaluation, STOP BANG, Epworth Somnolence Scale and Polyssonography Indexes helps OSAS Screen in Patients with Sleep Complaints: Our Experience in Rio De Janeiro State
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 14, Issue 5
Abstract
The aims of this study were to correlate STOP BANG score, Epworth Somnolence Scale and desaturation to OSA in a population with sleep complaints from a public reference hospital and to highlight OSA severity features in this mixed ethnic population. The median apnea-hypopnea index (AHI) was 23.8/hour in men and 11.2/hour in women. Although obesity, snoring, and sleepiness were similar features in both genders, the AHI and Oxygen Desaturation Index were significantly higher in men, as in epidemiological studies. Furthermore, after bivariate correlation, the AHI was associated with oxygen desaturation, which is responsible for cardiovascular and cognitive consequences, and also with body mass index, snore, and neck circumference, summarized in STOP BANG criteria. It is undeniable that the high prevalence of those with sleep complaints is an important health problem and our data suggest that pulse oximetry, and STOP BANG score, may be used to screen adults with sleep complaints. Obstructive sleep apnea (OSA) is an important public health issue, since epidemiological studies and observations of OSA patients have consistently shown the prevalence of hypertension, type II diabetes, cardiovascular disease, and stroke to be higher in this population (SOMERS 2008). Mental conditions and carotid plaque burden are also associated with low oxygen saturation related to sleep-disordered breathing (SDB) [1,2] OSA derives not only relevant consequences but also presented high prevalence in many studies. According to the population-based study of Hipnolaus in Switzerland, the prevalence of moderate-to-severe SDB (≥15 events per hour) was 23.4% in women and 49.7% in men, which was associated with hypertension, metabolic syndrome, diabetes, and depression [3]. Besides, of 1,042 volunteers selected independently of sleep complaints in São Paulo, OSA was observed in 32.8% and associated with obesity and male sex [4]. The aims of this study were to correlate STOP BANG score, Epworth Somnolence Scale and desaturation to OSA in a Rio de Janeiro population with sleep complaints from a public reference hospital and to highlight OSA severity features in this population. This retrospective analysis assessed OSAS severity and the profile of adults with sleep complaints from our database after Research Ethics Committee approval (CAAE 42785214.1.0000.5258). A total of 185 patients with sleep complaints aged 18 to 80 years old (yo) were included. They were systematically evaluated between April 2015 and December 2017 in the sleep ambulatory with a physical exam, translated and validated questionnaires (Epworth Sleepiness Scale [ESS] [5,6] and STOP BANG score [7-9], and laboratory polysomnography studies. Exclusion criteria were: Polyneuropathy; active heart and lung diseases; craniofacial malformations; immunodeficiency; systemic vasculitis; and neoplasia. We used the 2015 Portuguese version of STOP-BANG [7-9] to measure the risk of OSA, whereby three or more affirmative answers indicated a high risk of OSA [8,9] and the Epworth Sleepiness Scale (ESS) [6] to measure diurnal somnolence. In the ESS, sleep propensity was measured in 8 routine situations on a scale from 0 (indicating no chance of falling asleep) to 3 (indicating a high chance of dozing off). The final score ranged from 0 to 24 points accordingly, with excessive diurnal somnolence being defined as a score higher than 10 [6]. Polysomnography parameters: The subjects underwent transcutaneous pulse oximetry, with the respiratory effort recorded using inductance plethysmography. Apnea was measured by an oronasal thermistor and was defined as a drop in baseline airflow by 90% or more for at least 10 seconds. Hypopnea was measured by a nasal pressure cannula and was defined as a partial obstructive event with airflow drop by more than 30% from baseline for at least 10 seconds. Besides, hypopnea was also considered present with oxygen desaturation of 3% or more, with electroencephalographically confirmed arousal. The polysomnography data were measured based on polysomnography recordings (EMSA Equipamentos Médicos, Rio de Janeiro, Brazil). OSAS criteria using the Apnea–Hypopnea Index (AHI) of 5 or higher were defined according to the American Academy Sleep Manual. Our data were analyzed with SPSS 13.0 for Windows. The continuous variables distribution between groups was compared by the Mann–Whitney U test. Categorical variables comparison was performed by Chi-square or Fisher test when indicated. Correlations were performed by Spearman Correlation Coefficient. The significance level was fixed at 5%.
Authors and Affiliations
Migueis D, Simas C, Parma M, Sabaneeff L, Joffily L, Araujo Melo MH
Keywords
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- EP ID EP594769
- DOI 10.26717/BJSTR.2019.14.002609
- Views 146
- Downloads 0
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