Navegando por Palavras-chave "Excitação relacionada ao esforço respiratório"

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    Efeito das diferentes regras de marcação de eventos respiratórios na classificação da apneia obstrutiva do sono
    (Universidade Federal de São Paulo (UNIFESP), 2016-06-30) Garbuio, Silvério Aparecido [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; http://lattes.cnpq.br/6882391059348792; http://lattes.cnpq.br/9543235017267891; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Despite the high relevance of the Apnea and Hypopnea Index (AHI) and the Respiratory Disturbance Index (RDI) in the diagnosis of Obstructive Sleep Apnea (OSA), there is still a high disagreement in the definition of sleep-related respiratory events indexes. Objectives: To compare the different methodologies of scoring respiratory events related to sleep in an epidemiological sample. To evaluate the impact on the diagnosis of OSA and to determine the cut-off values according to severity. Methods: We evaluated 891 polysomnography of the epidemiological study Episono of individuals who represented the city of São Paulo in 2007 according to age, gender and socioeconomic. Sleep staging, arousals, apneas, hypopneas, and Respiratory-Effort Related Arousal (RERAs) were manually scored. A polysomnographic analysis system performed the association of decrease of the flow with oxygen desaturations and / or arousals and allocated them in different indices: AHI4: hypopnea associated with a drop of the SpO2 ?4%, AHI3: hypopnea associated with a drop of the SpO2 ?3%, IAH3A: hypopnea associated with a drop of the SpO2 ?3% or an arousal, and IDR: AHI3A + RERA Index. The equivalent cutoff points for AHI3, AHI3A and RDI (for 5, 15, 30 events / hour of sleep) were calculated using the AHI4 as a reference. Results: Using the SpO2 ? 3% and the addition of arousal in the rule, we observed higher rates than those with a drop ? 4% (Index: AHI4: 6.2±11.5/h; AHI3: 7.8±12.9/h; AHI3A: 9.5±13.9/h; RDI: 10.6±14.1/h). This trend was the same for the prevalences considering different values of severity (> 5,> 15 or> 30/h). In the comparative analysis between the indices and the AHI4 in their respective severities, we observed that 12.7%, 25.8% and 33.1% of the 16 individuals would be reclassified by the AHI3, AHI3A and RDI indices, respectively. We maximized the sum of sensitivity and specificity by the ROC curve for the determination of equivalent values by severity and observed an increase from 6.6 to 9.6/h for AHI4 = 5, from 16 to 19.7/h for AHI4 = 15, and from 34.3 to 35/h for AHI4 = 30/h. These values were 5 events/hour higher than the AHI4 cut-off. In analyzes separated by sex, age and BMI, we observed that the equivalent values for women, individuals between 20 and 40 years and eutrophic, were higher, between 10 and 15 more events in the cut-off values for AHI4?30. Using appropriately adjusted cut-off points, the agreement was between 92% and 99%. Conclusions: When the same cut-off value is used, the different definitions of hypopnea and the addition of RERA in the rule lead to large differences in the rates of OSA diagnoses. The AHI cut-off point using oxygen desaturation ? 3% and / or arousal, and RDI, should be adjusted to approximately 5 events/hour to be comparable to the AHI4 cut-off point and to maintain agreement > 92%. This adjustment should be greater when analyzing specific groups.