Prevalência e fatores associados ao endótipo de baixo limiar do despertar entre os pacientes diagnosticados com apneia obstrutiva do sono avaliados na 4ª edição do Estudo Epidemiológico do Sono (EPISONO) de São Paulo
Data
2024-12-13
Autores
Faria, Carlos Jaime Simiqueli de 
Orientadores
Poyares, Dalva Lucia Rollemberg
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A apneia obstrutiva do sono ocorre a partir de uma interação variada entre fatores anatômicos e não anatômicos. Dentre os fatores não anatômicos, o baixo limiar de despertar pode representar uma barreira à abordagem adequada e à adesão dos pacientes ao tratamento. Edwards e colaboradores desenvolveram uma ferramenta clínica cuja análise dos valores do índice de apneia e hipopneia, do nadir da saturação da oxiemoglobina e do percentual de hipopneias no exame de polissonografia permitiria presumir a presença do endótipo baixo limiar do despertar. A aplicação desse método complementar de diagnóstico em um estudo populacional representativo como o Estudo Epidemiológico do Sono de São Paulo possibilita reconhecer a prevalência do baixo limiar do despertar em indivíduos diagnosticados com AOS, além de permitir a análise das características sociodemográficas e dos sintomas associados ao endótipo em estudo.
Objetivos: Avaliar a prevalência do endótipo de baixo limiar de despertar entre os indivíduos participantes da 4ª edição do EPISONO através da aplicação do algoritmo proposto por Edwards et al. Analisar as diferenças entre os grupos e gêneros, relacionadas às características sociodemográficas, características polissonográficas, qualidade de vida, sintomas diurnos e insônia.
Métodos: Este estudo foi realizado a partir da análise do banco de dados da 4ª edição do EPISONO, conduzido entre 2018 e 2019. Através do algoritmo proposto, a população em estudo foi dividida em 3 grupos: participantes sem apneia obstrutiva do sono, com apneia obstrutiva do sono e baixo limiar de despertar, e com apneia obstrutiva do sono e alto limiar do despertar. As diferenças entre os grupos e o sexo dos participantes foram analisadas a partir dos resultados dos questionários aplicados e informações obtidas na 4ª edição do EPISONO no que concerne às características sociodemográficas, polissonográficas, qualidade de vida, sintomas diurnos e insônia.
Resultados: diferenças significativas foram observadas entre os grupos em relação ao sexo, idade, peso e ao índice de massa corporal, porém não houve diferenças significativas entre as etnias e para a maioria dos sintomas avaliados. As mulheres apresentaram maior frequência de sintomas, especialmente aquelas do grupo baixo limiar de despertar (apneia obstrutiva do sono), comparativamente aos homens do mesmo grupo. A insônia clínica também foi mais prevalente no sexo feminino. A caraterização do endótipo baixo limiar de despertar e a maior frequência de sintomas em mulheres com apneia obstrutiva do sono evidenciam a importância da valorização dos achados polissonográficos e dos sintomas relatados pelas mulheres durante a avaliação clínica. O baixo limiar de despertar não mostrou relação com a piora da despertabilidade entre os participantes com insônia comórbida e apneia do sono em comparação àqueles apenas com AOS neste estudo.
Conclusões: O endótipo de baixo limiar de despertar demonstrou ser prevalente na população de São Paulo, especialmente entre os participantes com sobrepeso e homens. Entretanto, atenção especial deve ser dada às mulheres, nas quais se observou maior frequência de sintomas diurnos, insônia comórbida com apneia do sono. Identificar os endótipos da apneia obstrutiva do sono, e conhecer suas características e impactos na população geral podem auxiliar no planejamento de terapias individualizadas, objetivando maior eficácia e adesão às mesmas.
Introduction: Obstructive sleep apnea occurs from a varied interaction between anatomical and non-anatomical factors. Among the non-anatomical factors, the low arousal threshold (BLD) can represent a barrier to the adequate approach and adherence of patients to treatment. Edwards et al. (2014) developed a clinical tool whose analysis of the values of the apnea and hypopnea index (AHI), the nadir of oxyhemoglobin saturation (SpO₂) and the percentage of hypopneas in the polysomnography (PSG) exam would make it possible to presume the presence of the BLD endotype. The application of this complementary diagnostic method in a representative population study such as the Epidemiological Sleep Study of São Paulo (EPISONO) makes it possible to recognize the prevalence of BLD in the population of individuals diagnosed with OSA, in addition to allowing the analysis of the sociodemographic characteristics and symptoms associated with the endotype under study. Objectives: To assess the prevalence of the low arousal threshold endotype among individuals participating in the 4th edition of EPISONO by applying the algorithm proposed by Edwards et al. (2014). To analyze the differences between groups and genders, related to sociodemographic and polysomnographic characteristics, quality of life, daytime symptoms and insomnia. Methods: This study was carried out based on the analysis of the database of the 4th edition of EPISONO, conducted between 2018 and 2019. Using the proposed algorithm, the study population was divided into 3 main groups: participants without obstructive sleep apnea, with obstructive sleep apnea and low arousal threshold, and with obstructive sleep apnea and high arousal threshold. The differences between the groups and the sex of the participants were analyzed based on the results of the questionnaires applied and information obtained from the participants of the 4th edition of EPISONO regarding sociodemographic and polysomnographic characteristics, quality of life, daytime symptoms and insomnia. Results: significant differences were observed between the groups in relation to sex, age, weight and body mass index, but there were no significant differences between ethnicities and for most of the symptoms evaluated. Women had a higher frequency of symptoms, especially those in the low arousal threshold group (obstructive sleep apnea), compared to men in the same group. Clinical insomnia was also more prevalent in women. The characterization of the low arousal threshold endotype and the higher frequency of symptoms in women with obstructive sleep apnea highlight the importance of valuing polysomnographic findings and symptoms reported by women during clinical evaluation. The low arousal threshold showed no relationship with worsening arousability among participants with comorbid insomnia and sleep apnea compared to those with OSA in this study alone. Conclusions: The low arousal threshold endotype has been shown to be prevalent in the São Paulo population, especially among overweight participants, and men. However special attention should be given to women, in whom a higher frequency of daytime symptoms, comorbid insomnia with sleep apnea was observed. Identifying the endotypes of obstructive sleep apnea and knowing their characteristics and impact on the general population could help planning individualized therapies, aiming for greater efficacy and adherence to them.
Introduction: Obstructive sleep apnea occurs from a varied interaction between anatomical and non-anatomical factors. Among the non-anatomical factors, the low arousal threshold (BLD) can represent a barrier to the adequate approach and adherence of patients to treatment. Edwards et al. (2014) developed a clinical tool whose analysis of the values of the apnea and hypopnea index (AHI), the nadir of oxyhemoglobin saturation (SpO₂) and the percentage of hypopneas in the polysomnography (PSG) exam would make it possible to presume the presence of the BLD endotype. The application of this complementary diagnostic method in a representative population study such as the Epidemiological Sleep Study of São Paulo (EPISONO) makes it possible to recognize the prevalence of BLD in the population of individuals diagnosed with OSA, in addition to allowing the analysis of the sociodemographic characteristics and symptoms associated with the endotype under study. Objectives: To assess the prevalence of the low arousal threshold endotype among individuals participating in the 4th edition of EPISONO by applying the algorithm proposed by Edwards et al. (2014). To analyze the differences between groups and genders, related to sociodemographic and polysomnographic characteristics, quality of life, daytime symptoms and insomnia. Methods: This study was carried out based on the analysis of the database of the 4th edition of EPISONO, conducted between 2018 and 2019. Using the proposed algorithm, the study population was divided into 3 main groups: participants without obstructive sleep apnea, with obstructive sleep apnea and low arousal threshold, and with obstructive sleep apnea and high arousal threshold. The differences between the groups and the sex of the participants were analyzed based on the results of the questionnaires applied and information obtained from the participants of the 4th edition of EPISONO regarding sociodemographic and polysomnographic characteristics, quality of life, daytime symptoms and insomnia. Results: significant differences were observed between the groups in relation to sex, age, weight and body mass index, but there were no significant differences between ethnicities and for most of the symptoms evaluated. Women had a higher frequency of symptoms, especially those in the low arousal threshold group (obstructive sleep apnea), compared to men in the same group. Clinical insomnia was also more prevalent in women. The characterization of the low arousal threshold endotype and the higher frequency of symptoms in women with obstructive sleep apnea highlight the importance of valuing polysomnographic findings and symptoms reported by women during clinical evaluation. The low arousal threshold showed no relationship with worsening arousability among participants with comorbid insomnia and sleep apnea compared to those with OSA in this study alone. Conclusions: The low arousal threshold endotype has been shown to be prevalent in the São Paulo population, especially among overweight participants, and men. However special attention should be given to women, in whom a higher frequency of daytime symptoms, comorbid insomnia with sleep apnea was observed. Identifying the endotypes of obstructive sleep apnea and knowing their characteristics and impact on the general population could help planning individualized therapies, aiming for greater efficacy and adherence to them.
Descrição
Citação
FARIA, Carlos Jaime Simiqueli de. Prevalência e fatores associados ao endótipo de baixo limiar do despertar entre os participantes da 4ª edição do EPISONO. 2024. 83 f. Dissertação (Mestrado em Psicobiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.