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OBJECTIVE: To compare subjective sleep evaluation obtained using four questionnaires with polysomnography results for individuals with and without obstructive sleep apnea. METHODS: Observational and analytical study in which individuals underwent polysomnography were studied retrospectively to investigate sleep disorders. We compared subjective data from a research database used to predict obstructive sleep apnea based on the STOP-BANG questionnaire, evaluation of excessive daytime sleepiness (Epworth Sleepiness Scale), sleep quality questionnaire (Mini Sleep Questionnaire) and Post-Sleep Data Collection Instrument with the self-reported total sleep time and sleep-onset latency for subjects with and without obstructive sleep apnea. RESULTS: The STOP-BANG questionnaire was a good predictor for the diagnosis of obstructive sleep apnea. However, the other instruments did not show a significant difference between healthy and sick individuals. Patients' perceptions of their sleep onset time were significantly lower than the polysomnographic data, but this difference remained for both subjects with and without obstructive sleep apnea. No difference was found between the subjective duration of sleep and the total sleep time assessed by polysomnography in either the healthy subjects or the patients. CONCLUSION: Except for the STOP-BANG questionnaire, subjective evaluation of sleepiness, sleep quality, perception of onset, and total sleep time are not important parameters for the diagnosis of obstructive sleep apnea, which reinforces the need for an active search for better management of these patients.

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Study Objectives: To develop and evaluate the measurement properties of child-report and parent-proxy versions of the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Sleep Disturbance and Sleep-Related Impairment item banks. Methods: A national sample of 1104 children (8-17 years old) and 1477 parents of children 5-17 years old was recruited from an internet panel to evaluate the psychometric properties of 43 sleep health items. A convenience sample of children and parents recruited from a pediatric sleep clinic was obtained to provide evidence of the measures' validity; polysomnography data were collected from a subgroup of these children. Results: Factor analyses suggested two dimensions: sleep disturbance and daytime sleep-related impairment. The final item banks included 15 items for Sleep Disturbance and 13 for Sleep-Related Impairment. Items were calibrated using the graded response model from item-response theory. Of the 28 items, 16 are included in the parallel PROMIS adult sleep health measures. Reliability of the measures exceeded 0.90. Validity was supported by correlations with existing measures of pediatric sleep health and higher sleep disturbance and sleep-related impairment scores for children with sleep problems and those with chronic and neurodevelopmental disorders. The sleep health measures were not correlated with results from polysomnography. Conclusions: The PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment item banks provide subjective assessments of child's difficulty falling and staying asleep as well as daytime sleepiness and its impact on functioning. They may prove useful in the future for clinical research and practice. Future research should evaluate their responsiveness to clinical change in diverse patient populations.

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OBJECTIVE: To compare subjective sleep evaluation obtained using four questionnaires with polysomnography results for individuals with and without obstructive sleep apnea. METHODS: Observational and analytical study in which individuals underwent polysomnography were studied retrospectively to investigate sleep disorders. We compared subjective data from a research database used to predict obstructive sleep apnea based on the STOP-BANG questionnaire, evaluation of excessive daytime sleepiness (Epworth Sleepiness Scale), sleep quality questionnaire (Mini Sleep Questionnaire) and Post-Sleep Data Collection Instrument with the self-reported total sleep time and sleep-onset latency for subjects with and without obstructive sleep apnea. RESULTS: The STOP-BANG questionnaire was a good predictor for the diagnosis of obstructive sleep apnea. However, the other instruments did not show a significant difference between healthy and sick individuals. Patients' perceptions of their sleep onset time were significantly lower than the polysomnographic data, but this difference remained for both subjects with and without obstructive sleep apnea. No difference was found between the subjective duration of sleep and the total sleep time assessed by polysomnography in either the healthy subjects or the patients. CONCLUSION: Except for the STOP-BANG questionnaire, subjective evaluation of sleepiness, sleep quality, perception of onset, and total sleep time are not important parameters for the diagnosis of obstructive sleep apnea, which reinforces the need for an active search for better management of these patients.

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OBJECTIVE: We aimed to determine reference values for respiratory indices in polygraphies (PGs) performed in infants aged 1 and 3months. METHODS: Healthy full-term neonates were recruited on the maternity ward. They were followed up by overnight PG at the age of 1month and again at the age of 3months. Indices of respiratory events, such as apneas, hypopneas, and percentage of periodic breathing were determined in each PG. Interpretation of PGs was performed blinded to the subject's data and the time of measurement. PG indices at 1 and 3months of age were compared. RESULTS: PG recordings were obtained for 37 healthy infants (22 boys). At the age of 1month, the median (minimum-maximum) central, obstructive, and mixed apnea index was 5.5 (0.9-44.3), 0.8 (0.1-6.7), and 0.3 (0-1.2), respectively. The same figures at the age of 3months were 4.1 (1.2-27.3), 0.8 (0-2.3), and 0.1 (0-0.8), respectively. Mixed obstructive apnea-hypopnea index (MOAHI) was 1.5 (0.2-7.0) and 0.9 (0.2-4.4) at the first and second measurements, respectively (P=.017). Only 1.2% of central apneas lasted longer than 20s. Periodic breathing was present in more than 90% of subjects studied. CONCLUSIONS: The infants in our study aged ⩽3months had respiratory event indices that were different from older children or adults. MOAHI showed a significant decrease during the first 3months after birth. We recommend that scoring of PG in infants of 3months or younger should consider age-specific reference values.

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BACKGROUND: No scientific evidence supports the use of portable devices to diagnose obstructive sleep apnea syndrome (OSAS) in patients with co-morbities. Our aim was to evaluate the accuracy of a portable monitoring device (Stardust - STD) in the detection of patients with chronic obstructive pulmonary disease (COPD). METHODS: Patients with COPD and clinical suspicion of OSAS were recruited for a prospective randomized study. The STD was used on two different nights: (1) at home (STDHome) and (2) at the sleep laboratory simultaneous with polysomnography (PSG-STDLab). RESULTS: A total of 72 patients underwent the proposed recordings. Forty-six volunteers were excluded due to recording problems, and data from 26 subjects were analyzed. The mean age was (mean±SD) 62.8±8.5 years, 50% were male, and the mean forced expiratory volume in the first second was 55±11%. Significant intraclass correlation was observed between apnea-hypopnea index (AHI)-PSG vs. AHI-STDLab (r=0.61, p<0.0001) and AHI-STDHome (r=0.47, p<0.007). Kappa analysis also showed a significant agreement for severe group. CONCLUSION: Despite the agreement found in a small number of patients between AHI, a large number of failures in the recording limits the use of this portable device for the diagnosis of OSAS in patients with COPD.

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Portable sleep studies may play an important role to take decisions on patients referred for suspicion of Sleep Apnea-Hypopnea Syndrome (SAHS). The aim of this study was to evaluate the diagnostic accuracy of automated analysis of ApneaLink in patients with suspicion of SAHS. All participants (75) performed the ApneaLink and polysomnography (PSG) simultaneously in the sleep laboratory. The two recordings were interpreted blindly. The ApneaLink software calculated: (1) risk indicator (RI)-a combination of apnea/hypopnea index (AHI) plus inspiratory flow limitation events and (2) the AHI. ApneaLink and SAHS were defined in three ways: AHI or respiratory disturbance index (RDI) >or= 5, 10 and 15 respectively. ROC curves analysis was performed. The sensitivity (S), specificity (E) and positive and negative likelihood ratio (LR+, LR-) for the different thresholds for RI or AHI were calculated; 66 patients were included (47 men, mean age 51, median RDI 10.6, mean BMI 29.3 kg/m2). The best cut off points of RI were: SAHS = RDI >or= 5: RI > 9 (S 80%, E 100%, LR- 0.20); SAHS =RDI >or= 10: RI > 13 (S 92%, E 93%, LR+ 13.7 LR- 0.089); SAHS = RDI >or= 15 =: RI > 16 (S 93.5%, E 91%, LR+10.9, LR- 0.071). The AHI had a similar diagnostic accuracy to RI for the different definitions of SAHS. The RI and AHI obtained from automated analysis of ApneaLink were highly sensitive and specific to diagnose moderate to severe SAHS.

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Portable sleep studies may play an important role to take decisions on patients referred for suspicion of Sleep Apnea-Hypopnea Syndrome (SAHS). The aim of this study was to evaluate the diagnostic accuracy of automated analysis of ApneaLinkT in patients with suspicion of SAHS. All participants (75) performed the ApneaLink and polysomnography (PSG) simultaneously in the sleep laboratory. The two recordings were interpreted blindly. The ApneaLink software calculated: (1) risk indicator (RI)-a combination of apnea/hypopnea index (AHI) plus inspiratory flow limitation events and (2) the AHI. ApneaLinkT and SAHS were defined in three ways: AHI or respiratory disturbance index (RDI) = 5, 10 and 15 respectively. ROC curves analysis was performed. The sensitivity (S), specificity (E) and positive and negative likelihood ratio (LR+, LR-) for the different thresholds for RI or AHI were calculated; 66 patients were included (47 men, mean age 51, median RDI 10.6, mean BMI 29.3 kg/m²). The best cut off points of RI were: SAHS = RDI = 5: RI > 9 (S 80%, E 100%, LR- 0.20); SAHS = RDI = 10: RI > 13 (S 92%, E 93%, LR+ 13.7 LR- 0.089); SAHS = RDI = 15 =: RI > 16 (S 93.5%, E 91%, LR+ 10.9, LR- 0.071). The AHI had a similar diagnostic accuracy to RI for the different definitions of SAHS. The RI and AHI obtained from automated analysis of ApneaLinkT were highly sensitive and specific to diagnose moderate to severe SAHS.

Los equipos portátiles para estudios del sueño pueden tener un rol importante para tomar decisiones en pacientes con sospecha de Síndrome Apneas-Hipopneas del Sueño (SAHS). El objetivo del estudio fue evaluar la exactitud diagnóstica del análisis automático del ApneaLinkT en pacientes con sospecha de SAHS. Setenta y cinco sujetos realizaron simultáneamente el ApneaLinkT y una polisomnografía (PSG) en el laboratorio de sueño. Los dos registros fueron interpretados en forma ciega. Un programa calculó: (1) el índice apnea/hipopnea (IAH), (2) el indicador de riesgo (IR)-IAH más respiraciones con limitación al flujo aéreo. ApneaLinkT y SAHS fueron definidos como: IAH o IPR (índice de perturbación respiratoria) = 5, 10 y 15 respectivamente. Se calcularon la sensibilidad (S), especificidad (E) y razón de probabilidad positiva y negativa (RP+, RP-) para los diferentes puntos de corte fueron calculadas. Se incluyeron 66 pacientes (47 varones, edad media 51, IPR mediano 10.6, IMC medio 29.3 kg/m²). Los mejores puntos de corte del IR fueron: SAHS = IPR = 5: IR > 9 (S 80%, E 100%, RP- 0.20); SAHS = IPR = 10: IR >13 (S 92%, E 93%, RP+ 13.7 RP- 0.089); SAHS = IPR = 15: IR > 16 (S 93.5%, E 91%, RP+ 10.9, RP- 0.071). El IAH tuvo una exactitud diagnóstica similar al IR para las diferentes definiciones de SAHS. El IR y el IAH obtenidos del análisis automático del ApneaLinkT fueron muy sensibles y específicos para diagnosticar SAHS moderado a grave.

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OBJECTIVE: The aim of this study was to develop a Portuguese-language version of the Epworth sleepiness scale (ESS) for use in Brazil. METHODS: The steps involved in creating the ESS in Brazilian Portuguese (ESS-BR) were as follows: translation; back-translation; comparison (by a committee) between the translation and the back-translation; and testing in bilingual individuals. The ESS-BR was applied to a group of patients who were submitted to overnight polysomnography in order to identify obstructive sleep apnea-hypopnea syndrome (OSAHS), insomnia and primary snoring. A control group was composed of subjects with a history of normal sleep habits, without reported snoring. RESULTS: A total of 114 patients and 21 controls were included. The 8-item scores of the ESS-BR had an overall reliability coefficient of 0.83. The study group was composed of 59 patients with OSAHS, 34 patients with primary snoring and 21 patients with insomnia. One-way ANOVA demonstrated significant differences in ESS-BR scores among the four diagnostic groups (p < 0.001). Post-hoc tests between groups showed that the ESS-BR scores of the patients with insomnia did not differ from those of the controls (p > 0.05). The ESS-BR scores were significantly higher for OSAHS patients and for primary snorers than for controls (p < 0.05). In addition, the scores for OSAHS patients were significantly higher than were those for primary snorers (p < 0.05). CONCLUSIONS: The results of the present study demonstrate that the ESS-BR is a valid and reliable instrument for the assessment of daytime sleepiness, equivalent to its original version when applied to individuals who speak Brazilian Portuguese.

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OBJECTIVE: The aim of this study was to develop a Portuguese-language version of the Epworth sleepiness scale (ESS) for use in Brazil. METHODS: The steps involved in creating the ESS in Brazilian Portuguese (ESS-BR) were as follows: translation; back-translation; comparison (by a committee) between the translation and the back-translation; and testing in bilingual individuals. The ESS-BR was applied to a group of patients who were submitted to overnight polysomnography in order to identify obstructive sleep apnea-hypopnea syndrome (OSAHS), insomnia and primary snoring. A control group was composed of subjects with a history of normal sleep habits, without reported snoring. RESULTS: A total of 114 patients and 21 controls were included. The 8-item scores of the ESS-BR had an overall reliability coefficient of 0.83. The study group was composed of 59 patients with OSAHS, 34 patients with primary snoring and 21 patients with insomnia. One-way ANOVA demonstrated significant differences in ESS-BR scores among the four diagnostic groups (p < 0.001). Post-hoc tests between groups showed that the ESS-BR scores of the patients with insomnia did not differ from those of the controls (p > 0.05). The ESS-BR scores were significantly higher for OSAHS patients and for primary snorers than for controls (p < 0.05). In addition, the scores for OSAHS patients were significantly higher than were those for primary snorers (p < 0.05). CONCLUSIONS: The results of the present study demonstrate that the ESS-BR is a valid and reliable instrument for the assessment of daytime sleepiness, equivalent to its original version when applied to individuals who speak Brazilian Portuguese.

OBJETIVO: Desenvolver uma versão da escala de sonolência de Epworth (ESE) para o português para uso no Brasil. MÉTODOS: A versão no português do Brasil (ESE-BR) foi desenvolvida de acordo com as seguintes etapas: tradução; retrotradução; comparação entre a tradução e a retrotradução (por um comitê); e aplicação em indivíduos bilíngues. A ESE-BR foi aplicada a um grupo de pacientes submetidos à polissonografia de noite inteira para identificar síndrome da apneia-hipopneia obstrutiva do sono (SAHOS), insônia e ronco primário. Um grupo controle foi composto de indivíduos com história de hábitos normais de sono, sem ronco aparente. RESULTADOS: Um total de 114 pacientes e 21 controles foram incluídos. Os 8 itens do ESE-BR tiveram um coeficiente de confiabilidade total de 0,83. O grupo em estudo foi composto por 59 pacientes com SAHOS, 34 pacientes com ronco primário e 21 pacientes com insônia. One-way ANOVA demonstrou diferenças significativas nos escores do ESE-BR entre os quatro grupos diagnósticos (p < 0,001). Testes post hoc entre grupos pareados mostraram que os escores do ESE-BR para insones não diferiram daqueles dos controles (p > 0,05). Os escores dos pacientes com SAHOS e nos roncadores primários foram significativamente maiores que os dos controles (p < 0,05). Além disso, os escores para pacientes com SAHOS foram significativamente maiores do que os daqueles com ronco primário (p < 0,05). CONCLUSÕES: Os resultados do presente estudo demonstraram que a ESE-BR é um instrumento válido e confiável para a avaliação da sonolência diurna e equivalente a sua versão original, quando aplicada em indivíduos que falam português do Brasil

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