RESUMO
BACKGROUND: Obstructive sleep apnea (OSA) is common among patients with coronary artery disease. However, OSA remains largely under recognized. The lack of clinical suspicion and difficulties to access full polysomnography (PSG) are limiting factors. The aim of this study was to evaluate, among patients referred to coronary artery bypass grafting (CABG): (i) the prevalence of OSA, (ii) the association of OSA with clinical symptoms, (iii) the performance of overnight unattended portable monitoring (PM) as an alternative method for the diagnosis of OSA. METHODS: Consecutive patients referred for CABG were evaluated by standard physical evaluation and validated questionnaires (Berlin questionnaire and Epworth Sleepiness Scale) and underwent full PSG and PM (Stardust II). RESULTS: We studied 70 consecutive patients (76% men), age 58±7 years (mean±SD), BMI [median (interquartile range)] 27.6 kg/m (25.8-31.1). The prevalence of OSA (full PSG) using an apnea-hypopnea index of at least 5 events/h was 87%. Commonly used clinical traits for the screening of OSA such as the Epworth Sleepiness Scale and neck circumference had low sensitivities to detect OSA. In contrast, the Berlin questionnaire showed a good sensitivity (72%) to detect OSA. PM showed good sensitivity (92%) and specificity (67%) for the diagnosis of OSA. CONCLUSION: OSA is strikingly common among patients referred for CABG. The Berlin questionnaire, but not symptom of excessive daytime sleepiness is a useful tool to screen OSA. PM is useful for the diagnosis of OSA and therefore is an attractive tool for widespread use among patients with coronary artery disease.
Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Polissonografia/métodos , Encaminhamento e Consulta , Apneia Obstrutiva do Sono/diagnóstico , Idoso , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia/instrumentação , Valor Preditivo dos Testes , Prevalência , Curva ROC , Sensibilidade e Especificidade , Apneia Obstrutiva do Sono/epidemiologia , Inquéritos e QuestionáriosRESUMO
Children suffering from neuromuscular diseases are at an increased risk of sleep-related breathing disorders (SRBD) such as obstructive sleep apnea syndrome (OSAS) and hypoventilation as well as central sleep apnea, which is frequent in these patients due to diaphragmatic weakness. They are at higher risk for developing complications of nocturnal hypoxemia, including pulmonary hypertension, cor pulmonale and neurocognitive dysfunction. Neuromuscular disorders and OSAS are both prevalent disorders and frequently overlap. Sleep-related hypoventilation/hypoxemia due to neuromuscular diseases may be exacerbated in the presence of OSAS; these children are likely to experience greater severity and duration of sleep-related hypoxemia than are children with either disorder alone. Additionally, some of these children have reduced central neural chemoresponsiveness. The development of SRBD in these patients further impairs their quality of life and worsens their respiratory status. We review the literature on the diagnosis and treatment of SRBD in children with a variety of neuromuscular disorders.
Assuntos
Doenças Neuromusculares/complicações , Síndromes da Apneia do Sono/etiologia , Criança , Transtornos Cognitivos/etiologia , Humanos , Hipertensão Pulmonar/etiologia , Hipoventilação/diagnóstico , Hipoventilação/etiologia , Hipóxia/etiologia , Polissonografia , Doença Cardiopulmonar/etiologia , Fatores de Risco , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/terapia , Apneia do Sono Tipo Central/diagnóstico , Apneia do Sono Tipo Central/etiologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologiaRESUMO
The aim of this study was to determine whether an orientation session led by a polysomnography (PSG) technician during the night of positive airway pressure (PAP) titration can improve objective sleep quality and acceptance of nasal mask in patients referred to a sleep laboratory. Consecutive patients (n = 1,481), referred for PAP titration during PSG, were retrospectively evaluated. Patients were distributed in two groups: the control group, patients referred for PAP titration (n = 699) who did not undertake an orientation session led by a PSG technician, and the oriented group, patients referred to PAP titration (n = 782) who followed the orientation session. Demographic data were similar (p > 0.05) between groups (control vs oriented) for: male/female proportion (76:24 vs 75:25%), age (mean +/- SD; 53 +/- 12 vs 52 +/- 12 years), Epworth Sleepiness Scale score (12 +/- 6 vs 12 +/- 6), and body mass index (31 +/- 6 vs 31 +/- 6 kg/m(2)). PSG data were different (p < 0.05) between the groups for: total sleep time (312 +/- 81 vs 326 +/- 85 min), sleep efficiency (74 +/- 17 vs 77 +/- 14%), sleep latency (22 +/- 24 vs 18 +/- 29 min), S1 (8 +/- 8 vs 6 +/- 5%), S3 4 (19 +/- 11 vs 21 +/- 13%), rapid eye movement sleep (17 +/- 9 vs 18 +/- 9%), and wake after sleep onset (106 +/- 68 vs 93 +/- 58 min). After the orientation session, the number of patients who did not accept nasal mask during PSG recording was higher in the control group than the oriented group (80 vs 44; p = 0.001). An orientation session led by a PSG technician can improve objective sleep quality and nasal mask acceptance during the night of PAP titration. Such an addition to PAP titration could be an efficient intervention to improve PAP compliance.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Distúrbios do Sono por Sonolência Excessiva/terapia , Educação de Pacientes como Assunto/métodos , Satisfação do Paciente , Apneia Obstrutiva do Sono/terapia , Adulto , Idoso , Pressão Positiva Contínua nas Vias Aéreas/psicologia , Distúrbios do Sono por Sonolência Excessiva/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Polissonografia , Apneia Obstrutiva do Sono/psicologiaRESUMO
This review attempts to assemble the characteristics of a distinct variant of sleepwalking called sexsomnia/sleepsex from the seemingly scarce literature into a coherent theoretical framework. Common features of sexsomnia include sexual arousal with autonomic activation (e.g. nocturnal erection, vaginal lubrication, nocturnal emission, dream orgasms). Somnambulistic sexual behavior and its clinical implications, the role of precipitating factors, diagnostic, treatment, and medico-legal issues are also reviewed. The characteristics of several individuals described in literature including their family/personal history of parasomnia as well as the abnormal behaviors occurring during sleep are reported.