10/h) diagnosticados por polissonografia nocturna (PSG), todos condutores de veículos, 18,4% do quais profissionais. Na altura da entrevista clínica foi inquirido se tinham tido, nos três anos antes acidentes e/ou quase acidentes devido a hipersonia diurna (Grupo II = 74) ou não (Grupo I = 89). Estes dois grupos foram comparados quanto a: idade, índice de massa corporal (IMC), escala de sonolência de Epworth (ESE), PaO2 e PaCO2 diurnas, avaliação da qualidade de vida pelo inquérito Functional Outcomes of Sleep Questionnaire (FOSQ teste) e dados da polissonografia - tempo total de sono (TTS), eficiência do sono, estádios do sono, índice de microdespertares (IMD), índice de apneia/hipopneia (IAH), SaO2 mínima e média, % tempo SaO2<90% (T90), índice de dessaturação (IDS), tempo total em apneia/hipopneia (TTOT) (teste t de Student). Resultados: (Grupo I / Grupo II) idade (anos) - 57,6±11,8 / 54,7±10,9 (ns); sexo masculino - 75%/ /78,4%; ESE - 12,3±5,4 / 17,6±4,3 (p<0,001); IMC (kg/m²) - 36,2±8,1 / 35,6±6,3 (ns); PaO2 (mmHg) - 76,1±11,4 / 78,5±12,6 (ns); PaCO2 (mmHg) - 42,6±5,1 / 42,2±4,7 (ns); FOSQ test - 15,1±3,1/ /12,9±3,4 (p<0,001). Dos dados da PSG só se encontraram diferenças no IAH - 45,0±21,6 / 56,2±29.7 (p=0,01) e no TTOT (minutos) - 98,5±63,7 / 133,3±83,2 (p=0,005). Conclusões: Nesta experiência, os doentes com acidentes e/ou quase acidentes tinham uma SAOS mais grave, nomeadamente com maiores IAH e hipersonia diurna, e menor qualidade de vida.]]>
10/h) diagnosed using nocturnal polysomnography (NPSG), all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age, body mass index (BMI), Epworth Sleepiness Scale (ESS), daytime PaO2 and PaCO2, Functional Outcomes of Sleep Questionnaire (FOSQ) test and NPSG data. This latter was total sleep time (TTS), sleep efficiency, sleep stages, arousal index (ARI), AHI, minimal and average SaO2, % of time with SaO2 < 90% (T90), desaturation index (ODI), total duration of apnoea-hypopnoea (TDAH) (T test). Results: (Grupo I / Grupo II) idade (anos) – 57,6±11,8 / 54,7±10,9 (ns); sexo masculino – 75%/ /78,4%; ESE – 12,3±5,4 / 17,6±4,3 (p<0,001); IMC (kg/m²) – 36,2±8,1 / 35,6±6,3 (ns); PaO2 (mmHg) – 76,1±11,4 / 78,5±12,6 (ns); PaCO2 (mmHg) – 42,6±5,1 / 42,2±4,7 (ns); FOSQ test – 15,1±3,1/ /12,9±3,4 (p<0,001). Dos dados da PSG só se encontraram diferenças no IAH – 45,0±21,6 / 56,2±29.7 (p=0,01) e no TTOT (minutos) – 98,5±63,7 / 133,3±83,2 (p=0,005). Conclusions: In our experience patients who had road traffic accidents and/or near misses had a more severe OSAS, with higher AHI, excessive daytime sleepiness and lower quality of life.]]>
M Aguiar 1
J Valença 1
M Felizardo 1
F Caeiro 1
S Moreira 1
R Staats 1
A A Bugalho de Almeida 1
]]>
Resumo
Vários estudos demonstram que os doentes com síndroma de apneia obstrutiva do sono (SAOS) têm um risco aumentado de acidentes de viação. O objectivo do presente trabalho consistiu em analisar, nestes doentes, se há diferenças nos que referem acidentes e/ /ou quase acidentes e aqueles que o não fazem.
Material e métodos: Estudaram-se prospectivamente 163 doentes com SAOS (índice apneia/hipopneia (IAH)>10/h) diagnosticados por polissonografia nocturna (PSG), todos condutores de veículos, 18,4% do quais profissionais. Na altura da entrevista clínica foi inquirido se tinham tido, nos três anos antes acidentes e/ou quase acidentes devido a hipersonia diurna (Grupo II = 74) ou não (Grupo I = 89).
Estes dois grupos foram comparados quanto a: idade, índice de massa corporal (IMC), escala de sonolência de Epworth (ESE), PaO2 e PaCO2 diurnas, avaliação da qualidade de vida pelo inquérito Functional Outcomes of Sleep Questionnaire (FOSQ teste) e dados da polissonografia – tempo total de sono (TTS), eficiência do sono, estádios do sono, índice de microdespertares (IMD), índice de apneia/hipopneia (IAH), SaO2 mínima e média, % tempo SaO2<90% (T90), índice de dessaturação (IDS), tempo total em apneia/hipopneia (TTOT) (teste t de Student).
Resultados: (Grupo I / Grupo II) idade (anos) – 57,6±11,8 / 54,7±10,9 (ns); sexo masculino – 75%/ /78,4%; ESE – 12,3±5,4 / 17,6±4,3 (p<0,001); IMC (kg/m2) – 36,2±8,1 / 35,6±6,3 (ns); PaO2 (mmHg) – 76,1±11,4 / 78,5±12,6 (ns); PaCO2 (mmHg) – 42,6±5,1 / 42,2±4,7 (ns); FOSQ test – 15,1±3,1/ /12,9±3,4 (p<0,001).
Dos dados da PSG só se encontraram diferenças no IAH – 45,0±21,6 / 56,2±29.7 (p=0,01) e no TTOT (minutos) – 98,5±63,7 / 133,3±83,2 (p=0,005).
Conclusões: Nesta experiência, os doentes com acidentes e/ou quase acidentes tinham uma SAOS mais grave, nomeadamente com maiores IAH e hipersonia diurna, e menor qualidade de vida.
Palavras-chave: SAOS, acidentes, FOSQ test.
]]>
Obstructive sleep apnoea syndrome as a cause of road traffic accidents
Abstract
Several studies have demonstrated that obstructive sleep apnoea syndrome (OSAS) patients have a higher rate of road traffic accidents. Our study aimed to analyse any differences in OSAS patients between those who reported having had road traffic accidents and/or near misses and those who did not.
Methods: We studied 163 patients with OSAS (apnoea-hypopnoea index (AHI)>10/h) diagnosed using nocturnal polysomnography (NPSG), all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age, body mass index (BMI), Epworth Sleepiness Scale (ESS), daytime PaO2 and PaCO2, Functional Outcomes of Sleep Questionnaire (FOSQ) test and NPSG data. This latter was total sleep time (TTS), sleep efficiency, sleep stages, arousal index (ARI), AHI, minimal and average SaO2, % of time with SaO2 < 90% (T90), desaturation index (ODI), total duration of apnoea-hypopnoea (TDAH) (T test).
Results: Group I (no road traffic accidents) No=89 patients; group II (road traffic accidents) No=74 patients. Age (years) was 57.6±11.8 vs. 54.7±10.9 (ns); male gender, 75% vs. 78.4%; ESS, 12.3±5.4 vs. 17.6±4.3 (p<0.001); BMI, (Kg/m2) 36.2±8.1 vs. 35.6±6.3 (ns); PaO2 (mmHg), 76.1±11.4 vs. 78.5±12.6 (ns); PaCO2 (mmHg), 42.6±5.1 vs. 42.2±4.7 (ns); FOSQ, 15.1±3.1 vs. 12.9±3.4 (p<0.001). NPSG data revealed differences only in AHI: 45.0±21.6 vs. 56.2±29.7 (p=0.01) and in TDAH (minutes), 98.5±63.7 vs. 133.3±83.2 (p=0,005).
Conclusions: In our experience patients who had road traffic accidents and/or near misses had a more severe OSAS, with higher AHI, excessive daytime sleepiness and lower quality of life.
Key-words: OSAS, road traffic accidents, FOSQ test.
]]> Texto completo disponível apenas em PDF.
Full text only available in PDF format.
Bibliografia/Bibliography
1. McNicholas WT. Diagnosis of obstructive sleep apnea in adults. Proc Am Thorac Soc 2008; 5:154-160. [ Links ]
2. George CF, Findley LJ, Hack MA, McEvoy RD, Across-country viewpoints on sleepiness during driving; Am J Respir Crit Care Med 2002; 165:746-749.
3. Hartenbaum N, Collop N, Rosen IM, Phillips B, George CF, Rowley JA, Freedman N, Weaver TI, Guru bhagavatula I, Strohl K, Leaman HM,Moffitt GL, Rosekind MR. Sleep apnea and commercial motor vehicle operators: statement from the joint task force of the American College of Chest Physicians, American College of Occupational and Environmental Medicine and the National Sleep Foundation. JOEM 2006; 48 (Supl 9).
4. Krieger J. Sleep apnoea and driving: How can this be dealt with? Eur Respir Rev 2007; 16(106):189-195.
5. Jimenez-Gomez J, Cordero-Guevara J. The cooperative group of Burgos-Santander. The association between sleep apnea and the risk of traffic accidents. N Engl J Med 1999; 340:847-851.
]]> 6. Mazza S, Pe´pin JL, Nae¨gele´ B, Rauch E, Deschaux C, Ficheux P, Levy P. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform. Eur Respir J 2006; 28: 1020-1028.7. Masa JF, Rubio M, Findley LJ, Cooperative Group. Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. Am J Respir Crit Care Med 2000; 162: 1407-1412.
8. Kriegar J, Meslier N, Lebrun T, Levy P, Phillip-Joet F, Sailly JC, Racineux JL. Accidents in obstructive sleep apnoea Patients treated with nasal continuous positive airway pressure-a prospective study. Chest 112:1561-1566.
9. Findley L, Smith C, Hooper J, Dineen, Suratt P. Treatment with nasal CPAP decreases automobile accidents in patients with sleep apnoea. Am J Respir Crit Care Med 2000; 161:857-859.
10. ERS Task Force, McNicholas WT, Kriegar J. Public Health and medicolegal implications of sleep apnoea. Eur Respir J 2002; 20:1594-1609.
11. Stradling JR, Crosby JH, Payne CD. Self-reported snoring and daytime sleepiness in men aged 35-65 years. Thorax 1991; 46: 807-810.
12. Barbe F, Pericas J, Munoz A, et al. Automobile accidents in patients with sleep apnoea syndrome. Am J Respir Crit Care Med 1998; 158: 18-22.
1 Serviço de Pneumologia I, Hospital de Santa Maria, CHLN, EPE, Lisboa / Pulmonology Unit I, Hospital de Santa Maria, CHLN, EPE, Lisboa
]]> Correspondência/Correspondence to:Margarida Aguiar
Hospital de Santa Maria
Av. Egas Moniz, 1500 Lisboa
Email: m_aguiar@netcabo.pt
Recebido para publicação/received for publication: 08.11.12
Aceite para publicação/accepted for publication: 08.12.23
]]>