Dados do Trabalho

Título

Occurrence and relevance of the evaluation of non-classical symptoms in patients with obstructive sleep apnea

Introdução

Obstructive sleep apnea (OSA) is characterized by the recurrent collapse of the oropharyngeal airway during sleep, leading to drops in oxyhemoglobin saturation and awakenings. Classical symptoms are common and guide clinical suspicion and diagnosis. However, there is a high prevalence of non-classical symptoms not well investigated, but can be crucial in raising clinical suspicion.

Objetivo

To describe the occurrence of classical and non-classical symptoms in consecutive OSA patients referred to CPAP therapy. To compare the frequency of these symptoms among patients with varying OSA severitiy. To determine the predominance of classical or non-classical symptoms in the same OSA severity patients.

Métodos

Results from Type I or III sleep tests were analyzed, and patients were categorized according to the apnea-hypopnea index (AHI) into mild (AHI 5 to 14.9 events/h), moderate (AHI 15 to 29.9 events/h), and severe (AHI ≥ 30 events/h) OSA. The investigators inquired the patients about the presence of classical and non-classical symptoms related to OSA. Statistical analysis was performed using the Shapiro-Wilk test, Paired Student’s t-test or Wilcoxon (for intragroup comparisons), ANOVA for intergroup comparisons. The significance level was set at 5%.

Resultados

We evaluated 109 patients (56% men, mean age 60±16 years, BMI 29±6 kg/m², and neck circumference 39±5 cm) and found 10% of mild OSA, 35% moderate, and 55% severe. In patients with mild OSA, complaints of low memory and concentration (91%) were the most frequent classical symptoms, while reflux (82%) and maintenance insomnia (73%) were the most common non-classical symptoms. Snoring and nocturia were the most frequent classical symptoms in moderate OSA (89% and 87%, respectively) and severe OSA (89% and 83%, respectively) and the most common non-classical symptoms were bruxism (63% and 73%, respectively) and oral dryness (68% and 67%, respectively). Surprisingly, patients with mild OSA reported similar numbers of classical and non-classical symptoms (p=0.208), while those with moderate and severe OSA reported more classical symptoms (p=0.000 and p=0.036, respectively). Moreover, the quantity of reported classical (p=0.830) and non-classical symptoms (p=0.314) was similar across all groups, including those with mild OSA.

Conclusões

Non-classical symptoms of OSA are highly prevalent, independent of OSA severity. Mild OSA patents are as symptomatic as those with moderate and severe OSA.

Palavras -chave

obstructive sleep apnea; non classical symptoms, sleepiness