Evaluación de riesgo de apnea obstructiva del sueño y de la adherencia al tratamiento farmacológico en pacientes con hipertensión arterial / Risk assessment of obstructive sleep apnea and adherence to pharmacological treatment in patients with arterial hypertension

Introducción:existe una sospecha sobre la relación bidireccional entre la apnea obstructiva del sueño (AOS) y la hipertensión arterial (HTA). Ambas ejercen una acción sinérgica sobre desenlaces cardiovasculares porlo quees trascendente ponderar la prevalencia de riesgo para AOS en los hipertensos. En este último grupo también hemos investigado la tasa de adherencia a los fármacos prescritos. Metodología:mediante un estudio de casos y controles y con la aplicación del cuestionario STOP-BANG se han discriminado las categorías de riesgo para apnea de sueño en las dos cohortes. Para el análisis de la adherencia a fármacos antihipertensivos se utilizó el cuestionario abreviado de Morisky. Resultados:se incluyeron a 590 individuos (295 casos y 295 controles. Se observó alto riesgo para AOS en el grupo de hipertensos (36,6%) comparado con el 14,2% del grupo control. Por otro lado, el sexo masculino OR 7,77 (IC95% 4,33-13,84), la obesidad OR 5,03 (IC95% 3,11-8,13) y la HTA OR 4,31 (IC95% 2,64-7,03) se ponderan significativos en un modelo de ajuste logístico aquí estudiado. El 61,69% de los hipertensos refería adherencia al tratamiento farmacológico prescrito. Discusión:el tamizaje de AOS es factible con un cuestionario aplicable en la práctica clínica diaria. De la probabilidad clínica pre-test hay que partir hacia métodos diagnósticos específicos para el diagnóstico de AOS, enfatizando casos de HTA resistente, HTA nocturna y HTA enmascarada. Se deberían realizar estudios locales que nos ayuden a comprender las causas de la falta de adherencia a fármacos antihipertensivos en una fracción importante de los individuos con HTA

Introduction:there is a suspicion about the bidirectional relationship between obstructive sleep apnea (OSA) and arterial hypertension (AHT). Both have a synergistic action on cardiovascular outcomes, so it is important to assess the prevalence of risk for OSA in hypertensive patients. In this last group we have also investigated the rate of adherence to prescribed drugs.Metodology:through a case-control study and with the application of the STOP-BANG questionnaire, the risk categories for sleep apnea in the two cohorts have been discriminated. For the analysis of adherence to antihypertensive drugs, the abbreviated Morisky questionnaire was used. Results:590 individuals were included (295 cases and 295 controls. A high risk for OSA was observed in the hypertensive group (36.6%) compared to 14.2% in the control group. On the other hand, the male sex OR 7.77 (95%CI 4.33-13.84), obesity OR 5.03 (95%CI 3.11-8.13) and hypertensionOR4.31(95%CI 2.64-7.03) they areweighted significant in a logistic adjustment model studied here.61.69% of hypertensive patients reported adherence to the prescribed pharmacological treatment.Discussion:OSA screening is feasible with a questionnaire applicable in daily clinical practice. From the pre-test clinical probability, specific diagnostic methods for the diagnosis of OSA must be started, emphasizing cases of resistant AHT, nocturnal AHT, andmasked AHT. Local studies should be carried out to help us understand the causes of non-adherence to antihypertensive drugs in a significant fraction of individuals with AHT

The association between sleep disturbances and tooth loss among post-stroke patients / Prevalência de edentulismo e distúrbios de sono após acidente vascular cerebral

ABSTRACT Background: Loss of teeth has been associated with neurological and sleep disorders. It is considered to be a predictor of stroke and leads to modifications of airway patency and predisposition to obstructive sleep apnea. Objective: To investigate sleep quality, risk of obstructive sleep apnea and excessive sleepiness among post-stroke patients with tooth loss attending the Neurovascular Clinic of the Federal University of São Paulo. Methods: The prevalence rates of different types of stroke were assessed among 130 patients with different degrees of tooth loss, along with the presence of sleep disturbances, risk of obstructive sleep apnea and excessive daytime sleepiness. Results: The prevalence of ischemic stroke was 94.6%, with either no significant disability or slight disability. Our sample had poor sleep quality, and a high risk of obstructive sleep apnea, but without excessive daytime sleepiness. Half of our sample had lost between 9 and 31 teeth, and more than 25% had edentulism. The majority used full removable dental prostheses, and more than half of these individuals slept without removing the prosthesis. Conclusions: We found high prevalence of poor sleep quality and high risk of obstructive sleep apnea among post-stroke patients with tooth loss. This indicates the need for further studies on treating and preventing sleep disturbances in stroke patients with tooth loss.

RESUMO Antecedentes: A perda de dentes tem sido associada a distúrbios neurológicos e do sono. É considerada um preditor de acidente vascular cerebral (AVC), com modificações na permeabilidade das vias aéreas e predisposição à apneia obstrutiva do sono. Objetivo: Investigar a qualidade do sono, o risco de apneia obstrutiva do sono e a sonolência excessiva em pacientes pós-AVC com perda dentária, atendidos na Clínica Neurovascular da Universidade Federal de São Paulo. Métodos: O estudo avaliou a prevalência de diferentes tipos de AVC em 130 pacientes com diferentes graus de perda dentária e a presença de distúrbios do sono, risco de apneia obstrutiva do sono e sonolência excessiva. Resultados: A prevalência de AVC isquêmico foi de 94,6%, sem deficiência significativa ou deficiência leve. Nossa amostra tinha má qualidade de sono e alto risco de apneia obstrutiva do sono, sem sonolência diurna excessiva. Metade de nossa amostra perdeu entre nove e 31 dentes, e mais de 25% tiveram edentulismo. A maioria usava próteses dentárias totalmente removíveis e, desses pacientes, mais da metade dormia com elas. Conclusões: Encontramos alta prevalência de má qualidade do sono e alto risco de apneia obstrutiva do sono em pacientes pós-AVC com perda dentária. Isso indica a necessidade de mais estudos sobre o tratamento e a prevenção de distúrbios do sono em pacientes com AVC e perda dentária.

Rendimiento y validación del puntaje NoSAS en la evaluación inicial del síndrome de apnea/hipopnea del sueño / Performance and validation of NoSAS score in sleep apnea-hypopnea syndrome initial assessment

Introducción: El método de referencia para diagnosticar el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es la polisomnografía, esta no es diagnóstica en otros trastornos respiratorios del sueño, por lo que es necesario la implementación de puntajes predictivos para diferenciar aquellos pacientes que tienen más riesgos de padecer SAHOS y necesiten de una polisomnografía. El objetivo de este estudio fue validar el puntaje NoSAS y la escala de Berlín frente a la polisomnografía tipo 1 en pacientes con sospecha de SAHOS. Materiales y métodos: Estudio de pruebas diagnósticas. A 264 pacientes se les realizó una polisomnografía basal, la aplicación del puntaje NoSAS y la escala de Berlín; luego, se hizo el análisis de las pruebas diagnósticas y se calculó el rendimiento de cada una en relación con el índice de apnea hipopnea (IAH). Resultados: La sensibilidad del puntaje NoSAS para un IAH ≥ 20 fue 88,57% con intervalo de confianza (IC) 95% 80,4-96,74; especificidad 56,70 %; IC 95% 49,47-63,93 y valor predictivo negativo (VPN) de 93,22, IC 95% 91,70- 99,82. Para la escala de Berlín, la sensibilidad fue de 81,43%, IC 95% 71,60-91,25; especificidad de 58,76%, IC 95% 51,58-65,95 y VPN 89,76%, IC 95% 89,08-98,32. Conclusión: Se demostró que el puntaje NoSAS y la escala de Berlín tienen una buena sensibilidad para descartar a las personas con un menor riesgo de SAHOS. Un paciente clasificado de bajo riesgo probablemente está sano o tiene bajo riesgo para SAHOS moderado a severo y no requeriría de una polisomnografía inicial.

Introduction: The gold standard for diagnosing obstructive sleep apnea-hypopnea syndrome (OSAHS) is the polysomnography, and it is not a diagnostic tool for another sleep breathing disorders, so that it is necessary to implement predictive scores to differentiate those patients who have more risk of suffering OSAHS, therefore they need a polysomnography. The aim to this study was to validate the NoSAS score and Berlin scale in relation to the polysomnography type 1, in patients who have the clinical suspicion of OSAHS. Material and methods: Diagnostic tests study. 264 patients underwent polysomnography, and the NoSAS score and Berlin scale were applied to them. After that, the diagnostic tests analysis was done and the performance of each one of them was calculated in relation to the apnea- hypopnea index (AHI). Results: The sensitivity of the NoSAS score for an AHI ≥ 20 was 88.57%, confidence interval (CI) 95% (80.4-96.74), specificity 56.70 %, CI 95% (49.47-63.93), and the negative predictive value (NPV) was 93.22, CI 95% (91.70-99.82). For Berlin scale the sensitivity was 81.43%, CI 95% (71.60-91.25), specificity 58.76%, CI 95% (51.58-65.95) and NPV 89.76%, CI 95% (89.08-98.32). Conclusions: It was shown that NoSAS score and Berlin scale have a good sensitivity to rule out people who have less OSAHS risk. A patient classified as low risk, probably is healthy or at low risk for moderate to severe OSAHS and would not require an initial polysomnography.

Estudios de prevalencia del síndrome de apneas obstructivas del sueño en la población adulta / Studies of prevalence of obstructive sleep apnea syndrome in adult population

El síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es un trastorno respiratorio común asociado con múltiples consecuencias adversas para la salud y su prevalencia ha aumentado en paralelo con el aumento de la obesidad en la población. MÉTODOS: revisión sistemática que examina los estudios de prevalencia de SAHOS en la población general. Se incluyeron los estudios transversales y los componentes transversales de los estudios longitudinales que midieron objetivamente la prevalencia de SAHOS en adultos empleando instrumentos de laboratorio. Se evaluaron cuarenta estudios poblacionales de las 8.876 publicaciones encontradas en la búsqueda sistemática realizada en PubMed y otras bases de datos. RESULTADOS: Se ha observado importantes diferencias metodológicas en los estudios poblacionales, lo cual ha determinado una amplia variación en la prevalencia de SAHOS reportada, con un valor promedio de 36,9% (IC95% 28,3-45,4%) en hombres y 24,0% (IC 95% 16,3-31,6%) en mujeres. Se ha reportado un aumento en la prevalencia de SAHOS en el curso del tiempo desde 1987 hasta el 2020. Esta condición es más prevalente en varones, aumenta progresivamente con la edad y se asocia a la obesidad. La somnolencia diurna excesiva se ha asociado al diagnóstico de SAHOS, pero sólo una fracción de los sujetos con índice de apnea-hipopnea ≥ 5 eventos/hora presentan somnolencia diurna. CONCLUSIÓN: La prevalencia de SAHOS ha aumentado en los estudios poblacionales realizados en el curso del tiempo. La variabilidad reportada en la prevalencia de SAHOS probablemente esté relacionada con los diferentes equipos y definiciones operacionales empleados en el proceso diagnóstico, y las características de los sujetos examinados, incluyendo el importante aumento de la obesidad en la población.

Obstructive sleep apnea syndrome (OSAS) is a common disorder associated with multiple adverse health consequences and its prevalence is increasing in parallel with global rising in obesity. METHODS: We have developed a systematic review to examine obstructive sleep apnea syndrome prevalence studies in adults in the general population. We included the cross-sectional studies and the cross-sectional components of longitudinal studies that objectively measured OSAS in adults using laboratory instruments. Forty studies out of 8,876 articles found by systematically searching in PubMed and other databases were included in this review. RESULTS: Substantial methodological heterogeneity in population prevalence studies has been observed, determining a wide variation in OSAS prevalence defined at an apnea-hypopnea index (AHI) ≥ 5 events/hour, the average OSAS prevalence was 36.9% (CI95% 28.3-45.4%) in men and 24.0% (CI95% 16.3-31.6%) in women. The OSAS prevalence has increased over the time. OSAS is more prevalent in men than in women and increases with age and obesity. Excessive daytime sleepiness has been suggested as the most important symptom associated to OSAS, but only a fraction of subjects with AHI ≥ 5 events/hour report daytime sleepiness. CONCLUSION: The prevalence of OSAS has increased in epidemiological studies over time. The differences in reported prevalence of obstructive sleep apnea are probably due to different diagnostic equipment, operational definitions, study design and characteristics of included subjects, including effects of the obesity epidemic.

Major risk factors for obstructive sleep apnea monitored in the home. A cross-sectional study

ABSTRACT BACKGROUND: Obstructive sleep apnea (OSA) is characterized by recurrent pharyngeal wall collapse during sleep caused by anatomical or functional changes associated with obesity or dislocation of maxillofacial structures. OBJECTIVE: To determine the major risk factors for obstructive sleep apnea monitored in the home. DESIGN AND SETTING: Cross-sectional study conducted in a private clinic in Fortaleza (CE), Brazil. METHODS: Between 2015 and 2018, 427 patients were screened for OSA with home-based monitoring, yielding 374 positives. Information was collected on age, sex, body mass index (BMI), hypertension, diabetes (DM), dyslipidemia, coronary artery disease (CAD), arrhythmia, peripheral artery occlusive disease (PAOD), heart failure (HF) and lung disease. The home sleep apnea test result was then compared with the clinical diagnosis. Lastly, parameters identified as significant in the univariate analysis were subjected to multivariate logistic regression. RESULTS: Male sex predominated, although not significantly. OSA was associated with hypertension, DM, dyslipidemia, age and BMI. The risk of OSA being associated with these parameters was 2.195 (hypertension), 11.14 (DM), 2.044 (dyslipidemia) and 5.71 (BMI). The association was also significant for BMI categories (normal, overweight or obese). No significant association was observed for CAD, arrhythmia, PAOD, HF or lung disease. After multivariate logistic analysis, only age and BMI (and its categories) remained significant. CONCLUSION: OSA was associated with hypertension, DM, dyslipidemia, age and BMI in univariate analyses, but only with age and BMI (and its categories) in multivariate logistic analysis.

Relationship between obstructive sleep apnea syndrome and functional capacity in patients with diabetes mellitus type 2: an observational transversal study

SUMMARY OBJECTIVE: The aim of this study was to verify the association among obstructive sleep apnea, functional capacity, and metabolic control. METHODS: This was a cross-sectional study involving individuals of both sexes with clinical diagnosis of diabetes mellitus type 2 who were above 18 years of age. The assessment consisted of a volunteer identification form, a 2-minute step test, and the Stop-Bang questionnaire. In order to assess metabolic control, HbA1c and fasting glucose data were collected from medical records. RESULTS: A total of 100 individuals with diabetes mellitus type 2, of whom 61% were women, were included in this study. According to the Stop-Bang instrument, 26, 57, and 17% of patients had low, intermediate, and high risk of developing OSA, respectively. There was no association between the 2-minute step test and metabolic variables and diabetes mellitus type 2 chronicity with Stop-Bang. CONCLUSIONS: We concluded that there is no association among obstructive sleep apnea measured by means of Stop-Bang instrument, functional capacity measured by means of 2-minute step test, and metabolic variables in individuals with diabetes mellitus type 2.

Obstructive sleep apnea and metabolic syndrome: an association study based on a large sample clinical database / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the prevalence and associated risk factors of metabolic syndrome (MS) in patients with obstructive sleep apnea (OSA). Methods: From July 2007 to June 2017, a total of 8 155 adult subjects, including 6 484 males and 1 671 females, aged 18-90 (43.13±12.28), body mass index 14.61~59.56 (25.59±3.98) kg/m2,who were admitted to the Department of Otorhinolaryngology head and Neck surgery of The Sixth People's Hospital affiliated to Shanghai Jiao Tong University, were retrospectively analyzed. All patients underwent polysomnography and biochemical tests. Subjects were divided into four groups (non-OSA, mild OSA, moderate OSA, and severe OSA) according to OSA severity. The prevalence of MS was expressed as percentage, and the correlation between OSA and MS and its characteristic pathophysiological indicators was evaluated by logistic regression model after adjusting for factors such as gender, age, BMI, neck circumference, hip circumference, smoking and alcohol consumption, and was expressed by odds ratio (OR). SPSS 25.0 software was used for statistical analysis. Results: The overall prevalence of MS was 43.6%, and that of non-/mild/moderate/severe OSA group was 18.6%, 30.4%, 43.8%, 57.1%.Logistic regression showed that patients with mild/moderate/severe OSA had an increased risk of MS compared with non-OSA patients, with adjusted OR values and confidence intervals of 1.27 (1.05-1.54), 1.84 (1.53-2.22), and 2.08 (1.76-2.46), respectively (P<0.01).In addition, indicators of OSA anoxic burden [oxygen drop index(Toxygen=7.1), minimum blood oxygen(Tminimum=56.3), blood oxygen saturation below 90% cumulative time ratio (TCT90=10.6) ]were closely associated with MS disease(P<0.01), but sleep fragmentation index (arousals index) was not significantly associated with MS disease. Conclusion: The risk of MS gradually increases with the severity of OSA, and the indicators reflecting OSA hypoxia burden are closely related to MS disease.

Clinical study on obstructive sleep apnea following pharyngeal flap surgery / 华西口腔医学杂志

OBJECTIVES@#This study aims to investigate the incidence and severity of obstructive sleep apnea (OSA) in cleft patients with velopharyngeal insufficiency (VPI) after pharyngeal flap surgery (PFS) and explore the influence of operation age.@*METHODS@#A retrospective study was conducted in 82 cleft patients after PFS. The patients were divided into two groups according to their age at the time of surgery. The incidence and severity of OSA were assessed at least 1.2 years (mean 6.0 years) postoperatively by polysomnography (PSG).@*RESULTS@#The incidence rates of OSA were 20% in the adult group and 31% in the child group. No significant difference was found between the two groups (@*CONCLUSIONS@#Some patients still have OSA average of 6.0 years after PFS, and operation ageis unrelated to the incidence and severity of OSA.

Estudio de prevalencia de síndrome de apneas obstructivas del sueño en la población adulta chilena. Subestudio de la Encuesta Nacional de Salud, 2016/17 / Prevalence of obstructive sleep apnea syndrome in Chilean adults. A sub-study of the national health survey, 2016/17

Background: Obstructive sleep apnea syndrome (OSAS) affects approximately 10%-20% of adults and is associated with obesity, hypertension and metabolic syndrome. Aim: To assess the prevalence and risk factors associated with OSAS in Chilean adults. Material and Methods: A standardized sleep questionnaire and respiratory polygraphy at home were conducted on adults aged 18 years or more, residing in the Metropolitan Region and enrolled in the 2016/17 National Health Survey. Results: Two-hundred and five people between 18 and 84 years old (46% men, mean age 50 years) underwent overnight respiratory polygraphy at home. The estimated obstructive sleep apnea prevalence was 49% (62% men, 31% women) considering an apnea-hypopnea index ≥ 5 respiratory events/hour, and 16% (21% men, 13% women) considering an apnea-hypopnea index ≥ 15 respiratory events/hour. The prevalence of obstructive sleep apnea continuously increased along with age for men and women, with a later onset for women. Age, gender, body mass index, cervical and waist circumference, snoring, reporting of apnea by proxies, self-reported cardiovascular and metabolic diseases such as hypertension, diabetes and dyslipidemia, were significantly associated with OSAS. No association was found with insomnia and daytime sleepiness. Conclusions: The prevalence and risk factors associated to obstructive sleep apnea syndrome were high among these adults.

Estimación de la prevalencia de riesgo de síndrome de apneas obstructivas del sueño en funcionarios de una Institución de Salud según el cuestionario STOP-Bang / Estimation of the prevalence of risk of obstructive sleep apnea syndrome in workers of a health institution according to the stop-bang questionnaire

INTRODUCCIÓN: En Chile, se estima que 8,5% de los adultos tiene riesgo elevado de síndrome de apnea e hipopnea obstructiva del sueño (SAHOS). OBJETIVO: Estimar el riesgo de SAHOS en funcionarios de la salud. MATERIAL Y MÉTODO: Se consignaron los datos clínicos, antropométricos, presión arterial, cuestionarios STOP-Bang (CSB), índice de Flemons y escalas de Epworth y de Thornton en trabajadores de Clínica Dávila, Santiago, Chile. RESULTADOS: Se evaluaron 1.332 funcionarios, 77,1% mujeres, circunferencia de cuello: 35,7 ± 3,7 cm (26-54), circunferencia de cintura: 89,3 ± 3,7 cm, e índice de masa corporal: 27,5 ± 4,5 (17,5-49,4) kg/m2; 42% tenía sobrepeso y 26% obesidad. El Cuestionario SB los clasificó en tres categorías: Riesgo alto (RA): 43 funcionarios (3,2%), 50 ± 10,5 años; riesgo moderado: 215 (16,1%), 45,6 ± 11,4 años y riesgo bajo: 1.074 (80,6%), 36,2 ± 10,6 años. En hombres, la edad y los puntajes de los cuestionarios de sueño fueron diferentes en las tres categorías de riesgo (p = 0,003 y 0,001). En mujeres, los puntajes de los cuestionarios fueron distintos en los tres grupos de riesgo, no hubo diferencias en la escala de Epworth (p = 0,274), ni en la edad (p = 0,08). La escala Mallampati no permitió predecir el riesgo de SAHOS en ambos sexos. CONCLUSIONES: El cuestionario SB identificó a 9,8% de los hombres con riesgo alto de SAHOS. En los hombres, la edad, cuestionario SB, Flemons, Epworth y Thornton, fueron diferentes en las tres categorías de riesgo de SAHOS. En las mujeres, la edad y escala de Epworth fueron similares en las tres categorías de riesgo.

INTRODUCTION: In Chile, it is estimated that 8.5% of adults are at high risk of Obstructive Sleep Apnea (OSA). OBJECTIVE: To estimate the risk of OSA in health workers. MATERIAL AND METHOD: clinical and anthropometric data, blood pressure, STOP-Bang (CSB) questionnaires, Flemons index and Epworth and Thornton scales were assessed in workers from Clínica Dávila, Santiago, Chile. RESULTS: 1,332 workers were evaluated, 77.1% women, neck circumference: 35.7 ± 3.7 cm (26-54), waist circumference: 89.3 ± 3.7 cm, and body mass index: 27.5 ± 4.5 (17.5-49.4) kg/m2; 42% were overweight and 26% obese. The SB Questionnaire classified them into three risk categories: High risk (HR): 43 workers (3.2%), 50 ± 10.5 years-old; moderate risk: 215 (16.1%), 45.6 ± 11.4 years-old and low risk: 1,074 (80.6%), 36.2 ± 10.6 years-old. In men, age and sleep questionnaire scores were different in the three risk categories (p = 0.003 and 0.001). In women, the sleep questionnaire scores were different in the three risk groups, there were no differences in the Epworth scale (p = 0.274), nor in age (p = 0.08). The Mallampati scale did not allow predict OSA risk in both sexes. CONCLUSIONS: The SB questionnaire identified 9.8% of the men with high risk of OSA. In men, age, SB questionnaire, Flemons index, Epworth and Thornton scale, were different in the three OSA risk categories. In women, the age and Epworth scale were similar in the different risk categories.

Prevalence of OSA in chilean children and adolescents based on subscale of pediatric sleep questionnaire / Prevalencia de OSA en niños y adolescentes chilenos según la subescala del cuestionario de sueño pediátrico

Objectives: We aimed to determine the prevalence of Obstructive Sleep Apnea (OSA) in children and adolescents from four districts of Santiago, Chile by using a six-question subscale from the Sleep-Related Breathing Disorders (SRBD) scale, which measures respiratory symptoms while sleeping. Material and Methods: Cross-sectional observational study. The six-question subscale of the SRBD scale was applied to the parents or guardians of the children and adolescents from four educational establishments in different districts of Santiago. Convenience sampling was used. This subscale allowed to divide the sample into two groups: one group with OSA and one at low risk of OSA. In addition, statistical tests were applied to evaluate the variation between gender and age range. Results: Of the total number of subjects (n=838, 4-18 years, mean: 11.3±4.2), 681 were included. According to the six-question subscale, 2.2% (CI 95% 1.64-2.76%) of the sample had OSA. There is a slight predominance in males, without statistically significant difference (p=0.083). In relation to the age of the participants, there was no statistically significant difference (p=0.512).Conclusion: The prevalence of OSA in Chilean children and adolescents was similar to previous reports. The results obtained by the analysis of the six-question subscale of the SRBD scale allow a more accurate detection of OSA. Future research should promote the translation of this questionnaire into the Chilean context and its use throughout the country.

Objetivos: Nuestro objetivo fue determinar la prevalencia de la apnea obstructiva del sueño (AOS) en niños y adolescentes de cuatro distritos de Santiago, Chile mediante el uso de una subescala de seis preguntas de la escala de trastornos respiratorios relacionados con el sueño (Sleep-Related Breathing Disorders, SRBD), que mide los síntomas respiratorios mientras dormido. Material y Métodos: estudio observacional transversal. La subescala de seis preguntas de la escala SRBD se aplicó a los padres o tutores de los niños y adolescentes de cuatro establecimientos educativos en diferentes distritos de Santiago. Se utilizó muestreo de conveniencia. Esta subescala permitió dividir la muestra en dos grupos: un grupo con OSA y otro con bajo riesgo de OSA. Además, se aplicaron pruebas estadísticas para evaluar la variación entre el género y el rango de edad. Resultados: Del número total de sujetos (n=838, 4-18 años, media: 11,3±4,2), se incluyeron 681. Según la subescala de seis preguntas, el 2,2% (IC 95% 1,64-2,76%) de la muestra tenía AOS. Hay un ligero predominio en varones, sin diferencia estadísticamente significativa (p=0,083). En relación con la edad de los participantes, no hubo diferencias estadísticamente significativas (p=0,512). Conclusión: La prevalencia de AOS en niños y adolescentes chilenos fue similar a informes anteriores. Los resultados obtenidos mediante el análisis de la subescala de seis preguntas de la escala SRBD permiten una detección más precisa de OSA. Investigaciones futuras deberían promover la adaptación de este cuestionario al contexto chileno y su uso en todo el país

Rendimiento de los cuestionarios de sueño en la pesquisa de pacientes adultos con síndrome de apnea obstructiva del sueño según sexo / Gender differences in clinical features and performance of sleep questionnaires in adults with obstructive sleep apnea syndrome

Background: Women with obstructive sleep apnea-hypopnea syndrome (OSAS) are less likely to be assessed or to receive an appropriate diagnosis, and they may have poorer quality of life and survival rates. Aim: To assess gender-specific clinical differences in adult patients with OSAS. Material and Methods: A standardized clinical questionnaire and four sleep questionnaires (Berlin, Epworth Sleepiness Scale, STOP and STOP-Bang) were administered and anthropometric data were measured. Patients underwent an overnight in-laboratory polysomnography to confirm the diagnosis of OSAS. Receiver operating characteristic curves, sensitivity and specificity of clinical manifestations and sleep questionnaires were calculated. Results: Of 1,464 screened patients, 509 were female, 58.6% had moderate to severe OSAS. Clinical variables associated with OSAS risk in women were age, insomnia, nocturia, hypertension and cervical circumference. Paired by age and respiratory events, the snoring frequency was similar in both genders, although witnessed apneas and high cervical circumference and waist/hip ratio were more common in males. Morning headaches, insomnia, excessive daytime sleepiness, depression, anxiety and poor quality of sleep were more common in women. Women were older than men, more obese (although with an obesity pattern less centrally distributed) and referred hypertension, diabetes, depression and hypothyroidism with higher frequency. Sleep questionnaires performance were similar in both sexes. Conclusions: It is likely that women with OSAS may partially be underdiagnosed due to circumstances related to a different OSAS clinical expression.

Obstructive sleep apnea and Parkinson's disease: characteristics and associated factors / Apneia obstrutiva do sono e doença de Parkinson: características e fatores relacionados

ABSTRACT Obstructive sleep apnea (OSA) occurs in up to 66% of Parkinson's disease (PD) patients, higher than in the general population. Although it is more prevalent, the relationship between OSA and PD remains controversial, with some studies confirming and others denying the relationship of OSA with some risk factors and symptoms in patients with PD. Objective: To determine the factors associated with OSA in PD patients com DP. Methods: A cross-sectional study was performed with 88 consecutive patients with PD from the outpatient clinic. Participants underwent clinical interviews with neurologists and a psychiatrist, assessment using standardized scales (Epworth Sleepiness Scale, Parkinson's Disease Questionnaire, Pittsburgh Sleep Quality Index and, for individuals with a diagnosis of restless legs syndrome/Willis-Ekbom disease, the International Restless Legs Syndrome Rating Scale), and video-polysomnography. Results: Individuals with PD and OSA were older and had less insomnia than those with PD without OSA. Regarding the polysomnographic variables, we observed a lower percentage of stage N3 sleep, a higher arousal index, and a higher oxygen desaturation index in those individuals with OSA, relative to those without OSA. In the multivariate analysis, only the percentage of stage N3 sleep and the oxygen desaturation index were significantly different. Besides this, most of the PD patients with OSA had a correlation with sleeping in the supine position (58% of OSA individuals). Conclusion: The PD patients showed a high prevalence of OSA, with the supine position exerting a significant influence on the OSA in these patients, and some factors that are associated with OSA in the general population did not seem to have a greater impact on PD patients.

RESUMO A Apneia Obstrutiva do Sono (AOS) chega a acometer até 66% dos pacientes com doença de Parkinson (DP), prevalência maior, portanto, que a da população geral. Embora seja mais prevalente, a relação entre AOS e DP permanence controversa, com trabalhos confirmando e outros afastando a relação de AOS com alguns fatores de risco e sintomas em pacientes com DP. Objetivo: Determinar quais fatores estão relacionados à AOS em pacientes com DP. Métodos: Estudo transversal, observacional, realizado com 88 pacientes com DP, provenientes do ambulatório de hospital público. Os pacientes foram submetidos à entrevista clínica com neurologista e psiquiatra, à aplicação de escalas padronizadas (escala de sonolência de Epworth, questionário de qualidade de vida da DP, índice de qualidade de sono de Pittsburgh e, para os indivíduos com diagnóstico de Síndrome das Pernas Inquietas, a escala internacional de graduação da SPI), e vídeo-polissonografia. Resultados: Indivíduos com DP e AOS apresentaram maior idade e menor prevalência de insônia crônica que os indivíduos com DP, sem AOS. Em relação às variáveis polissonográficas, observamos uma baixa proporção de sono N3, elevado índice de microdespertares e maior índice de desaturações nos indivíduos com AOS, em comparação ao grupo sem AOS. Na análise multivariada, apenas a porcentagem de sono N3 e o índice de dessaturação permaneceu significativo. Além disso, a maior parte dos pacientes tem relação com a posição supina (58% dos pacientes com AOS). Conclusão: Pacientes com DP apresentaram prevalência elevada de AOS, a posição supina exerceu influência importante na AOS destes pacientes e alguns fatores que estão associados à AOS na população geral não mostraram impacto significativo nos pacientes com DP.

Características clínicas de los pacientes con apneas obstructivas del sueño: diferencias según género / Clinical features in patients with obstructive sleep apnea syndrome: differences by gender

INTRODUCCIÓN: El síndrome de apnea obstructiva del sueño (SAHOS) es más prevalente en hombres, los estudios poblacionales muestran una relación de 2:1, sin embargo, en los estudios clínicos la frecuencia llega a ser de hasta de 6:1. Estas diferencias en el ambiente clínico puede ser consecuencia de variaciones en el reporte de síntomas en hombres comparados con mujeres. OBJETIVO: Evaluar las diferencias de género en la presentación clínica de apnea obstructiva de sueño. Pacientes: Estudio transversal de pacientes sometidos a una poligrafía respiratoria (PR) con sospecha clínica de SAHOS. Se recolectaron datos demográficos, antropométricos, comorbilidades y las variables de la PR. Se realizó estudio t de student, Mann-Whitney y chi-cuadrado según correspondiera. RESULTADOS: Se incluyeron 1.044 pacientes: edad promedio 53,2 ± 14 años, 76% hombres. Las mujeres con SAHOS poseen mayor IMC (32,2 ± 6,1 vs 30,8 ± 5,0; p=0,002) y edad (61,4 ± 12,2 vs 52,6 ± 13,9; p < 0,001), pero menor circunferencia de cuello (CC) (38,1 ± 3,6 vs 43,2 ± 3,3; p < 0,001), además, presentan menor IA/H y menor duración de las apneas. No hubo diferencias en los síntomas clásicos de apneas presenciada y somnolencia diurna, sin embargo, describen más frecuentemente insomnio, cefalea matinal, depresión y uso de fármacos hipnóticos. CONCLUSIONES: Las mujeres al momento del diagnóstico son de mayor edad y más obesas, aunque presentan una CC menor, presentan una enfermedad más leve, pero refieren más fatiga, cansancio, cefalea e insomnio. Debemos estar alerta en la presentación clínica diferente de las mujeres para mejorar la sospecha diagnóstica.

INTRODUCTION: Obstructive sleep apnea (OSA) is more prevalent in men, population studies show a ratio of 2:1, however in clinical studies the frequency is as high as 6:1. These differences in the clinical setting may be a consequence of variations in the reporting of symptoms in men compared to women. OBJECTIVE: To evaluate gender differences between women and men with recent diagnosis of OSA. Patients: A cross-sectional, study of patients undergoing home sleep apnea testing (HSAT) with clinical suspicion of OSA. Demographic, anthropometric, comorbidities and HSAT variables were collected. We performed t student analysis, Mann-Whitney test or chi square test as appropriate. RESULTS: 1,044 patients were included: mean age 53.2 ± 14 years, 76% men. Women with OSA have a higher BMI (32.2 ± 6.1 vs 30.8 ± 5.0, p = 0.002), were older (61.4 ± 12.2 vs 52.6 ± 13.9, p <0.001), but have a lower neck circumference (NC) (38.1 ± 3.6 vs. 43.2 ± 3.3, p <0.001). The women presented lower AHI and shorter duration of apneas. Although the classic symptoms of apnea and daytime sleepiness showed no differences, women reported more frequently insomnia, morning headache, depression and use of hypnotic drugs. CONCLUSIONS:: Clinical differences between gender are present at time of diagnosis. Woman are older and more obese, although they have a lower NC. They have a milder disease, but they refer to be more tired, headache, insomnia and depression. We must be alert in the different clinical presentation of women to improve the diagnostic suspicion.

Poligrafía pediátrica: experiencia de 6 años / Pediatric polygraphy: a 6-year experience

INTRODUCCIÓN: El diagnóstico precoz de los Trastornos Respiratorios del Sueño (TRS) puede permitir una intervención oportuna. La poligrafía (PG) es una alternativa confiable y accesible en la actualidad. OBJETIVO: Describir y analizar PG de niños > 1 año con sospecha de TRS. PACIENTES Y MÉTODO: Se incluyeron PG de niños y adolescentes > 1 año de edad con sospecha de TRS, desde diciembre de 2011 hasta agosto de 2017 provenientes de la ciudad de Concepcion, Chile. Se recopilaron datos demo gráficos, clínicos y variables poligráficas. Estadística descriptiva, expresando resultados en mediana y rango. Se determinó asociación entre índice de apnea hipopnea (IAH) y saturación mediante Rho de Spearman; considerando significancia p < 0,05. RESULTADOS: Se analizaron 190 estudios. Edad 7,9 años (1,0-20,6), varones 61%. Diagnósticos: enfermedades neuromusculares (ENM) (24,2%), daño pulmonar crónico (21,1%), obstrucción de vía aérea superior (OVAS) (19,5%), daño neurológico (11%), síndrome de Down (8,9%) malformaciones VAS (7,4%), hipoventilación central (3,7%), obesidad (2,6%) y otros (1,6%). El 55,3% de las PG resultaron alteradas; síndrome de apnea hipopnea obstructiva del sueño (SAHOS) leve en 53,3%, moderado 30,5% y severo 16,2%. No se observaron diferencias significativas en IAH entre grupos de patologías (p = 0,032), destacando un mayor IAH en Obesidad 9,0 (0,41-51) y ENM 23,9 (0,4-36,6). Se constató asociación entre IAH y parámetros de saturación; saturación promedio (rho = -0,425; p = 0,001); mínima (rho = -0,654; p = 0,001); y saturación bajo 90% (rho = 0,323; p = 0,001) en la totalidad de la muestra. DISCUSIÓN: Existió un alto porcentaje de SAHOS en pacientes pediátricos de riesgo, en especial en aquellos con ENM y obesidad. La PG es una herramienta accesible e implementable en un hospital público; situación potencialmente extrapolable a otros centros asistenciales.

INTRODUCTION: The early diagnosis of Sleep Disordered Breathing (SDB) may allow proper intervention. Currently, polygraphy (PG) is a reliable and accessible alternative. OBJECTIVE: To describe and analyze the PG of children > 1 year old with suspicion of SDB. PATIENTS AND METHOD: PG of children > 1 year old and adolescents from Concepcion, Chile, with suspected SDB were included, from December 2011 to August 2017. Demographic, clinical and polygraphic variables were collected. It was used descriptive sta tistics, expressing results in median and range. The association between apnea-hypopnea index (AHI) and oxygen saturation was determined by Spearman's Rho, considering significance of p < 0.05. RESULTS: 190 studies were analyzed. Age 7.9 years old (1.0-20.6), 61% males. Diagnosis: neuromuscular disease (NMD) (24.2%), chronic lung damage (21.1%), upper airway obstruction (UAO) (19.5%), neurological damage (11%), Down syndrome (8.9%), upper airway malformations (7.4%), central hypoventilation (3.7%), obesity (2.6%), and others (1.6%). 55.3% were altered PG, with 53.3% of mild Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS), 30.5% moderate, and 16.2% severe. There were no significant differences in AHI between groups of pathologies (p = 0.032), highlighting a higher AHI in obese patients 9 (0.41-51), and those with NMD 23.9 (0.4-36.6). It was found asso ciation between AHI and oxygen saturation parameters: mean saturation (rho = -0.425; p = 0.001), minimum (rho = -0.654; p = 0.001), and oxygen saturation below 90% (rho = 0.323; p = 0.001) in the whole sample. DISCUSSION: There was a high percentage of OSAHS in at-risk pediatric patients, especially in those with NMD and obesity. PG is an accessible and implementable tool in a public hospital, a situation that can potentially be extrapolated to other healthcare centers.

Riesgo de apnea obstructiva del sueño y nivel de actividad física y su asociación con riesgo cardiovascular elevado en adultos chilenos / Risk of obstructive sleep apnea and levels of physical activity and its association with elevated cardiovascular risk in chilean adults

Introducción: La apnea obstructiva del sueño (AOS) está asociada a alta morbi-mortalidad cardiovascular. Sujetos y métodos: Se seleccionaron 3.657 sujetos entre 30 y 74 años (x: 50,1 ±12,1 DS) de la Encuesta Nacional de Salud 2010. Se estimó el riesgo de AOS mediante una regla de predicción clínica (RPC) basada en las variables del Cuestionario STOP-Bang. Según puntaje se clasificaron en Riesgo BAJO (< 3), MEDIO (3-4) y ALTO (≥ 5) de AOS. El nivel de actividad física (NAF) fue clasificado en 3 niveles: Bajo, Moderado y Alto, según los resultados autorreportados con el cuestionario GPAQ. Para estudiar la asociación entre el riesgo de AOS y NAF con el RCV Alto/Muy Alto (≥ 10%, Framingham) construimos un modelo de regresión logística ajustado por sexo, edad, IMC, diabetes tipo 2, hipertensión arterial, colesterol total elevado, colesterol HDL bajo, triglicéridos elevados, nivel educacional, tabaquismo y horas de sueño autorreportadas. Resultados: 3.098 sujetos se clasificaron como riesgo de AOS: BAJO 1.683 (54,3%), MEDIO 1.116 (36%) y ALTO 299 (9,7%). El NAF fue evaluado en 3.570 sujetos, y clasificado como: Nivel Bajo 1.093 (30,6%), Moderado 705 (19,7%), y Alto 1.772 (49,6%). El RCV fue determinado en 3.613 sujetos, y 711 (19,7%) clasificaron como riesgo Alto /Muy Alto. El modelo de regresión muestra: riesgo MEDIO un OR = 1,75 (1,05-2,90; p = 0,03), riesgo ALTO un OR = 3,86 (1,85-8,06; p < 0,001). Para el NAF Bajo un OR = 1,14 (0,75-1,74; p = 0,525), NAF Moderado un OR = 1,18 (0,73-1,92; p = 0,501). Conclusión: El riesgo MEDIO y ALTO de AOS, pero no el NAF autorreportado, constituyen un factor de riesgo independiente para riesgo cardiovascular elevado.

Introduction: Obstructive sleep apnea (OSA) is associated with high cardiovascular morbidity and mortality. Subjects and methods: 3,657 subjects between 30 and 74 years-old ( x ¯: 50.1 ± 12.1 SD) from 2010 Chilean National Health Survey were selected. Risk of OSA was estimated using a clinical prediction rule (CPR) based on the variables of the STOP-Bang Questionnaire. According to their score they were classified as LOW (< 3), MEDIUM (3-4) and HIGH (≥ 5) risk of OSA. Their physical activity level (PAL) was classified into 3 levels: Low, Moderate and High, according to the self-reported results with the GPAQ questionnaire. To study the association between the risk of OSA and PAL with High / Very High CVR (≥ 10%, Framingham) we constructed a logistic regression model adjusted for sex, age, BMI, type 2 diabetes, high blood pressure, high total cholesterol, low HDL cholesterol, high triglycerides, educational level, smoking and self-reported sleep hours. Results: 3,098 subjects were classified as OSA risk: LOW 1.683 (54.3%), MEDIUM 1.116 (36%) and HIGH 299 (9.7%). The PAL was evaluated in 3,570 subjects and classified as: Low 1,093 (30.6%), Moderate 705 (19.7%), and High 1,772 (49.6%). The CVR was determined in 3,613 subjects, and 711 (19.7%) classified as High/Very High risk. The regression model shows: MEDIUM risk an OR = 1.75 (1.05 - 2.90, p = 0.03), HIGH risk an OR = 3.86 (1.85-8.06, p < 0.001). For the PAL Low an OR = 1.14 (0.75-1.74, p = 0.525), PAL Moderate an OR = 1.18 (0.73-1.92, p = 0.501). Conclusion: The MEDIUM and HIGH risk of OSA, but not the self-reported PAL, constitute an independent risk factor for high cardiovascular risk.

Perfil clínico e laboratorial de pacientes com e sem apneia obstrutiva do sono / Clinical and laboratory profile of patients with or without obstructive sleep apnea

OBJETIVO: Descrever o perfil de pacientes com e sem apneia obstrutiva do sono. MÉTODOS: Estudo transversal, descritivo, observacional, realizado em centro terciário de cardiologia, por meio da análise de 255 prontuários de pacientes consecutivos submetidos à polissonografia em um laboratório do sono do hospital. Os pacientes foram divididos de acordo com a presença de apneia obstrutiva do sono clinicamente significativa (índice de apneia e hipopneia ≥15 eventos/hora). Dentre as informações analisadas, estavam: características clínicas; dados antropométricos; antecedentes pessoais; medicamentos em uso; doença aterosclerótica; exames laboratoriais e polissonografia. RESULTADO: A prevalência da apneia obstrutiva do sono foi de 35,6%; deste porcentual, 90,1% apresentaram hipertensão arterial sistêmica; 70,3%, dislipidemias; 36,3%, tabagismo; e 35,2%, diabetes. Não houve diferença estatística com relação à maior parte dos parâmetros analisados, mas os pacientes com apneia obstrutiva do sono eram, em sua maioria, do sexo feminino, com idade mais avançada e maior índice de massa corporal, quando comparados aos indivíduos sem apneia obstrutiva do sono. CONCLUSÃO: Foi alta a prevalência de apneia obstrutiva do sono em indivíduos portadores de diversos fatores de risco cardiovasculares. Esta condição deve sempre ser pesquisada em indivíduos de maior risco cardiovascular.(AU)

OBJECTIVE: To describe the profile of patients with and without obstructive sleep apnea. METHODS: This is a cross-sectional, descriptive and observational study that was conducted in a tertiary cardiology center through the analysis of 255 records of consecutive patients who underwent polysomnography in a sleep laboratory of the hospital. Patients were divided according to the presence of clinically significant obstructive sleep apnea (apnea-hypopnea index ≥15 events/ hour). The analyses included: clinical features, anthropometric data, personal background, ongoing medication, atherosclerotic disease, laboratory tests and polysomnography. RESULTS: The prevalence of obstructive sleep apnea was 35.6%; of these, 90.1% had hypertension, 70.3% dyslipidemias, 36.3% were smokers, and 35.2% had diabetes. There was no statistical difference in most of the parameters analyzed; however, patients with obstructive sleep apnea were mostly female, older and with higher BMI when compared to individuals without obstructive sleep apnea. CONCLUSION: The prevalence of obstructive sleep apnea was high in individuals with various cardiovascular risk factors. Therefore, it is a condition that should always be investigated in patients with higher cardiovascular risk.(AU)

Prevalencia de síntomas de sueño y riesgo de apnea obstructiva del sueño en México / Prevalence of sleep symptoms and risk of obstructive sleep apnea in Mexico

Resumen: Objetivo: Estimar la prevalencia nacional de síntomas asociados con el sueño (SAS) en México, y su distribución por región, localidad y sexo. Material y métodos: Estudio transversal con muestreo probabilístico, representativo a nivel nacional en adultos mayores de 20 años. Se aplicó un cuestionario sobre duración de sueño, insomnio, uso de hipnóticos y riesgo de síndrome de apnea obstructiva del sueño (SAOS). Resultados: Los SAS más frecuentes fueron ronquido (48.5%) y dificultad para dormir (36.9%). Se identificó riesgo elevado de SAOS en 27.3% de los adultos, y se incrementa por índice de masa corporal (RM=1.1), edad (RM=1.03) y habitar zona urbana (RM=1.37). Se reportó insomnio en 18.8% de los participantes, que predomina en mujeres (RM=1.88). La duración promedio de sueño fue de 7.6 ± 3 horas; 28.4% de los adultos duermen <7 horas/noche. Conclusiones: Existe una elevada prevalencia de SAS. Uno de cada cuatro adultos mexicanos tiene elevada probabilidad de padecer SAOS. La detección y tratamiento de SAS pudieran minimizar los efectos deletéreos en la salud.

Abstract: Objective: To estimate the prevalence of sleep related symptoms (SRS) in Mexico, and their distribution by region, urbanization and gender. Materials and methods: Cross-sectional study using a national probabilistic sample among adults over 20 years old. We applied the Berlin questionnaire for sleep apnea risk (OSA) and questions on sleep duration, insomnia and sedative use. Results: The most frequent SRS were snoring 48.5% and difficulty falling asleep 36.9%. High risk for OSA was found in 27.3% of adults, increases with BMI (OR=1.1), age (OR=1.03) and urban residence (OR=1.37). Insomnia was in 18.8% with female predominance (OR=1.91). Average sleep time was 7.6 ±3 hours; 28.4% of adults sleep <7 h/night. Conclusions: SRS are highly prevalent. One in four Mexican adults have an elevated risk for OSA. Their detection and treatment could minimize detrimental health outcomes for them.

Prevalência da apneia obstrutiva do sono em trabalhadores de turno: uma revisão sistemática / Prevalence of obstructive sleep apnea in shift workers: a systematic review

Resumo A apneia obstrutiva do sono (AOS) é um dos distúrbios do sono mais frequentes, associada ao risco aumentado para obesidade, hipertensão e evento cardiovascular. O presente estudo buscou investigar a prevalência da AOS em trabalhadores de turno. Foi realizada a revisão sistemática da literatura, utilizando-se os descritores "sleep apnea" AND "shift work", nas bases de dados do PubMed Central, Biblioteca Virtual em Saúde, Web of Science e Scopus, incluindo-se artigos que apresentaram a frequência da AOS em trabalhadores de turno, publicados entre 2004 e 2014, em inglês, português ou espanhol, apenas com seres humanos, maiores de 18 anos, utilizando polissonografia. Artigos de revisão ou com participantes com comorbidades prévias (exceto sobrepeso/obesidade), tratados para doença do sono ou gestantes foram excluídos. Dos 1.428 artigos identificados, quatro foram incluídos para análise, totalizando 819 participantes, com predomínio do sexo masculino. A prevalência da AOS em trabalhadores de turno variou de 14,3% a 38,1%, superior à estimada para a população geral, sugerindo associação importante com o trabalho de turno e a necessidade de prevenção, diagnóstico e intervenção sobre possíveis impactos negativos da escala de trabalho na saúde desses trabalhadores.

Abstract The obstructive sleep apnea (OSA) is one of the most common sleep disorders and is associated with increased risk for obesity, hypertension and cardiovascular event. The present study aimed to investigate the prevalence of OSA in shift workers. The systematic literature review was performed using the descriptors "sleep apnea" and "shift work", in the databases PubMed, PubMed Central, Biblioteca Virtual em Saúde, Web of Science and Scopus, including studies that presented the frequency of OSA in shift workers; published between 2004 and 2014; in English, Portuguese or Spanish; only with human beings, older than 18 years old; using the polysomnography. Review articles or those including participants with previous comorbidities (except overweight/obesity), treated for sleep disorders or pregnant women were excluded. From 1,428 studies identified, four were included in the analysis, resulting in 819 participants, with a predominance of men. The prevalence of OSA in shift workers varied from 14.3% to 38.1%, higher than that estimated for the general population, suggesting an important association with shift work and the need for prevention, diagnostic and intervention on the possible negative impacts of working range on the health of shift workers.