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SAOS : novas perspetivas no diagnóstico
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O Síndrome da Apneia obstrutiva do sono (SAOS) é caracterizada pela interrupção do fluxo de ar para os pulmões durante pelo menos 10 segundos, associada a uma diminuição de 4% da saturação do oxigénio. Apresenta grande heterogeneidade clínica e fisiopatológica, múltiplos fatores de risco e graves consequências para a saúde dos doentes (cardiovasculares, metabólicas e sociais). Atinge 10% a 30% dos adultos, mas uma grande parte dos doentes com SAOS não tem o diagnóstico estabelecido.
Isto pode ser explicado pelos inconvenientes do exame que, atualmente, é considerado gold-standard no diagnóstico da SAOS: a polissonografia. O elevado custo, a dificuldade no acesso ou a exigência técnica da realização do exame, faz com que muitos doentes a evitem. Assim, a investigação de novos meios diagnósticos para a SAOS intensificou-se nos últimos anos, com particular interesse para os que possam ser realizados em casa.
Com os recentes avanços tecnológicos, a aplicação dos sensores da polissonografia em casa é possível, surgindo os dispositivos portáteis. Com a inclusão da roncopatia no diagnóstico da SAOS, meios diagnósticos que utilizem as características dos sons respiratórios traqueais e da roncopatia têm vindo a ser estudados. Por outro lado, o progresso das aplicações dos smartphones na área da monitorização do sono tem vindo a crescer e, nos últimos anos, surgiram aplicações com o objetivo de diagnosticar a SAOS.
Este trabalho é uma revisão da literatura sobre estas novas perspetivas no diagnóstico da SAOS que apresentam acuidade diagnóstica semelhante à polissonografia (sob determinadas condições) e vantagens para os doentes, para os profissionais de saúde e impacto na área socioeconómica. Contudo, nas guidelines mais recentes a polissonografia ainda é o exame gold-standard no diagnóstico da SAOS. No futuro, deverão ser desenvolvidos mais estudos para ampliar as aplicações diagnósticas destes novos métodos
Obstructive sleep apnea (OSA) is described as a cessation of airflow to the lungs that lasts at least for 10 seconds and is associated with at least a 4% drop in the blood’s oxygen saturation level. It presents multiple pathophysiological and clinical pathways and serious health consequences (cardiovascular, metabolic and social). It affects 10 to 30% of the adults’ population but is underdiagnosed. This can be explained by the difficulties of the gold-standard exam to diagnose OSA: polysomnography. It is relatively expensive, technically complex and the access to the sleep test is limited, justifying why patients avoid this test. Thus, the investigation of new diagnostic tools for OSA has intensified in the last years, particularly on those who can be performed at home. The recent technological advances made it possible for the portable sleep testing to emerge and be performed at home. By the inclusion of snoring into the OSA diagnosis process, the number of studies using tracheal sounds and snoring properties has been increasing. On the other hand, the progress of smartphone applications in the area of sleep monitoring has been growing and, in recent years, several applications for OSA diagnosis has been investigated. This work is a review on the new perspectives in OSA diagnosis. Their results in OSA diagnosis is highly correlated with polysomnography (under certain circumstances) and these methods have various advantages for the patients and health-care providers, with a significant impact on the socioeconomic area. Nevertheless, in the most recent guidelines, polysomnography is still the gold-standard test for the OSA diagnosis. In a near future, more studies to expand the diagnostic applications of these new tools are expected.
Obstructive sleep apnea (OSA) is described as a cessation of airflow to the lungs that lasts at least for 10 seconds and is associated with at least a 4% drop in the blood’s oxygen saturation level. It presents multiple pathophysiological and clinical pathways and serious health consequences (cardiovascular, metabolic and social). It affects 10 to 30% of the adults’ population but is underdiagnosed. This can be explained by the difficulties of the gold-standard exam to diagnose OSA: polysomnography. It is relatively expensive, technically complex and the access to the sleep test is limited, justifying why patients avoid this test. Thus, the investigation of new diagnostic tools for OSA has intensified in the last years, particularly on those who can be performed at home. The recent technological advances made it possible for the portable sleep testing to emerge and be performed at home. By the inclusion of snoring into the OSA diagnosis process, the number of studies using tracheal sounds and snoring properties has been increasing. On the other hand, the progress of smartphone applications in the area of sleep monitoring has been growing and, in recent years, several applications for OSA diagnosis has been investigated. This work is a review on the new perspectives in OSA diagnosis. Their results in OSA diagnosis is highly correlated with polysomnography (under certain circumstances) and these methods have various advantages for the patients and health-care providers, with a significant impact on the socioeconomic area. Nevertheless, in the most recent guidelines, polysomnography is still the gold-standard test for the OSA diagnosis. In a near future, more studies to expand the diagnostic applications of these new tools are expected.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Síndrome apneia obstrutiva do sono Polissonografia Roncopatia Dispositivos portáteis Smartphones Otorrinolaringologia