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acidente vascular cerebral<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; diabetes mellitus<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; disfun&#231;&#227;o cognitiva<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> e depress&#227;o<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A cada ciclo do sono REM o homem apresenta uma ere&#231;&#227;o funcional &#40;SRE &#8211; sleep related erection&#41;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> importante para a manuten&#231;&#227;o da integridade estrutural e funcional do tecido er&#233;til<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Na SAOS&#44; os epis&#243;dios intermitentes de hip&#243;xia impedem a ocorr&#234;ncia de SRE&#44; com efeitos delet&#233;rios na fisiologia er&#233;til<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;22</span></a>&#46; Diversos estudos sugerem uma associa&#231;&#227;o entre SAOS e DE&#44; que se deve essencialmente aos efeitos delet&#233;rios da hip&#243;xia e da fragmenta&#231;&#227;o do sono no tecido er&#233;til<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;21</span></a>&#46; A literatura sugere mecanismos hormonais<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;26</span></a>&#44; neurais<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#8211;30</span></a>&#44; endoteliais<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#8211;35</span></a> e psicog&#233;nicos<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> para explicar a DE na SAOS&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A DE e SAOS podem tamb&#233;m estar relacionadas atrav&#233;s de comorbilidades como hipertens&#227;o arterial e diabetes mellitus<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Dados relativos &#224; preval&#234;ncia s&#227;o alvo de algumas inconsist&#234;ncias<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Assim&#44; o objetivo principal deste estudo prende-se com a determina&#231;&#227;o da preval&#234;ncia de DE numa popula&#231;&#227;o de doentes com SAOS enviados ao Hospital de S&#46; Jo&#227;o para diagn&#243;stico e seguimento&#46; Adicionalmente&#44; reuniram-se dados cl&#237;nicos e demogr&#225;ficos de modo a conhecer os determinantes de DE na nossa popula&#231;&#227;o&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Popula&#231;&#227;o em Estudo</span><p id="par0030" class="elsevierStylePara elsevierViewall">Entre 28 de setembro e 31 de dezembro de 2010&#44; todos os pacientes do sexo masculino com sintomas de SAOS&#44; admitidos no Laborat&#243;rio do Sono do Hospital S&#46; Jo&#227;o &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>207&#41; para a primeira consulta&#44; foram convidados a participar neste estudo&#46; A cada paciente foi entregue uma Declara&#231;&#227;o do Consentimento Informado&#44; um question&#225;rio IIEF-5 e um documento com informa&#231;&#227;o relativa ao estudo&#44; que os mesmos deveriam entregar devidamente preenchido&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Noventa e cinco doentes entregaram o question&#225;rio preenchido&#46; Trinta e tr&#234;s participantes foram exclu&#237;dos ap&#243;s o estudo do sono por n&#227;o se confirmar o diagn&#243;stico de SAOS&#46; Um participante foi exclu&#237;do por apresentar DE j&#225; diagnosticada&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Dados acerca do IMC &#40;&#237;ndice de massa corporal&#41;&#44; antecedentes pessoais &#40;diabetes&#44; hipertens&#227;o arterial&#44; acidente vascular cerebral&#44; enfarte agudo do mioc&#225;rdio&#41; e terap&#234;utica habitual foram recolhidos dos registos cl&#237;nicos&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">O estudo foi aprovado pela Comiss&#227;o de &#201;tica do Hospital de S&#46; Jo&#227;o&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">IIEF-5 &#40;International Index Erectile Dysfunction &#8211; 5 Item Version&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall">IIEF-5 &#233; um question&#225;rio simples e &#250;til para o rastreio de DE<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#46; Desenvolvido como uma vers&#227;o simplificada do IIEF&#44; &#233; composto por 5 quest&#245;es relativas &#224; fun&#231;&#227;o er&#233;til e satisfa&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> &#40;<a class="elsevierStyleCrossRef" href="#sec0055">anexo 1</a>&#41;&#46; A pontua&#231;&#227;o obtida no question&#225;rio IIEF-5 varia entre 5 a 25&#44; permitindo a classifica&#231;&#227;o de DE em 5 categorias&#58; ausente &#40;22-25&#41;&#44; ligeira &#40;17-21&#41;&#44; ligeira a moderada &#40;12-16&#41;&#44; moderada &#40;8-11&#41; e grave &#40;5-7&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Foi validada a sua tradu&#231;&#227;o para a l&#237;ngua portuguesa<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Estudo poligr&#225;fico cardiorrespirat&#243;rio do sono &#40;EPCRS&#41;</span><p id="par0060" class="elsevierStylePara elsevierViewall">A SAOS &#233; definida pela presen&#231;a de pelo menos 5 eventos respirat&#243;rios obstrutivos &#40;apneia&#44; hipopneia ou <span class="elsevierStyleItalic">respiratory effort related arousals</span>&#41; por hora de sono associados a sonol&#234;ncia diurna&#44; roncopatia&#44; pausas respirat&#243;rias testemunhadas ou despertar em <span class="elsevierStyleItalic">gasping</span> ou <span class="elsevierStyleItalic">choking</span><a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#46; A presen&#231;a de 15 ou mais eventos respirat&#243;rios obstrutivos na aus&#234;ncia de sintomas relacionados com o sono &#233; suficiente para o diagn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A polissonografia &#233; utilizada frequentemente para o diagn&#243;stico das doen&#231;as respirat&#243;rias do sono<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a>&#44; sendo o seu uso limitado pelos custos e listas de espera<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">O EPCRS &#233; uma alternativa &#224; polissonografia na presen&#231;a de uma elevada probabilidade pr&#233;-teste<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#46; O EPCRS &#233; realizado com um monitor port&#225;til<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> que regista o fluxo oronasal &#40;medido por canula nasal&#41;&#44; satura&#231;&#227;o de oxig&#233;nio arterial &#40;medido por oximetria de pulso&#41;&#44; frequ&#234;ncia card&#237;aca&#44; movimentos dos membros superiores&#44; m&#250;sculos abdominais e tor&#225;cicos&#44; posi&#231;&#227;o corporal e roncopatia<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Todos os participantes foram submetidos ao PCSS com aparelhos da ApneaLink<span class="elsevierStyleSup">&#174;</span>&#44; AlphaScreen Pro<span class="elsevierStyleSup">&#174;</span>&#44; EMBLETTA<span class="elsevierStyleSup">&#174;</span> ou Stardust<span class="elsevierStyleSup">&#174;</span>&#44; que calculam o n&#250;mero de apneias &#40;epis&#243;dios de &#8804; 20&#37; do fluxo a&#233;reo pr&#233;vio com pelo menos 10<span class="elsevierStyleHsp" style=""></span>s de dura&#231;&#227;o&#41; e hipopneias &#40;epis&#243;dios de 20 a 50&#37; do fluxo a&#233;reo pr&#233;vio&#44; com dura&#231;&#227;o de pelo menos 10<span class="elsevierStyleHsp" style=""></span>s associados a diminui&#231;&#227;o de 4&#37; na satura&#231;&#227;o de oxig&#233;nio&#41; por hora de sono&#46; Deteta tamb&#233;m epis&#243;dios de dessatura&#231;&#227;o<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4&#37; por hora de sono &#40;&#237;ndice de dessatura&#231;&#227;o de oxig&#233;nio&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A nossa an&#225;lise focou o &#237;ndice de apneia-hipopneia &#40;IAH&#41;&#44; &#237;ndice de dessatura&#231;&#227;o de oxig&#233;nio &#40;IDO&#41;&#44; e a satura&#231;&#227;o m&#237;nima e m&#233;dia de oxig&#233;nio&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Conforme os crit&#233;rios estabelecidos<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#44; a gravidade da SAOS foi estratificada de acordo com o valor do IAH&#58; ligeira &#40;5-15&#41;&#44; moderada &#40;16-29&#41; e grave &#40;&#8805; 30&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lise estat&#237;stica</span><p id="par0090" class="elsevierStylePara elsevierViewall">A an&#225;lise dos dados foi realizada com o SPSS<span class="elsevierStyleSup">&#174;</span> &#40;Statistical Package for Social Sciences&#41;&#44; vers&#227;o 18&#46;0&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A an&#225;lise de frequ&#234;ncias foi realizada para descrever a popula&#231;&#227;o&#46; O teste Chi-Quadrado foi aplicado para determinar a associa&#231;&#227;o entre vari&#225;veis categ&#243;ricas e o teste Kruskall Wallis para definir qualquer associa&#231;&#227;o entre vari&#225;veis categ&#243;ricas e cont&#237;nuas&#46; A regress&#227;o log&#237;stica multivariada foi utilizada para avaliar o efeito de cada vari&#225;vel ajustada a outros poss&#237;veis fatores de confundimento&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Foi considerada estatisticamente significativa as associa&#231;&#245;es com p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0105" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas gerais da popula&#231;&#227;o encontram-se descritas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; De um modo geral&#44; constata-se que a m&#233;dia de idades dos participantes &#233; de 52 anos&#46; Dos 62 participantes 28 &#40;45&#44;1&#37;&#41; s&#227;o obesos&#44; 23 &#40;37&#44;1&#37;&#41; apresentam dislipidemia&#44; 36 &#40;58&#44;1&#37;&#41; hipertens&#227;o arterial&#44; 10 &#40;16&#44;1&#37;&#41; diabetes mellitus e 4 &#40;6&#44;5&#37;&#41; insufici&#234;ncia card&#237;aca&#46; Antecedentes de EAM&#44; AVC e cirurgia p&#233;lvica s&#227;o identificados em 2 &#40;3&#44;2&#37;&#41;&#44; 6 &#40;9&#44;7&#37;&#41; e 2 &#40;3&#44;2&#37;&#41; participantes&#44; respetivamente&#46; Foi diagnosticada SAOS ligeira em 30 &#40;48&#44;4&#37;&#41;&#44; SAOS moderada em 14 &#40;22&#44;6&#37;&#41; e SAOS grave em 17 &#40;27&#44;4&#37;&#41; participantes&#46; A preval&#234;ncia de DE &#233; de 64&#44;4&#37;&#44; sendo ligeira em 24 &#40;38&#44;7&#37;&#41;&#44; ligeira a moderada em 11 &#40;17&#44;7&#37;&#41;&#44; moderada em 2 &#40;3&#44;2&#37;&#41; e grave em 3 &#40;4&#44;8&#37;&#41; participantes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Os resultados da an&#225;lise univariada encontram-se expressos na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46; Constata-se que o aumento da idade se associa de forma direta com a DE&#58; OR &#40;IC 95&#37;&#41; de 3&#44;90 &#40;1&#44;00-15&#44;28&#41;&#59; 5&#44;50 &#40;1&#44;16-26&#44;14&#41;&#59; e 6&#44;00 &#40;1&#44;00-35&#44;91&#41;&#59; nos grupos et&#225;rios 46-55&#44; 56-65 e<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>65 anos&#44; respetivamente&#46; O mesmo acontece com o grupo de ex-fumadores &#40;OR 4&#44;32 &#40;1&#44;09-17&#44;11&#41;&#41;&#46; A hipertens&#227;o arterial e a terap&#234;utica habitual com IECAS&#47;ARAS &#40;inibidores da enzima de convers&#227;o da angiotensina&#47;antagonistas dos recetores da angiotensina II&#41; evidenciam uma associa&#231;&#227;o estatisticamente significativa com a presen&#231;a de DE &#40;OR 3&#44;25 &#91;1&#44;09-9&#44;65&#93; e 7&#44;39 &#91;1&#44;52-35&#44;99&#93;&#44; respetivamente&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">N&#227;o foi encontrada associa&#231;&#227;o entre dislipidemia &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;239&#41;&#44; s&#237;ndrome metab&#243;lica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;215&#41;&#44; terap&#234;utica habitual com bloqueadores-beta &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;217&#41;&#44; antagonistas do c&#225;lcio &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;827&#41;&#44; inibidores seletivos recapta&#231;&#227;o de serotonina &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;500&#41; e DE&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Todos os doentes com DM&#44; AVC&#44; IC e antecedentes de cirurgia p&#233;lvica apresentaram DE&#44; pelo que n&#227;o foi poss&#237;vel quantificar Odds ratio &#40;OR&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A an&#225;lise dos par&#226;metros do ECRS encontra-se descrita na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46; N&#227;o se verificam diferen&#231;as estatisticamente significativas entre DE e gravidade da SAOS&#44; traduzida pelo &#237;ndice de dessatura&#231;&#227;o&#44; satura&#231;&#227;o de oxig&#233;nio m&#237;nima e m&#233;dia e IAH &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;494&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;657&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;498 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;403&#44; respetivamente&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">A an&#225;lise multivariada &#233; expressa na <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#46; A idade e a DM s&#227;o fatores de risco independentes para graus mais severos de DE&#58; OR &#40;IC 95&#37;&#41; de 1&#44;226 &#40;1&#44;062-1&#44;415&#41; e 31&#44;205 &#40;1&#44;222-796&#44;557&#41;&#44; respetivamente&#46; O IMC &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;932&#41;&#44; h&#225;bitos tab&#225;gicos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;853&#41; e alco&#243;licos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;683&#41;&#44; HTA &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;077&#41; e gravidade da SAOS &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;661&#41; n&#227;o constituem fatores de risco independentes para DE&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discuss&#227;o</span><p id="par0135" class="elsevierStylePara elsevierViewall">Em 1981&#44; Schmidt e Wise foram pioneiros em propor uma associa&#231;&#227;o entre DE e doen&#231;as do sono<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a>&#46; Posteriormente&#44; diversos estudos confirmaram a elevada preval&#234;ncia da DE na SAOS<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">51&#8211;54</span></a>&#58; Guilleminault et al&#46; registaram disfun&#231;&#227;o ejaculat&#243;ria e diminui&#231;&#227;o da libido em 48&#37; dos pacientes do sexo masculino com o SAOS<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a>&#59; Hirshkowitz et al&#46; verificaram que 91&#44;3&#37; dos doentes com sintomas de DE apresentavam tamb&#233;m SAOS&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> Seftel et al conclu&#237;ram que 40&#37; dos pacientes com SAOS apresentavam DE<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a>&#46; Contudo&#44; esta rela&#231;&#227;o &#233; negada por Schiavi RC et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a>&#46; No presente estudo&#44; encontrou-se uma preval&#234;ncia de DE de 64&#44;4&#37;&#44; o que apoia a maioria das publica&#231;&#245;es&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Na nossa amostra&#44; a DE n&#227;o se encontra associada &#224; gravidade da SAOS&#46; Contudo&#44; verificou-se que a preval&#234;ncia de DE era mais elevada no grupo de doentes com SAOS grave &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; e que os doentes que referiram DE grave obtiveram os piores resultados no estudo do sono &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Estes achados sugerem a necessidade de se realizarem estudos com tamanhos amostrais mais extensos&#46; Margel D et al&#46; conclui que a DE se associa exclusivamente com SAOS grave<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a>&#46; Para al&#233;m disso&#44; os ensaios de avalia&#231;&#227;o do tratamento da SAOS constaram benef&#237;cios na DE<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">54&#8211;58</span></a>&#44; o que sugere uma eventual associa&#231;&#227;o entre ambas patologias&#44; deduzida pelo efeito do CPAP na diminui&#231;&#227;o da hipoxia&#44; da tens&#227;o arterial e da hiperatividade simp&#225;tica e na melhoria da fun&#231;&#227;o endotelial&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Neste estudo&#44; a idade constitui um fator de risco independente para a DE&#44; tal como &#233; sugerido na literatura<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a>&#46; Confirmou-se que o risco de DE aumenta com o envelhecimento&#46; Sabe-se que a idade tem um impacto maior na fun&#231;&#227;o er&#233;til do que a gravidade do SAOS<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a>&#44; tal como foi verificado neste estudo&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Al&#233;m disso&#44; a diabetes constitui tamb&#233;m um fator de risco independente para a DE&#46; Verificou-se que pacientes diab&#233;ticos t&#234;m um risco 31 vezes superior para graus mais elevados de DE&#44; o que &#233; apoiado pelo efeito da hiperglicemia na estrutura vascular peniana<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">A hipertens&#227;o arterial associou-se &#224; DE na an&#225;lise univariada&#46; Contudo&#44; n&#227;o se confirmou uma associa&#231;&#227;o com classes de maior gravidade de DE na an&#225;lise multivariada&#46; Esta discrep&#226;ncia deve-se provavelmente a um efeito de confundimento pela diabetes&#44; uma vez que 9 em cada 10 pacientes diab&#233;ticos tamb&#233;m referiram hipertens&#227;o arterial &#40;dados n&#227;o apresentados nas tabelas&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">N&#227;o foi encontrada uma associa&#231;&#227;o entre SM &#40;s&#237;ndrome metab&#243;lica&#41; e DE&#46; Contudo&#44; &#233; poss&#237;vel que a classifica&#231;&#227;o utilizada tenha subestimado a propor&#231;&#227;o real de doentes afetados uma vez que foi baseada no relato do pr&#243;prio doente&#44; n&#227;o tendo sido inclu&#237;dos doseamentos de triglicer&#237;deos ou colesterol s&#233;ricos<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a>&#46; Como marcador de disfun&#231;&#227;o endotelial sist&#233;mica&#44; a dislipidemia pode ser mais prevalente em pacientes com DE<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a>&#46; Os fibratos e estatinas&#44; f&#225;rmacos antilipid&#233;micos&#44; podem causar DE como efeito secund&#225;rio<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a>&#44; o que n&#227;o foi observado na nossa amostra&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Da mesma forma&#44; n&#227;o foi provada uma associa&#231;&#227;o entre IMC e DE&#44; com os doentes com IMC entre 25 e 29 apresentando-se mais sintom&#225;ticos do que aqueles com IMC superiores&#46; Isto deve-se provavelmente ao facto de que a categoria de IMC 25-29 inclu&#237;a doentes mais idosos &#40;43&#37; dos pacientes entre 56 e 65 anos de idade e 50&#37; dos pacientes com mais de 65 anos de idade&#41;&#44; comparativamente &#224;s outras categorias &#40;dados n&#227;o apresentados nas tabelas&#41;&#46; Na nossa amostra&#44; o envelhecimento &#233; um fator de confundimento quando analisado com os dados do IMC&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">No que se refere aos h&#225;bitos tab&#225;gicos&#44; encontrou-se uma associa&#231;&#227;o estatisticamente significativa no grupo de ex-fumadores&#44; o que se relaciona eventualmente com a maior carga tab&#225;gica &#40;34 ma&#231;os&#47;ano&#41; descrita por estes doentes&#44; comparativamente ao grupo dos fumadores &#40;25 ma&#231;os&#47;ano&#41;&#46; Num estudo transversal recente<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a>&#44; h&#225;bitos tab&#225;gicos mantidos durante mais de 23 anos ou com mais de 20 cigarros&#47;dia associaram-se significativamente a DE&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">No que se refere &#224; terap&#234;utica farmacol&#243;gica habitual&#44; encontrou-se uma associa&#231;&#227;o entre IECA&#47;ARA e a DE&#46; Efetivamente&#44; a terap&#234;utica anti-hipertensora pode complicar-se com efeitos adversos na fun&#231;&#227;o sexual&#44; o que &#233; mais comum com os diur&#233;ticos e beta-bloqueadores<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a>&#46; Os ACEI&#47;ARA foram os f&#225;rmacos mais utilizados e a sua rela&#231;&#227;o com a DE pode estar relacionada com a hipertens&#227;o&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Este estudo tem algumas vantagens&#46; Foi utilizado um instrumento v&#225;lido&#44; criado por urologistas&#44; para diagnosticar DE em contexto cl&#237;nico&#44; acrescentando uma abordagem multidisciplinar &#224; SAOS&#46; N&#227;o foram exclu&#237;dos doentes com comorbilidades&#44; permitindo a medi&#231;&#227;o do seu impacto na fun&#231;&#227;o er&#233;til&#46; O efeito da terap&#234;utica habitual tamb&#233;m foi avaliado&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Contudo&#44; este estudo apresenta algumas limita&#231;&#245;es&#46; Apesar de a amostra ser representativa da popula&#231;&#227;o em estudo&#44; foram analisadas m&#250;ltiplas vari&#225;veis cl&#237;nicas&#44; algumas delas comuns a um n&#250;mero limitado de participantes&#44; o que pode ter interferido na obten&#231;&#227;o de mais associa&#231;&#245;es estatisticamente significativas&#46; Assim&#44; o tamanho da nossa amostra poder&#225; n&#227;o ser adequado para tal an&#225;lise&#46; Efetivamente&#44; o nosso estudo obteve uma elevada taxa de recusa na participa&#231;&#227;o &#40;54&#37;&#41;&#44; o que se deve eventualmente ao pudor em abordar o assunto em estudo&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Para investiga&#231;&#245;es futuras sugerem-se estudos em larga escala que permitam avaliar m&#250;ltiplas vari&#225;veis cl&#237;nicas&#46; Entre as diversas comorbilidades associadas &#224; SAOS &#233; extremamente importante n&#227;o desprezar complica&#231;&#245;es como a DE&#46; Aplicando uma perspetiva biopsicossocial na abordagem aos nossos doentes&#44; o nosso impacto certamente ser&#225; mais eficaz&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclus&#245;es</span><p id="par0195" class="elsevierStylePara elsevierViewall">A DE &#233; bastante comum nos pacientes com o SAOS&#44; podendo encontrar-se subestimada devido ao constrangimento por parte dos doentes em referir o problema&#46; Os fatores que se associam a DE nos doentes com SAOS incluem a idade&#44; diabetes&#44; ex-fumadores e hipertens&#227;o arterial e medica&#231;&#227;o com IECA&#47;ARA&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflito de interesses</span><p id="par0200" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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            0 => "Abstract"
            1 => "Introduction"
            2 => "Methods"
            3 => "Results"
            4 => "Conclusions"
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          "titulo" => "Keywords"
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          "titulo" => "Introdu&#231;&#227;o"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Popula&#231;&#227;o em Estudo"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "IIEF-5 &#40;International Index Erectile Dysfunction &#8211; 5 Item Version&#41;"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Estudo poligr&#225;fico cardiorrespirat&#243;rio do sono &#40;EPCRS&#41;"
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            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "An&#225;lise estat&#237;stica"
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          "identificador" => "sec0035"
          "titulo" => "Resultados"
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          "identificador" => "sec0040"
          "titulo" => "Discuss&#227;o"
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          "identificador" => "sec0045"
          "titulo" => "Conclus&#245;es"
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        9 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflito de interesses"
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        10 => array:2 [
          "identificador" => "xack184915"
          "titulo" => "Agradecimentos"
        ]
        11 => array:1 [
          "titulo" => "Bibliografia"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-07-08"
    "fechaAceptado" => "2011-10-06"
    "PalabrasClave" => array:2 [
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec565568"
          "palabras" => array:5 [
            0 => "Apneia obstrutiva do sono"
            1 => "Disfun&#231;&#227;o er&#233;til"
            2 => "Envelhecimento"
            3 => "Diabetes mellitus"
            4 => "Hipertens&#227;o"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec565569"
          "palabras" => array:5 [
            0 => "Sleep Apnea Obstructive"
            1 => "Erectile dysfunction"
            2 => "Aging"
            3 => "Diabetes mellitus"
            4 => "Hypertension"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A SAOS &#40;s&#237;ndroma de apneia obstrutiva do sono&#41; define-se pela ocorr&#234;ncia frequente de obstru&#231;&#227;o da via a&#233;rea superior durante o sono&#44; com m&#250;ltiplas consequ&#234;ncias cl&#237;nicas&#46; Estudos anteriores sugerem que a SAOS provoca altera&#231;&#245;es na regula&#231;&#227;o neural&#44; hormonal e vascular que contribuem para o desenvolvimento de DE &#40;disfun&#231;&#227;o er&#233;til&#41;&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Este estudo tem como principais objetivos estimar a preval&#234;ncia da DE numa amostra de doentes com SAOS e avaliar os seus determinantes&#46;</p></span> <span><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 62 doentes do Laborat&#243;rio do Sono do Hospital S&#46; Jo&#227;o com diagn&#243;stico recente de SAOS&#44; que responderam ao question&#225;rio IIEF-5 &#40;International Index Erectile Function-5 Item version&#41;&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia da DE em pacientes com SAOS foi de 64&#44;4&#37;&#46; A idade e a diabetes constitu&#237;ram fatores de risco independentes para graus avan&#231;ados de DE&#58; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;226 &#40;IC 95&#37;&#58;1&#44;062-1&#44;415&#41; e OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#44;205 &#40;IC 95&#37;&#58;1&#44;222-796&#44;557&#41;&#44; respetivamente&#46; Comparados com pacientes fumadores&#44; o grupo de pacientes ex-fumadores revelou associar-se &#224; DE&#58; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;32 &#40;IC 95&#37;&#58;1&#44;09-17&#44;11&#41;&#46; A hipertens&#227;o e o tratamento com IECAS &#40;inibidores da enzima conversora da angiotensina&#41; ou ARA &#40;antagonistas dos recetores da angiotensina&#41; evidenciaram uma associa&#231;&#227;o com DE&#58; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;25 &#40;IC 95&#37;&#58;1&#44;09-9&#44;65&#41; e 7&#44;39 &#40;IC 95&#37;&#58;1&#44;52-35&#44;99&#41;&#44; respetivamente&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">N&#227;o foi encontrada nenhuma rela&#231;&#227;o no que diz respeito ao IMC &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;254&#41;&#44; h&#225;bitos alco&#243;licos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;357&#41;&#44; enfarte agudo do mioc&#225;rdio &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;315&#41;&#44; dislipidemia &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;239&#41; ou s&#237;ndrome metab&#243;lico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;215&#41; e DE&#46; A gravidade da SAOS n&#227;o se encontra associada a DE na amostra estudada&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia da DE em doentes com SAOS &#233; elevada&#46; Os determinantes da DE na amostra estudada foram a idade e a diabetes&#46; Ex-fumadores&#44; hipertens&#227;o e tratamento com ACEI&#47;ARB tamb&#233;m revelaram uma associa&#231;&#227;o estatisticamente significativa com a DE&#46;</p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">OSAS &#40;Obstructive Sleep apnea syndrome&#41; is defined by recurrent episodes of upper airway obstruction during sleep&#44; causing multiple clinical consequences&#46; Literature review suggests that OSAS induces a spectrum of abnormalities in neural&#44; hormonal and vascular regulation that contribute to the development of ED &#40;erectile dysfunction&#41;&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The aims of this study were to estimate the prevalence of ED in OSAS patients and evaluate its determinants&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">62 patients from Hospital S&#46; Jo&#227;o Sleep Laboratory with newly diagnosed OSAS were included in the study and answered the IIEF-5 &#40;international index erectile function 5 item version&#41; questionnaire&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The prevalence of ED in OSAS patients was 64&#46;4&#37;&#46; Age and Diabetes constituted themselves as independent risk factors for more severe degrees of ED&#58; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;226 &#40;95&#37;CI&#58; 1&#46;062&#8211;1&#46;415&#41; and OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#46;205 &#40;95&#37;CI&#58; 1&#46;222&#8211;796&#46;557&#41;&#44; respectively&#46; Compared with nonsmokers&#44; ex-smokers group revealed a positive association with ED&#58; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;32 &#40;95&#37;CI&#58; 1&#46;09&#8211;17&#46;11&#41;&#46; Hypertension and ACEI &#40;angiotensin converting enzyme inhibitors&#41; or ARB &#40;angiotensin II receptor blockers&#41; therapy were also correlated to ED symptoms&#58; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;25 &#40;95&#37;CI&#58; 1&#46;09-9&#46;65&#41; and 7&#46;39 &#40;95&#37;CI&#58; 1&#46;52-35&#46;99&#41;&#44; respectively&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">No association was found relating BMI &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;254&#41;&#44; alcoholic habits &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;357&#41;&#44; acute myocardial infarction &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;315&#41;&#44; dyslipidemia &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;239&#41;&#44;metabolic syndrome &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;215&#41; and ED&#46; OSAS severity was not associated with ED in our sample&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The prevalence of ED in OSAS patients is high&#46; ED determinants in our sample were age and diabetes&#46; Past smoking habits&#44; hypertension and ACEI&#47;ARB therapy also revealed a statistically significant association with ED&#46;</p></span>"
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                "apendice" => "<p id="par0230" class="elsevierStylePara elsevierViewall">&#40;IIEF-5 &#8211; International Index of Erectile Function&#44; 5 item version&#41;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0235" class="elsevierStylePara elsevierViewall">Como classifica o seu grau de confian&#231;a em conseguir e manter uma ere&#231;&#227;o&#63;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">1&#46;</span><p id="par0240" class="elsevierStylePara elsevierViewall">Muito baixo&#47;nenhum</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">2&#46;</span><p id="par0245" class="elsevierStylePara elsevierViewall">Baixo</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">3&#46;</span><p id="par0250" class="elsevierStylePara elsevierViewall">Moderado</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">4&#46;</span><p id="par0255" class="elsevierStylePara elsevierViewall">Elevado</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">5&#46;</span><p id="par0260" class="elsevierStylePara elsevierViewall">Muito elevado</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0265" class="elsevierStylePara elsevierViewall">Quando conseguiu a ere&#231;&#227;o por estimula&#231;&#227;o sexual&#44; quantas vezes &#233; que essa ere&#231;&#227;o foi suficientemente firme para a penetra&#231;&#227;o&#63;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">1&#46;</span><p id="par0270" class="elsevierStylePara elsevierViewall">Quase nunca&#47;nunca</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">2&#46;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Poucas vezes &#40;menos que metade das vezes&#41;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">3&#46;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Algumas vezes &#40;cerca de metade das vezes&#41;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">4&#46;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Muitas vezes &#40;mais que metade das vezes&#41;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">5&#46;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Quase sempre&#47;sempre</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0295" class="elsevierStylePara elsevierViewall">Durante as rela&#231;&#245;es sexuais quantas vezes &#233; que conseguiu manter a ere&#231;&#227;o ap&#243;s a penetra&#231;&#227;o&#63;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">1&#46;</span><p id="par0300" class="elsevierStylePara elsevierViewall">Quase nunca&#47;nunca</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">2&#46;</span><p id="par0305" class="elsevierStylePara elsevierViewall">Poucas vezes &#40;menos que metade das vezes&#41;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">3&#46;</span><p id="par0310" class="elsevierStylePara elsevierViewall">Algumas vezes &#40;cerca de metade das vezes&#41;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">4&#46;</span><p id="par0315" class="elsevierStylePara elsevierViewall">Muitas vezes &#40;mais que metade das vezes&#41;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">5&#46;</span><p id="par0320" class="elsevierStylePara elsevierViewall">Quase sempre&#47;sempre</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#40;4&#41;</span><p id="par0325" class="elsevierStylePara elsevierViewall">Durante as rela&#231;&#245;es sexuais&#44; foi dif&#237;cil manter uma ere&#231;&#227;o at&#233; ao final da atividade sexual&#63;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">1&#46;</span><p id="par0330" class="elsevierStylePara elsevierViewall">Extremamente dif&#237;cil</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">2&#46;</span><p id="par0335" class="elsevierStylePara elsevierViewall">Muito dif&#237;cil</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">3&#46;</span><p id="par0340" class="elsevierStylePara elsevierViewall">Dif&#237;cil</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">4&#46;</span><p id="par0345" class="elsevierStylePara elsevierViewall">Ligeiramente dif&#237;cil</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">5&#46;</span><p id="par0350" class="elsevierStylePara elsevierViewall">N&#227;o dif&#237;cil</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">&#40;5&#41;</span><p id="par0355" class="elsevierStylePara elsevierViewall">Quando tentou ter rela&#231;&#245;es sexuais&#44; quantas vezes &#233; que teve satisfa&#231;&#227;o&#63;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">1&#46;</span><p id="par0360" class="elsevierStylePara elsevierViewall">Quase nunca&#47;nunca</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">2&#46;</span><p id="par0365" class="elsevierStylePara elsevierViewall">Poucas vezes &#40;menos que metade das vezes&#41;</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">3&#46;</span><p id="par0370" class="elsevierStylePara elsevierViewall">Algumas vezes &#40;cerca de metade das vezes&#41;</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">4&#46;</span><p id="par0375" class="elsevierStylePara elsevierViewall">Muitas vezes &#40;mais que metade das vezes&#41;</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">5&#46;</span><p id="par0380" class="elsevierStylePara elsevierViewall">Quase sempre&#47;sempre</p></li></ul></p></li></ul></p>"
                "titulo" => "1&#46;1&#46; INQU&#201;RITO SOBRE FUN&#199;&#195;O ER&#201;TIL"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">IMC &#40;&#237;ndice de massa corporal&#41;&#59; SAOS &#40;s&#237;ndrome de apneia obstrutiva do sono&#41;&#59; Classifica&#231;&#227;o de DE &#40;disfun&#231;&#227;o er&#233;ctil&#41;&#58; ausente &#40;IIEF-5 22-25&#41;&#59; ligeira &#40;IIEF-5 17-21&#41;&#59; ligeira a moderada &#40;IIEF-5 12-16&#41;&#59; moderada &#40;IIEF-5 8-11&#41;&#59; grave &#40;IIEF-5 5-7&#41;&#46;</p>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;14&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">H&#225;bitos tab&#225;gicos</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fumadores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Carga tab&#225;gica &#40;m&#233;dia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ex-fumadores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;37&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Carga tab&#225;gica &#40;m&#233;dia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o-fumadores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;33&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">H&#225;bitos alco&#243;licos</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ausentes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;46&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 60 g&#47;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;37&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 60 g&#47;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;16&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Comorbilidades</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;37&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hipertens&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36 &#40;58&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;16&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome metab&#243;lico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;17&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Insufici&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;6&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Antecedentes pessoais</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Acidente vascular cerebral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Enfarte do mioc&#225;rdio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;9&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cirurgia p&#233;lvica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Gravidade da SAOS</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ligeira&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;48&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;22&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;27&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Disfun&#231;&#227;o er&#233;til</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;35&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ligeira&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;38&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ligeira a moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;19&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DE &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Idade</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>46-55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;90 &#40;1&#44;00-15&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>56-65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;50 &#40;1&#44;16-26&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;00 &#40;1&#44;00-35&#44;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">IMC</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>20-24&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>25-29&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;06 &#40;0&#44;42-9&#44;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;254&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30-34&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;64 &#40;0&#44;14-2&#44;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;71 &#40;0&#44;12-4&#44;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Gravidade da SAOS</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ligeira&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;50 &#40;0&#44;14-1&#44;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;723&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;63 &#40;0&#44;42-6&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">S&#237;ndrome metab&#243;lica</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Presente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;4 &#40;0&#44;59-9&#44;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;215&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Hipertens&#227;o</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>Presente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top" style="border-bottom: 2px solid black">75&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">3&#44;25 &#40;1&#44;09-9&#44;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top" style="border-bottom: 2px solid black">0&#44;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Dislipidemia</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Presente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;97 &#40;0&#44;64-6&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;239&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Enfarte mioc&#225;rdio</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Presente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;00 &#40;0&#44;32-27&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;215&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">H&#225;bitos alco&#243;licos</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ausentes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 60 g&#47;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;84 &#40;0&#44;26-2&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;357&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 60 g&#47;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;45 &#40;0&#44;10-1&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">H&#225;bitos tab&#225;gicos</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o-fumadores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;719&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ex-fumadores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;32 &#40;1&#44;09-17&#44;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fumadores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;14 &#40;0&#44;32-4&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Terapia IECAS&#47;ARAs</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;39 &#40;1&#44;52-35&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Presente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncia de DE de acordo com vari&#225;veis demogr&#225;ficas e cl&#237;nicas&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">N&#227;o foi poss&#237;vel analisar a categoria &#171;DE moderada&#187; uma vez que s&#243; &#233; composta por um participante&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Classifica&#231;&#227;o de DE &#40;disfun&#231;&#227;o er&#233;ctil&#41;&#58; ausente &#40;IIEF-5 22-25&#41;&#59; ligeira &#40;IIEF-5 17-21&#41;&#59; ligeira a moderada &#40;IIEF-5 12-16&#41;&#59; moderada &#40;IIEF-5 8-11&#41;&#59; grave &#40;IIEF-5 5-7&#41;&#59; IAH&#58; &#237;ndice de apneia-hipopneia&#59; IDO&#58; &#237;ndice de dessatura&#231;&#227;o de oxig&#233;nio&#59; Min-Max&#58; valor m&#237;nimo-m&#225;ximo&#59; Sat O2<span class="elsevierStyleInf">Min</span>&#58; satura&#231;&#227;o de oxig&#233;nio m&#237;nima&#59; Sat O2<span class="elsevierStyleInf">Med</span>&#58; satura&#231;&#227;o de oxig&#233;nio m&#233;dia&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IDO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sat O2<span class="elsevierStyleInf">Min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sat O2<span class="elsevierStyleInf">Med</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IAH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Mediana</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Min-Max</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;8-85&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#44;0-94&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#44;0-96&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#44;2-48&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ligeira&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Mediana</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Min-Max</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;6-70&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#44;0-91&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#44;0-98&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;3-76&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ligeira a moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Mediana</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Min-Max</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;4-67&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#44;0-92&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#44;0-97&#44;0&nbsp;\t\t\t\t\t\t\n
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                  "referenciaCompleta" => "Douglas N&#46; Sleep apnea syndrome&#46; En&#58; Fauci AS&#44; Braunwald E&#44; Kasper DL&#44; Hauser SL&#44; Longo DL&#44; Jameson JL&#44; Loscalzo J&#46; Harrison&#39;s Principles of Internal Medicine&#46; Vol&#46; II&#44; cap&#237;tulo 259&#46; 17&#46;<span class="elsevierStyleSup">a</span> ed&#46; Nueva York&#58; McGraw Hill&#59; 2008&#46; p&#46; 1665-8&#46;"
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                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => false
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                    0 => array:2 [
                      "doi" => "10.1007/s11906-010-0112-8"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => false
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                    0 => array:2 [
                      "doi" => "10.1016/j.cardfail.2009.08.006"
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