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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Objectivo</span>&#58; Foi objectivo deste estudo determinar a sensibilidade e a especificidade da oximetria nocturna &#40;ON&#41; como m&#233;todo de <span class="elsevierStyleItalic">screening</span> diagn&#243;stico para a s&#237;ndroma de apneia-hipopneia obstrutiva do sono &#40;SAHOS&#41;&#44; utilizando como m&#233;todo de refer&#234;ncia a polissonografia &#40;PSG&#41;&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Metodologia</span>&#58; Foram inclu&#237;dos 63 doentes com sus-peita cl&#237;nica de SAHOS e exclus&#227;o de doen&#231;a respirat&#243;ria&#44; sendo submetidos a uma PSG completa&#44; incluin-do ON&#46; Posteriormente&#44; foram determinados&#58; a sensibilidade&#44; a especificidade e os valores preditivos positivo &#40;VPP&#41; e negativo &#40;VPN&#41; da ON&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados</span>&#58; A SAHOS foi diagnosticada em 47 doentes com uma m&#233;dia et&#225;ria de 54 anos&#46; Verificaram-se diferen&#231;as significativas na avalia&#231;&#227;o da percentagem do tempo total de sono &#40;TTS&#41; com dessatura&#231;&#227;o de O<span class="elsevierStyleInf">2</span> abaixo de 90&#37; entre doentes com SAHOS &#40;25&#44;4 29&#44;7&#37;&#41; e sem SAHOS &#40;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5&#37;&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#46; A fim de avaliar a sensibilidade&#44; a especificidade&#44; o VPP e o VPN&#44; utiliz&#225;mos dois pontos de corte baseados na gravidade da dessatura&#231;&#227;o&#46; Com o primeiro ponto de corte consider&#225;mos positivos para o diagn&#243;stico da SAHOS todos os doentes que apresentassem valores de dessatura&#231;&#227;o &#40;satura&#231;&#227;o de O<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>90&#37;&#41;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>a 1&#37; do TTS&#44; tendo-se obtido para a ON uma sensibilidade de 76&#44;6&#37;&#44; uma especificidade de 75&#37;&#44; um VPP de 90&#37; e um VPN negativo de 52&#44;2&#37;&#46; Utili-zando o segundo ponto de corte&#44; foram considerados positivos todos os doentes que apresentassem valores de dessatura&#231;&#227;o<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>a 5&#37; do TTS&#44; tendo-se obtido uma sensibilidade de 65&#44;9&#37;&#44; uma especificidade de 100&#37;&#44; um VPP de 100&#37; e um VPN de 50&#37;&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclus&#245;es</span>&#58; A ON &#233; um bom teste de <span class="elsevierStyleItalic">screening</span> diagn&#243;stico da SAHOS&#44; desde que seja exclu&#237;da patologia respirat&#243;ria&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007&#59; XIII &#40;4&#41;&#58; 525-551</span></p></span>"
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        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Aim&#58;</span> The aim of our study was to evaluate the sensitivity and specificity of Nocturnal Oximetry &#40;NO&#41; as a diagnostic screening tool for obstructive sleep apnoea hypopnoea syndrome &#40;OSAHS&#41;&#44; compared with polysomnography &#40;PSG&#41; as the gold standard&#46;</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Methodology&#58;</span> 63 patients with clinical suspicion of OSAHS and exclusion of respiratory disease under-went PSG and NO&#46; We then determined NO sensitivity&#44; specificity&#44; positive &#40;PPV&#41; and negative predictive values &#40;NPV&#41;&#46;</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results&#58;</span> OSAHS was diagnosed in 47 patients with a mean age of 54 years&#46; In the evaluation of the percentage of Total Sleep Time &#40;TST&#41; with oxygen desaturation below 90&#37;&#44; we found significant differences between patients with OSAHS &#40;25&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;7&#37;&#41; and without OSAHS &#40;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5&#37;&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#46; We used two cutoff points to evaluate sensitivity&#44; specificity&#44; positive &#40;PPV&#41; and negative predictive values &#40;NPV&#41;&#44; based on the severity of O<span class="elsevierStyleInf">2</span> desaturation &#40;StO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>90&#37;&#41;&#46; Using the first cutoff point we diagnosed with NO as positive all the patients with TST desaturation values &#8805;<span class="elsevierStyleHsp" style=""></span>1&#37; of the TST&#46; Under these circumstances we found a sensitivity of 76&#46;6&#37;&#44; a specificity of 75&#37;&#44; a PPV of 90&#37; and an NPV value of 52&#46;2&#37; for our screening test &#40;NO&#41;&#46; Using the second cutoff point&#44; we diagnosed with NO as positive all the patients with TST desaturation values &#8805;<span class="elsevierStyleHsp" style=""></span>5&#37; of the TST&#46; With this method we found a sensitivity of 65&#46;9&#37;&#44; a specificity of 100&#37;&#44; a PPV of 100&#37; and an NPV of 50&#37;&#46;</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusion&#58;</span> NO is a useful screening test for the diagnosis of OSAHS in patients without respiratory disease&#46;</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007&#59; XIII &#40;4&#41;&#58; 525-551</span></p></span>"
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Vol. 13. Issue 4.
Pages 525-551 (July - August 2007)
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Vol. 13. Issue 4.
Pages 525-551 (July - August 2007)
Artigo Original / Original Article
Open Access
Papel da oximetria nocturna no rastreio da síndroma de apneia-hipopneia obstrutiva do sono*
The role of nocturnal oximetry in obstructive sleep apnoea-hypopnoea syndrome screening*
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Celestina Ventura1, Ana Sofia Oliveira2, Rita Dias3, Joana Teixeira3, Cristina Canhão3, Odete Santos4, Paula Pinto5, Cristina Bárbara6
1 Assistente Graduada de Medicina Familiar, Centro de Saúde de Grândola. / General Practice Specialist Consultant, Grândola Health Centre.
2 Interna do Internato Complementar de Pneumologia do Hospital de Pulido Valente. / Pulmonology Resident, Hospital Pulido Valente.
3 Técnica de Cardiopneumologia do Hospital de Pulido Valente. / Cardiopulmonology Technician, Hospital Pulido Valente.
4 Assistente Hospitalar Graduada do Hospital de Pulido Valente. / Specialist Consultant, Hospital Pulido Valente.
5 Assistente Hospitalar de Pneumologia do Hospital de Pulido Valente. Assistente Convidada de Pneumologia da Faculdade de Ciências Médicas da Universidade Nova de Lisboa. / Pulmonology Consultant, Hospital Pulido Valente. Guest Pulmonolgy Consultant, Nova University School of Medical Sciences.
6 Coordenadora da Unidade de Fisiopatologia Respiratória do Hospital de Pulido Valente. Professora Auxiliar de Pneumologia da Faculdade de Ciências Médicas da Universidade Nova de Lisboa. / Coordinator, Respiratory Physiopathology Unit, Hospital Pulido Valente. Assistant Pulmonology Professor, Nova University School of Medical Sciences.
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Resumo

Objectivo: Foi objectivo deste estudo determinar a sensibilidade e a especificidade da oximetria nocturna (ON) como método de screening diagnóstico para a síndroma de apneia-hipopneia obstrutiva do sono (SAHOS), utilizando como método de referência a polissonografia (PSG).

Metodologia: Foram incluídos 63 doentes com sus-peita clínica de SAHOS e exclusão de doença respiratória, sendo submetidos a uma PSG completa, incluin-do ON. Posteriormente, foram determinados: a sensibilidade, a especificidade e os valores preditivos positivo (VPP) e negativo (VPN) da ON.

Resultados: A SAHOS foi diagnosticada em 47 doentes com uma média etária de 54 anos. Verificaram-se diferenças significativas na avaliação da percentagem do tempo total de sono (TTS) com dessaturação de O2 abaixo de 90% entre doentes com SAHOS (25,4 29,7%) e sem SAHOS (1±1,5%), p<0,001. A fim de avaliar a sensibilidade, a especificidade, o VPP e o VPN, utilizámos dois pontos de corte baseados na gravidade da dessaturação. Com o primeiro ponto de corte considerámos positivos para o diagnóstico da SAHOS todos os doentes que apresentassem valores de dessaturação (saturação de O2<90%)a 1% do TTS, tendo-se obtido para a ON uma sensibilidade de 76,6%, uma especificidade de 75%, um VPP de 90% e um VPN negativo de 52,2%. Utili-zando o segundo ponto de corte, foram considerados positivos todos os doentes que apresentassem valores de dessaturaçãoa 5% do TTS, tendo-se obtido uma sensibilidade de 65,9%, uma especificidade de 100%, um VPP de 100% e um VPN de 50%.

Conclusões: A ON é um bom teste de screening diagnóstico da SAHOS, desde que seja excluída patologia respiratória.

Rev Port Pneumol 2007; XIII (4): 525-551

Palavras-chave:
Síndroma de apneia/hipopneia obstrutiva do sono
oximetria nocturna
Abstract

Aim: The aim of our study was to evaluate the sensitivity and specificity of Nocturnal Oximetry (NO) as a diagnostic screening tool for obstructive sleep apnoea hypopnoea syndrome (OSAHS), compared with polysomnography (PSG) as the gold standard.

Methodology: 63 patients with clinical suspicion of OSAHS and exclusion of respiratory disease under-went PSG and NO. We then determined NO sensitivity, specificity, positive (PPV) and negative predictive values (NPV).

Results: OSAHS was diagnosed in 47 patients with a mean age of 54 years. In the evaluation of the percentage of Total Sleep Time (TST) with oxygen desaturation below 90%, we found significant differences between patients with OSAHS (25.4±29.7%) and without OSAHS (1±1.5%), p<0,001. We used two cutoff points to evaluate sensitivity, specificity, positive (PPV) and negative predictive values (NPV), based on the severity of O2 desaturation (StO2<90%). Using the first cutoff point we diagnosed with NO as positive all the patients with TST desaturation values ≥1% of the TST. Under these circumstances we found a sensitivity of 76.6%, a specificity of 75%, a PPV of 90% and an NPV value of 52.2% for our screening test (NO). Using the second cutoff point, we diagnosed with NO as positive all the patients with TST desaturation values ≥5% of the TST. With this method we found a sensitivity of 65.9%, a specificity of 100%, a PPV of 100% and an NPV of 50%.

Conclusion: NO is a useful screening test for the diagnosis of OSAHS in patients without respiratory disease.

Rev Port Pneumol 2007; XIII (4): 525-551

Key-words:
Obstructive sleep apnoea hypopnoea syndrome
nocturnal oximetry
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Bibliografia / Bibliography
[1.]
J.R. Stradling, R.J. O Davies.
Sleep 1: Obstructive sleep apnoea/hypopnoea syndrome: definitions, epidemiology, and natural history.
Thorax, 59 (2004), pp. 73-78
[2.]
U.J. Magalang, J. Dmochowski, S. Veermachaneni, A. Draw, M.J. Mador, A. El-Solh, B.J.B. Grant.
Prediction of the apnea-hypopnea index from overnight pulse oximetry.
Chest, 124 (2003), pp. 1694-1701
[3.]
Oximetry in sleep Apnea in Adults, (2004),
[4.]
D. Schlosshan, M.W. Elliott.
Sleep 3: Clinical presentation and diagnosis of the obstructive sleep apnoea hypopnoea syndrome.
Thorax, 59 (2004), pp. 347-352
[5.]
American Academy of Sleep Medicine Task Force.
Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research.
Sleep, 22 (1999), pp. 667-689
[6.]
H.M. Engleman, N.J. Douglas.
Sleep 4: Sleepiness, cognitive function, and quality of life in obstructive sleep apnoea/hypopnoea syndrome.
Thorax, 59 (2004), pp. 618-622
[7.]
C.F.P. George.
Sleep 5: Driving and automobile crashes in patients with obstructive sleep apnoea/hypopnoea syndrome.
Thorax, 59 (2004), pp. 804-807
[8.]
G.V. Robinson, J.R. Stradling, R.J. O Davies.
Sleep 6: Obstructive sleep apnoea/hypopnoea syndrome and hypertension.
Thorax, 59 (2004), pp. 1089-1094
[9.]
Konrad E. Bloch.
Getting the most out of nocturnal pulse oximetry.
Chest, 124 (2003), pp. 1628-1630
[10.]
C. Zamarrón, F. Gude, J. Barcala, J.R. Rodriguez, P.V. Ro-mero.
Utility of oxygen saturation and heart rate spectral analysis obtained from pulse oximetric recordings in the diagnosis of sleep apnea syndrome.
Chest, 123 (2003), pp. 1567-1576
[11.]
N. Netzer, A.H. Eliasson, C. Netzer, D.A. Kristo.
Overnight pulse oximetry for sleep-disordered breathing in adults: a review.
Chest, 120 (2001), pp. 625-633
[12.]
British Thoracic Society.
Management of obstructive sleep apnoea/hypopnoea syndrome in adults.
A national clinical guideline, (June 2003),
[13.]
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults, National Institutes of Health, National Heart, Lung and Blood Institute, (1998),
[14.]
A. Machado, M. Drummond, J.C. Winck.
A escala de sonolência de Epworth reflecte a gravidade do síndro-me de apneia do sono?.
Rev Port Pneumol, VIII (2002), pp. 525
[15.]
M.W. Johns.
Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth sleepiness scale.
Chest, 103 (1993), pp. 30-36
[16.]
C. Bárbara, P. Pinto.
Síndroma de apneia obstrutiva do sono: diagnóstico e terapêutica.
Monografia, (2005),
[17.]
J.C. Winck, L. Ferreira.
Oximetria: papel no estudo do doente respiratório.
Rev Port Pneumol, IV (1998), pp. 307
[18.]
E. Chiner, J. Signes-Costa, J.M. Arriero, J. Marco, I. Fuentes, A. Sergado.
Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies?.
Thorax, 54 (1999), pp. 968-971
[19.]
J.C. Vázquez, W.H. Tsai, W.W. Flemons, A. Masuda, R. Brant, E. Hajduk, W.A. Whitelaw, J.E. Remmers.
Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnoea.
Thorax, 55 (2000), pp. 302-307
[20.]
F. Series, I. Marc, Y. Cormier, J. La Forge.
Utility of nocturnal home oximetry for case finding in patients with suspected sleep apnea hypopnea syndrome.
Ann Int Med, 119 (1993), pp. 449-453
[21.]
N.J. Douglas, S. Thomas, M.A. Jan.
Clinical value of polysomnography.
Lancet, 339 (1992), pp. 347-350
[22.]
P.J. Ryan, M.F. Hilton, D.A. Boldy, A. Evans, S. Bradbury, S. Sapiano, K. Prowse, R.M. Cayton.
Validation of British Thoracic Society guidelines for the diagnosis of the sleep apnoea/hypopnea syndrome: can polysomnography be avoided?.
Thorax, 50 (1995), pp. 972-975
[23.]
P.C. Deegan, W.T. McNicholas.
Predictive value of clinical features for the obstructive sleep apnoea syndrome.
Eur Respir J, 9 (1996), pp. 117-124
[24.]
C.F. George.
Diagnostic techniques in obstructive sleep apnea.
Prog Cardiovas Dis, 41 (1999), pp. 355-366
[25.]
P.S. Pradhan, R.E. Gliklich, J. Winkelman.
Screening for obstructive sleep apnea in patients presenting for snoring surgery.
Laryngoscope, 106 (1996), pp. 1393-1397
[26.]
B.G. Cooper, D. Veale, C.J. Griffiths, G.J. Gibson.
Value of nocturnal oxygen saturation as a screening test for sleep apnea.
Thorax, 46 (1991), pp. 586-588
[27.]
A.J. Williams, G. Yu, S. Santiago, M. Stein.
Screening for sleep apnea using pulse oximetry and a clinical score.
Chest, 100 (1991), pp. 631-635
[28.]
H. Rauscher, W. Popp, H. Zwick.
Model for investigating snorers with suspected sleep apnoea.
Thorax, 48 (1993), pp. 275-279
[29.]
P. Levy, J.L. Pepin, C. Deschaux-Blanc, et al.
Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome.
Chest, 109 (1996), pp. 395-399
[30.]
S. Choi, L.S. Bennett, R. Mullins, et al.
Which derivative from overnight oximetry best predicts symptomatic response to nasal continuous positive airway pressure in pa- tients with obstructive sleep apnoea?.
Respir Med, 94 (2000), pp. 895-899
[31.]
S. Gyulay, L.G. Olson, M.J. Hensley, M.T. King, K.M. Allen, N.A. Saunders.
A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea.
Am Rev Respir Dis, 147 (1993), pp. 50-53

Estudo efectuado no âmbito de um mestrado em Patologia Respiratória da Faculdade de Ciências Médicas de Lisboa. / Study undertaken as part of an MSc in Respiratory Pathology, Lisbon University School of Medical Sciences.

Copyright © 2007. Sociedade Portuguesa de Pneumologia/SPP
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