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DIAGNOSIS AND TREATMENT OF SLEEP APNEA PATIENTS IN THE PUBLIC HEALTH SYSTEM
The Obstructive Sleep Apneia (OSA) is a common disease among adult population. However, the maiority of patients remain undiagnosed and untreated. Polysomnography is the gold-standard for OSA diagnosis, but inaccessible and very expensive for our population. The Home Sleep Apneia Test (HSAT) evaluates respiratory variables and can be used when there is a high risk of OSA. The effective treatment to moderate and severe OSA is the Continuous Positive Airway Pressure (CPAP). However, this device is so expensive for population of Public Health System of Brazil (SUS).
Describe a model available for management of sleep apnea patients from public health system in Southern Brazil.
One hundred and thirty patients were referred to sleep clinic of Santa Casa de Misericórdia de Porto Alegre/RS. All patients underwent a clinical evaluation and those with high probability of OSA performed to HSAT (Stardust II©) from March 2018 to March 2019. The severity of OSA was classified according to the apnea/hypopnea index (AHI) as mild (5 to 14,9), moderate (15 to 29,9) and severe (≥ 30 events/h). Patients with severe OSA and moderate OSA with cardiovascular comorbidities or excessive daytime sleepiness were referred to CPAP treatment. Oral appliance (OA) and maxillomandibular advancement surgery (MMA) were other forms to OSA treatment in select cases. Weight loss was indicated for all overweight and obese patients.
Were studied 106 patients, 61% female (n=65), mean age 58 years and mean body index 32±6,5kg/m2. Most patients (63%) had excessive daytime sleepiness (ESS 12 [2-24]). HSAT was performed 285 days after clinical evaluation and confirmed the OSA diagnosis in 87 patients (82%). Mean AHI was 21 events/h and most of the sample was moderate to severe OSA (n=51). Only 8,5% of the sample (n=9) needed to repeat the HSAT and oximetry loss represented the mainly reason for the repetition (n=6). Among 51 patients with moderate to severe OSA, 42 had indication for CPAP treatment, but few patients were using the device (n=12) due to financial constraints. Four patients were referred to OA and one to MMA.
The HSAT is an accessible model for OSA diagnosis among patients with high probability of OSA. However, the waiting time to perform the HSTA is still long in the public health system. Similarly, after OSA diagnosis, few patients have access to treatment, especially those with indication for CPAP treatment.
Obstructive sleep apnea; continuous positive airway pressure; home sleep test
BARBARA HUNHOFF, MARCELO BELLON, FERNANDO GUSTAVO STELZER, EDUARDO GARCIA, FABIOLA SCHORR