berlin questionnaire and epworth sleepiness scale pdf

Berlin Questionnaire And Epworth Sleepiness Scale Pdf

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Evaluation of obstructive sleep apnea in obese patients scheduled for bariactric surgery 1. Main author. Conception of the study, interpretation of data, critical revision. Out of these individuals, 35 performed a full-night sleep study using a type 3 portable monitoring PM. The questionnaire results were compared for gender and BMI. The presence and severity of OSA was correlated with gender and both questionnaires. Key words: Sleep Apnea, Obstructive. Obesity, Morbid. Bariatric Surgery. Obstructive sleep apnea OSA is characterized by the intermittent partial or complete upper airway collapse during sleep, leading to sleep fragmentation, hypoxemia, hypercapnia, intrathoracic pressure oscillations as well as the increased sympathetic activity 1.

The data concerning the Brazilian population are still very restricted, but in a recent study in Sao Paulo City, including volunteers aged from 20 to 80 years, Obesity is the main risk factor for the development of OSA and is its most important reversible risk factor Obesity is a chronic disease considered as a worldwide epidemic.

Since , the number of obese has doubled around the world The bariatric surgery was recommended for obesity treatment and its comorbidities in this population and the risks of OSA have been studied by several authors 14,15, OSA increases the morbidity as well as perioperative and post-operative mortality rate during the bariatric surgery 15,25, Its diagnosis and treatment before surgery decrease such complications 18,21,23, The American Academy of Sleep Medicine recommends that this group of patients should perform an objective sleep study 1.

However, due to the unavailability of sleep laboratories in addition to the high demand of individuals waiting for bariatric surgery, most part of these patients will not be investigated.

Thus, the purpose of the present study was to evaluate the frequency and classify the severity of OSA in obese patients scheduled for bariatric surgery in a University Hospital in Brazil. Written and informed consent was obtained from all the participants. A group of 59 subjects was submitted to anamnesis and specific physical examination.

Body mass index BMI was calculated from body weight in kilograms kg and height in meters m. The neck circumference was measured in centimeters cm taking the cricothyroid membrane as reference.

A person showing two positive categories is considered as high risk for OSA The diagnosis and severity of OSA was correlated to gender and positivity of both questionnaires. The t-test for variables with symmetric distribution and Wilcoxon non-parametric test for variables with non-symmetric distribution were used for the statistical analysis.

Moreover, the Chi-square test was used for qualitative variables whereas the Pearson correlation coefficient for quantitative variables. Fifty-nine patients from Gastro-surgery Outpatient were evaluated Table 1. There was no difference between the genders concerning to age and BMI. The ESS was considered positive in A total of 35 patients underwent a full-night sleep study. Relating to male subjects, Male patients showed a higher AHI, as well as in the supine position.

However, 34 subjects responded BQ and The ESS was positive in Table 2. Table 3. The value p of the correlation Berlin positive with severity of OSA was 0.

Similar results were found for ESS. The present study evaluated the frequency of obstructive sleep apnea in a group of obese patients scheduled for bariatric surgery.

All the patients presented OSA in the full-night sleep study, the majority presented the severe form. Our data were similar to the study of Lettieri et al. Other studies also showed high prevalence of OSA in pre-operative bariatric surgery, varying from In the present study, genders are similar concerning to age and BMI.

However, the exact frequency of OSA in female is still uncertain, as they show different symptomatology and may be misdiagnosed Perhaps further studies will show a reduction of the gender difference as in the study of Franklin et al.

Due to the high prevalence of OSA and the difficulty in accessing objective sleep studies, several methods are used in order to perform a screening of patients who would be referred to a Sleep Study. BQ and ESS are the most commonly used questionnaires in a sleep laboratory, even though other questionnaires were developed for surgical patients, as STOP snoring, tiredness during daytime, observed apnea and high blood pressure or STOP-Bang BMI, age, neck circumference and gender The high frequency of BQ positivity observed in our study, may be related to the fact, that all pre-operative bariatric surgery patients are obese, so they automatically will present one positive category of BQ what may interfere in the test specificity.

In patients scheduled for any surgery, BQ presented sensitiveness of There was a tendency for positivity of ESS in male patients; probably in a larger sample we would find significance, what corroborates to literature data where OSA diagnosis in women has no correlation to daytime sleepiness In several studies, the ESS has been applied in pre-operative bariatric surgery patients 15,18, The subjective complaints of daytime sleepiness and snoring were not recognized as predictors of OSA in obese patients 15,16,18,21,24, We expected a higher positivity of ESS in our study, as we considered that as soon as AHI increases, more symptomatic the patient becomes due to physiological consequences induced by hypoxemic events Our interpretation was that some patients may have denied their symptoms fearing that surgery will not be performed.

Another reason would be the incapacity to recognize daytime sleepiness and other OSA symptoms. Obese patients present other problems related to weight such as nocturia, sexual dysfunction, gastro-esophageal reflux, depression, articulation pain, dyspnea limiting daily activities.

Thus, patients may believe that functional disabilities are not due to sleep disorders Also, many are users of serotonin reuptake inhibitors for treatment of depression and eating disorders, which also affect the daytime sleepiness Due to the fact that there are few patients with non-severe OSA and no one without OSA in the present study, it is difficult to analyze the sensitivity and specificity in the questionnaires for diagnosis of OSA and the statistical analysis was limited.

Further studies on screening methods and diagnosis are necessary for a better evaluation in this population due to the high frequency of OSA and the difficulty in performing polysomnography in a large number of people. Patients scheduled for bariatric surgery present a high frequency of obstructive sleep apnea, mostly classified as severe.

Both presented a positive correlation with OSA diagnosis. However it was not possible to predict the specificity of OSA diagnosis of each questionnaire in this group of patients. Barros for the English version. Adult obstructive sleep apnea task force of the American Academy of Sleep Medicine.

Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. Young T. Rationale, design and findings from the Wisconsin Sleep Cohort Study: toward understanding the total societal burden of sleep disordered breathing.

Sleep Med Clin. Sleep Med. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Obesity and obstructive sleep apnea-hypopnea syndrome. Obes Rev. Malhotra A, White DP. Obstructive sleep apnea. Marien H, Rodenstein D. Morbid obesity and sleep apnea. Is the weight loss the answer?

Interactions between obesity and obstructive sleep apnea: implications for treatment. Association between serum neopterin, obesity and daytime sleepiness in patients with obstructive sleep apnea. Respir Med. Neurol Int. Sleep apnea syndrome is significantly underdiagnosed in bariatric surgical patients. Surg Obes Relat Dis. Persistence of obstructive sleep apnea after surgical weight loss.

Is mandatory screening for obstructive sleep apnea with polysomnography in all severely obese patients indicated? Sleep Breath. Respiratory sleep disturbances in patients undergoing gastric bypass surgery and their relation to metabolic syndrome.

Obes Surg. World Health Organization. Geneva: World Health Organization. Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery. Eur Arch Otorhinolaryngol.

Evaluation of obstructive sleep apnea in obese patients scheduled for bariactric surgery 1. Main author. Conception of the study, interpretation of data, critical revision. Out of these individuals, 35 performed a full-night sleep study using a type 3 portable monitoring PM. The questionnaire results were compared for gender and BMI.

The American Thoracic Society improves global health by advancing research, patient care, and public health in pulmonary disease, critical illness, and sleep disorders. Tobacco Control Tuberculosis Washington Letter. Lung Disease Week Sleep Related Questionnaires. Berlin questionnaire. Scaling of items Variable Scoring available: with permission or free With permission from Annals of Internal Medicine Scoring test-retest reliability Variable: 0. Developer contact information nikinetzer yahoo.

Miguel Gus, Sandro C. Moreira, Sandra C. Overnight polysomnography and portable sleep monitors are not generally available and questionnaires may be useful for screening OSAS. In a case—control study, we investigate the association between resistant hypertension and sleep disorders evaluated by the Berlin Questionnaire and Epworth Sleepiness Scale ESS. Controls were 63 patients with controlled BP under drug treatment. All the patients were submitted to ambulatory BP monitoring and level III polysomnography by means of a portable monitor.


(BMI is defined as weight (kg) divided by height (m) squared, i.e.., kg/m2). High Risk: if there are 2 or more categories where the score is positive. Low Risk: if there.


Metrics details. Obstructive sleep apnea syndrome OSAS is a common disorder with significant morbidity and mortality. Patients were randomized to undergo either home-based sleep test group A or hospital-based polysomnography PSG group B. The Berlin questionnaire identified

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