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Abstract(s)
Introdução: A Síndrome da Apneia Obstrutiva do Sono e a Diabetes Mellitus são duas
patologias com importante prevalência e impacto na saúde comunitária. A partilha de fatores
de risco e a fisiopatologia sugerem retroalimentação entre ambas. Neste estudo, objetivou-se
esta interação, através da análise de uma população com diabetes tipo 2 sob ventilação não
invasiva e avaliação da sua repercussão no controlo glicémico, considerando a variação da
hemoglobina glicada A1c.
Materiais e Métodos: Trata-se de um estudo populacional, longitudinal, retrospetivo,
descritivo e analítico. A população do estudo foi constituída por 41 pacientes com Diabetes
Mellitus tipo 2, selecionados de um total de 133, com ventiloterapia iniciada entre 1 de abril
de 2012 e 31 de março de 2014, no Hospital Sousa Martins. Procedeu-se à caracterização da
população, avaliação da severidade da Apneia do Sono e quantificação da variação glicémica,
após introdução da terapêutica ventilatória.
Resultados: A população do estudo foi constituída por 13 pacientes do sexo feminino e
28 do sexo masculino, com uma distribuição etária entre os 37-79 anos e média aproximada
de 64,2 ± 9,5. Nesta amostra, observou-se uma prevalência elevada de Síndrome da Apneia
Obstrutiva do Sono grave, traduzida pelo predomínio inicial de Índice de Apneia/Hipopneia
J30 (n=34). O Auto-CPAP foi o ventilador mais utilizado. As mensurações pré-ventilatórias de
hemoglobina glicada A1c revelaram um valor médio de 7,48% ± 1,54% (N=36). Dos 21
pacientes com registo deste parâmetro posterior à introdução de ventiloterapia e melhoria
comprovada do Índice de Apneia/Hipopneia, verificou-se diminuição da hemoglobina glicada
em 14. Assim, este decréscimo mostrou tendência a acompanhar a melhoria do Índice.
Conclusão: Neste estudo parece existir uma importante correlação entre estas
patologias com tradução, desde logo, na prevalência de pacientes diabéticos tipo 2 (cerca de
31%), no total de doentes ventilados. Este resultado aproxima-se do anteriormente sugerido
noutro estudo (40%) e é muito superior ao expectável, por extrapolação da taxa estimada de
pacientes diabéticos, em Portugal (12,9%). No que respeita ao impacto da ventilação não
invasiva no controlo glicémico, as limitações encontradas e a fraca correlação observada não
permitem aferir sobre a existência de correlação na variação da hemoglobina glicada A1c com
a diminuição do Índice de Apneia/hipopneia. Estudos posteriores com controlo dos fatores de
enviesamento seriam úteis na análise desta hipótese. Recomenda-se a vigilância desta
coexistência patológica para um diagnóstico precoce e melhoria da saúde populacional.
Introduction: Obstructive Sleep Apnea Syndrome and Diabetes Mellitus are two diseases with significant prevalence and great impact on community health. Shared risk factors and pathophysiology suggest feedback between both. This study was directed to this interaction, through the analysis of a population with type 2 diabetes under non-invasive ventilation and assessment of its impact on glycemic control, by the Glycated Hemoglobin measurement. Materials and Methods: This was a longitudinal retrospective descriptive and analytical population-based study. The studied population was composed by forty-one patients with type 2 Diabetes Mellitus, selected from a total of one hundred and thirty-three with ventilotherapy started between April 1 2012 and March 31 2014, at the Hospital Sousa Martins. The population was characterized, severity of sleep apnea was assessed and the glycemic variation, after ventilotherapy introduction, was quantified. Results: The study population consisted of 13 females and 28 males, with an age distribution between 37-79 and a mean of 64.2 ± 9.5 years. This group showed high prevalence of severe Sleep Apnea Obstructive Syndrome, translated in the initial predominance of Apnea/Hypopnea Index J 30 (n=34). Auto-CPAP was the most used equipment. The pre-ventilotherapy glycated hemoglobin A1c showed a mean value of 7.48% ± 1.54% (N=36). From the 21 patients with post-ventilotherapy registry of this parameter and Apnea/Hypopnea Index improvement, there was decreased glycated hemoglobin in 14. Thus, this decline tended to follow the improvement of the Index. Conclusion: In this study appears to be an important correlation between these pathologies. First, the prevalence of type 2 diabetic patients was about 31% of the total ventilated patients. This result is close to the previously suggested in another study (40%) and much higher than expected through the extrapolation of estimated diabetes rate, in Portugal (12.9%). In what regards to the impact of noninvasive ventilation in glycemic control, the found obstacles and weak level of correlation do not allow to prove the existence of a correlation between the variation of glycated hemoglobin A1c and the Apnea/Hypopnea Index decrease. Further studies with control of bias factors would be useful to analyze this hypothesis. It is recommended to supervise this pathological coexistence, in order to increase early diagnosis and improve public health.
Introduction: Obstructive Sleep Apnea Syndrome and Diabetes Mellitus are two diseases with significant prevalence and great impact on community health. Shared risk factors and pathophysiology suggest feedback between both. This study was directed to this interaction, through the analysis of a population with type 2 diabetes under non-invasive ventilation and assessment of its impact on glycemic control, by the Glycated Hemoglobin measurement. Materials and Methods: This was a longitudinal retrospective descriptive and analytical population-based study. The studied population was composed by forty-one patients with type 2 Diabetes Mellitus, selected from a total of one hundred and thirty-three with ventilotherapy started between April 1 2012 and March 31 2014, at the Hospital Sousa Martins. The population was characterized, severity of sleep apnea was assessed and the glycemic variation, after ventilotherapy introduction, was quantified. Results: The study population consisted of 13 females and 28 males, with an age distribution between 37-79 and a mean of 64.2 ± 9.5 years. This group showed high prevalence of severe Sleep Apnea Obstructive Syndrome, translated in the initial predominance of Apnea/Hypopnea Index J 30 (n=34). Auto-CPAP was the most used equipment. The pre-ventilotherapy glycated hemoglobin A1c showed a mean value of 7.48% ± 1.54% (N=36). From the 21 patients with post-ventilotherapy registry of this parameter and Apnea/Hypopnea Index improvement, there was decreased glycated hemoglobin in 14. Thus, this decline tended to follow the improvement of the Index. Conclusion: In this study appears to be an important correlation between these pathologies. First, the prevalence of type 2 diabetic patients was about 31% of the total ventilated patients. This result is close to the previously suggested in another study (40%) and much higher than expected through the extrapolation of estimated diabetes rate, in Portugal (12.9%). In what regards to the impact of noninvasive ventilation in glycemic control, the found obstacles and weak level of correlation do not allow to prove the existence of a correlation between the variation of glycated hemoglobin A1c and the Apnea/Hypopnea Index decrease. Further studies with control of bias factors would be useful to analyze this hypothesis. It is recommended to supervise this pathological coexistence, in order to increase early diagnosis and improve public health.
Description
Keywords
Diabetes Mellitus Tipo 2 Hemoglobina Glicada A1c Índice de Apneia/Hipopneia Síndrome da Apneia Obstrutiva do Sono Ventilação Não Invasiva