Elaboração e aplicação de um instrumento para triagem de apneia obstrutiva do sono em diabéticos tipo 2 na atenção primária à saúde

Abstract

Introduction: Diabetes Mellitus (DM) and Obstructive Sleep Apnea (OSA) are highly prevalent conditions with a bidirectional relationship. While DM is a classic focus of Primary Health Care (PHC), OSA remains neglected. Despite the high prevalence of OSA in the Brazilian population (37,1%), it is estimated that at least 85% of individuals with the condition remain undiagnosed. These figures are alarming given the morbidity and mortality associated with OSA; beyond its impact on glycemic control, it constitutes an additional cardiovascular risk factor. Objectives: This Master’s thesis—developed within the stricto sensu Professional Master’s Program in Family Health (PROFSAUDE)—aimed to develop and apply a clinical screening tool for OSA in patients with type 2 diabetes receiving care in PHC settings in the city of Nossa Senhora do Socorro, Sergipe (SE). Method: The first stage involved creating a clinical tool to guide data collection. This tool consolidated data from medical histories and physical examinations—previously scattered across various questionnaires, clinical scales, and systematic reviews on OSA. The second stage consisted of a pilot, exploratory, cross-sectional observational study involving patients with type 2 diabetes receiving PHC. The newly created tool was initially administered to a sample of 17 participants, who subsequently underwent home nocturnal oximetry. Collected data were analyzed using frequency, mean, standard deviation, median, and interquartile range. Results: The study found a 64.2% (n=14) positivity rate regarding the Oxygen Desaturation Index among the evaluated diabetic patients, indicating a positive oximetry screen for OSA. Within this group, all individuals presented with systemic arterial hypertension, as well as daytime sleepiness and nocturia. High-arched palate, macroglossia, retrognathia, and a high Mallampati score were the most frequently observed anatomical abnormalities. Conclusion: The clinical instrument developed constitutes a technicaltechnological product of this study and enabled the assessment of a population of patients with type 2 diabetes within the context of primary health care, revealing a high frequency of classic signs and symptoms of OSA. Furthermore, a high rate of positive results was observed in nocturnal oximetry, a screening method for OSA. With further research in this field, this clinical and oximetric screening protocol could offer a structured approach to addressing OSA in primary health care scenario.