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Adiposity Indicators As a Screening Method for Polysomnography In Revista Brasileira de Saúde Ocupacional Tema livre/Artigo ISSN: 2317-6369 (online) http://dx.doi.org/10.1590/2317-6369000026317 1 Amanda Popolino Diniza Indicadores de adiposidade como método http://orcid.org/0000-0002-3300-0440 Virgínia Capistrano Fajardob de rastreamento para polissonografia em http://orcid.org/0000-0001-9175-6142 trabalhadores de turno Silvia Nascimento de Freitasa http://orcid.org/0000-0002-4119-0352 Adiposity indicators as a screening method for Fernando Luiz Pereira de Oliveirac http://orcid.org/0000-0001-6513-3339 polysomnography in shift workers Raimundo Marques do Nascimento Netod http://orcid.org/0000-0003-2038-5203 Fausto Aloísio Pedrosa Pimentad Resumo http://orcid.org/0000-0002-9169-0443 George Luiz Lins Machado-Coelhoe Objetivo: verificar o potencial discriminatório dos indicadores de adiposidade http://orcid.org/0000-0002-9806-9721 na predição da apneia obstrutiva do sono (AOS) em trabalhadores de turnos. Métodos: estudo transversal realizado em uma empresa de extração de minério de ferro, em Minas Gerais, Brasil. Dados antropométricos foram coletados e a Universidade Federal de Ouro Preto polissonografia (PSG) foi realizada em 118 trabalhadores de turno do sexo (UFOP), Escola de Nutrição. Ouro Preto, masculino que possuíam ao menos um fator de risco global para doença MG, Brasil. cardiovascular. Resultados: a prevalência de AOS na amostra foi de 84,7%. Entre b Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina. Belo os indicadores de adiposidade usados para predizerem a AOS (≥ 5 eventos/ Horizonte, MG, Brasil. hora), o índice de massa corporal (IMC), a circunferência da cintura (CC), a c Universidade Federal de Ouro Preto relação cintura/estatura (RCE) e a gordura corporal total (GCT), revelaram (UFOP), Departamento de Estatística. Ouro valores de sensibilidade acima de 70%. Gordura visceral (GV), circunferência Preto, MG, Brasil. do pescoço (CP) e relação pescoço-estatura (RPE) foram as mais efetivas em d Universidade Federal de Ouro Preto identificar corretamente trabalhadores sem AOS (valores de especificidade (UFOP), Departamento de Clínicas acima de 70%). As áreas sob a curva de Característica de Operação do Receptor Pediátrica e do Adulto. Ouro Preto, MG, Brasil. (COR) para CC e RPE foram maiores que 0,7, o que indicou que o teste foi e Universidade Federal de Ouro Preto eficaz na discriminação de indivíduos com AOS. Conclusões: alterações nos (UFOP), Departamento de Medicina de indicadores de adiposidade abdominal e cervical têm relação significativa com Família, Saúde Mental e Saúde Coletiva. a presença de AOS e demostraram eficácia como método de rastreamento para Ouro Preto, MG, Brasil. PSG. CC e RPE são considerados bons indicadores para predizerem a AOS. Contato: Palavras-chave: obesidade; ritmo circadiano; transtorno do ciclo vigília-sono; Amanda Popolino Diniz ronco; saúde ocupacional. E-mail: [email protected] Abstract Artigo baseado nos resultados obtidos pelo Objective: to verify the discriminatory power of adiposity indicators in the Projeto Prevenção da Fadiga, Laboratório prediction of obstructive sleep apnoea (OSA) in shift workers. Methods: a cross- de Cardiometabolismo – Projeto: 1325, sectional study carried out in an iron ore extraction company, in Minas Gerais, apoiado pela Fundação Educativa de Ouroa Preto. George Luiz Lins Machado-Coelho e Brazil. Anthropometric data were collected and polysomnography (PSG) was Fernando Luiz Pereira de Oliveira receberam performed in 118 male shift workers who owned at least one overall risk factor apoio financeiro do Conselho Nacional de for cardiovascular disease. Results: the OSA prevalence in the sample was Desenvolvimento Científico e Tecnológico – CNPq (projetos PQ 306467/2018-6 e 84.7%. Among the adiposity indicators used to predict OSA (≥ 5 events/hour), PQ 300825 / 2016-1). O projeto recebeu body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), apoio da Coordenação de Aperfeiçoamento and total body fat (TBF) showed sensitivity values higher than 70%. Visceral fat de Pessoal de Nível Superior (CAPES) - (VF), neck circumference (NC), and neck-to-height ratio (NHtR) were the most Código de financiamento 001’’. effective in correctly identifying workers without OSA (specificity values higher than 70%). The areas under the receiver operating characteristic (ROC) curves Os autores declaram que não há conflitos de interesses. for WC and NHtR were greater than 0.7, which indicated the test was effective in discriminating individuals with OSA. Conclusions: alterations in abdomen Os autores informam que este estudo não and neck adiposity indicators have a significant relationship with the presence foi apresentado em eventos científicos. of OSA and showed effectiveness as a screening method for PSG. WC and NHtR are considered good indicators for OSA prediction. Recebido em: 24/10/2017 Revisado em: 11/06/2018 Keywords: obesity; circadian rhythm; sleep-wake disorders; snoring; occupational Aprovado em: 19/06/2018 health. Rev Bras Saude Ocup 2019;44:e7 1/8 Introdução a qual o excesso de gordura na região do pescoço e o aumento da relação cintura/quadril também são 10 A Apneia Obstrutiva do Sono (AOS) é uma con- fatores de risco para a AOS . dição crônica de saúde com uma etiologia multifa- A avaliação clínica da AOS baseia-se em sintomas torial, incluindo obesidade, idade, sexo, genética e comumente presentes em distúrbios do sono, como fatores anatômicos1. A dessincronização do ciclo cir- sonolência diurna excessiva, cefaleia, fadiga, sono cadiano causada pelo horário de trabalho em turnos agitado, sensação de falta de ar, alterações cognitivas pode levar à AOS. Estudos observaram uma alta pre- e, principalmente, ronco, o qual é produzido pela valência de distúrbios do sono em trabalhadores de vibração das estruturas faríngicas moles, resultante turno. Um estudo utilizando a polissonografia (PSG) do baixo fluxo de ar através das vias aéreas estreitas11. mostrou uma prevalência de AOS de 32,8% em uma A avaliação clínica e o exame físico não são suficien- amostragem representativa de adultos da cidade de tes para o diagnóstico. O padrão de referência para o 2 São Paulo, Brasil . Outro estudo brasileiro encontrou diagnóstico de distúrbios do sono é a PSG12. uma prevalência de AOS de 35,03% em trabalhado- res de turno3. Apesar da alta confiabilidade da PSG para a detecção de distúrbios do sono, esse exame tem um O trabalho em turnos é uma forma de organiza- custo elevado13. Atualmente, a PSG é indicada sem- ção laboral com o objetivo de garantir uma produ- pre que as análises clínicas e físicas sugerem distúr- ção ininterrupta, de 24 horas por dia, de bens e/ou bios respiratórios do sono, principalmente AOS, com serviços. O horário de trabalho é organizado como base na presença de ronco e de sonolência diurna permanente (horário de trabalho fixo, seja de manhã, excessiva9. No entanto, essas avaliações clínicas e à tarde ou à noite) ou rotativo (alternando entre físicas são subjetivas e demostram pouca eficácia na manhã, tarde e noite). Esse tipo de organização do identificação de distúrbios do sono14. Assim, outro trabalho provoca mudanças no ciclo de sono e no método de rastreamento, menos subjetivo, deve ser ritmo circadiano dos trabalhadores, e prejudica suas desenvolvido para avaliar o risco de AOS e para indi- funções fisiológicas e metabólicas4,5. car a realização da PSG. Alterações do sono têm sido associadas a efeitos O rastreamento de pacientes para exame de polis- neuro-hormonais que aumentam a ingestão de calo- sonografia pode ser definido por indicadores antro- rias, devido ao aumento de grelina e à redução na pométricos como circunferência do pescoço (CP), produção de leptina. Esses dois hormônios atuam como sinais periféricos e contribuem para a regu- circunferência da cintura (CC) e índice de massa lação da ingestão alimentar central6. Assim, uma corporal (IMC), os quais são usados para definir o 15 mudança na sinalização endócrina reguladora do risco de AOS . Por exemplo, uma CP elevada, maior apetite, a qual pode levar ao ganho de peso6, é uma ou igual a 40 cm para homens, tem sido usada como 9 das várias consequências do trabalho em turnos. um parâmetro clínico no rastreamento para PSG . Um estudo de Grundy et al.7, com 1.561 homens, A obesidade pode aumentar a resistência das vias demonstrou uma associação entre a obesidade e o aéreas superiores, seja pelo acúmulo de gordura na trabalho em turnos, principalmente se este incluir área ao redor da região mais facilmente colapsável 8 turnos rotativos. Outro estudo, de Mazucca et al. , da faringe (CP) e/ou pela redução da atividade dia- demonstrou que diferentes parâmetros antropométri- fragmática, como resultado do excesso de gordura na cos relacionados à adiposidade corporal estão asso- parede abdominal (CC)1,9. ciados a uma maior gravidade da AOS em homens. Estudos mostram que essas circunferências são A obesidade é um fator de risco anatômico para a medidas preditivas para AOS16-19, assim, a hipótese AOS quando a gordura acumula nas regiões abdomi- levantada neste estudo foi a de que os indicadores nal e cervical. O aumento da gordura na região abdo- de adiposidade são eficazes como testes de rastrea- minal reduz a atividade do diafragma e o volume de mento para a AOS, indicando a necessidade de se ar inspirado, consequentemente, contribuindo para realizar a PSG. a obstrução das vias aéreas superiores1. O acúmulo de gordura ao redor da região faríngica diminui o O uso de indicadores de adiposidade como um calibre das vias aéreas e contribui para o colapso critério eficaz para a indicação de PSG diminuirá o da faringe, consequentemente levando à redução da número de exames polissonográficos e o custo corres- capacidade e do volume pulmonares, bem como aos pondente, além de permitir a implementação de ações repetitivos bloqueios respiratórios durante o sono9. preventivas. Portanto, este estudo teve como objetivo Portanto, a distribuição da gordura corporal obser- verificar o potencial discriminatório dos indicadores vada em indivíduos com sobrepeso e com distúrbios de adiposidade na predição da apneia obstrutiva do respiratórios do sono conduziu à hipótese segundo sono (AOS) em trabalhadores de turnos.
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