Avaliação polissonográfica e de função cardio-respiratória de adolescentes portadores de anemia falciforme clinicamente estáveis

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

Introduction: sickle cell anemia is the most prevalent hereditary disease in Brazil, occurring in 0,1 to 0,3% of the negro population. The occurrence of 1-3/1000 new annual cases in the country are also estimated, thus characterizing an important public health problem in our environment. Its also know that the prevalence of nocturnal desaturation of hemoglobin in children and teenagers with SS is higher than 40% and that abnormality of the pulmonary function may be present even before any clinical evidence of vaso-occlusive crisis or acute chest syndrome. In adults, with sickle cell disease, pulmonary arterial hypertension has emerged as the biggest independent risk factor for death. Objectives: to study the quality of sleep and cardio-respiratory function of patients with clinically stable sickle cell disease; investigate the presence of respiratory disorders in these patients, evaluating the role of such disorders in the possible sleep alterations and also investigate the presence of cardiac alterations. Patients and Methods: observational descriptive cross-sectional study, that included patients with sickle cell disease (SS), with ages [greater-than or equal to]10 and [less-than or equal to]18 years old and absence of previous diagnosis of respiratory disease or sleep disorder. The patients underwent clinical evaluation, sleep questionnaire, overnight polysomnography, spirometry and pulmonary volumes, electrocardiography, hemogram, upper airway and chest tomography and nasal fiber optic examination. Results: 50 patients were studied, from which 25 (50%) were male. The average age was 142,5 years, average weight 3911 Kg and average height 15014 cm. Forty patients (80%) referred to snoring and among these 48% in most nights. The complaints about sleeping with the mouth open and dribbling on the pillow were present in 80% and 62%, respectively. 38% of the patients stated to have smokers at home. The total sleep time had an average of 41064 minutes, the average latency of sleep 1820 minutes and the latency of REM sleep 182100 minutes, being that two patients did not present REM sleep. The average of stage shifts was 8226, of the total number of awakenings 10673 and movement during sleep 2912. We observed a decrease of the REM stage that was of 136%, an increase of the E2= 578%, and the remaining was within normality for the age. The average of the respiratory disorder index was of 23 events/hour, of the obstructive apnea index of 0,20,8/h and 20 patients (40%) presented obstructive sleep apnea syndrome. The average of SpO2 in alertness was of 876%. The patients were subdivided into two groups regarding SpO2 in REM sleep, the greater number of respiratory disorders and less fragmented sleep being in the nocturnal desaturation group. In the general analysis, the mean values of the spirometric variables were within normality for the age group, with the exception of the residual volume and the RV/TLC relationship that were increased. The average of the hematocrit was of 25,33,9% and of hemoglobin of 8,31,3 g/dl. The average systolic artery pressure was of 11314 mmHg and dyastolic artery pressure of 6310 mmHg and of pulmonary artery systolic pressure of 38,317 mmHg. The electrocardiogram was normal in 56% of the patients. The echocardiogram showed an isolated increase of the left ventricle in 34% of the patients. Hypertrophic pharyngeal tonsils were found in 22 patients (44%) and hypertrophic palatal tonsils in 52%. Regarding chest tomography, 73% of the patients didnt present any alterations of lung tissue. Conclusions: from the group of patients studied we can conclude that there is loss of sleep quality, and that this loss probably correlates to the desaturation of hemoglobin. There is alteration of the pulmonary function characterized by hyperactivity of the airway, as a consequence to the exposure to cigarette smoke, and electro and echocardiographic alterations and presence of pulmonary arterial hypertension.

ASSUNTO(S)

eletrocardiograma tomografia anemia falciforme via aérea superior espirometria adolescente polissografia ecocardiograma medicina cardiologia distúrbios do sono

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