Predição do escore sage para rigidez arterial elevada em pacientes com diagnóstico ou suspeita de apneia obstrutiva do sono: um estudo transversal

Abstract

Introduction: Arterial stiffness (AR) has been analyzed in different population groups using pulse wave velocity (PWV). Several studies have shown an association between obstructive sleep apnea (OSA) and increased AR. The evaluation of AR in individuals with suspected OSA represents an opportunity to identify subclinical lesions early. PWV can be performed using an oscillometric method. Despite the non-invasive nature of the test, its implementation in clinical practice is still rarely carried out. The SAGE score is a clinical tool with good predictive capacity for determining PWV values ≥ 10 m/s, using easily obtainable data (systolic blood pressure, age, fasting glucose, and estimated glomerular filtration rate). There is still no data evaluating this score in patients with OSA or suspected comorbidity. Objective: To establish a predictive relationship for PWV ≥ 10 m/s in patients diagnosed or suspected of OSA, using the SAGE score. Method: Cross-sectional study of individuals of both sexes being monitored at a private cardiology service in the city of Santa Maria, and who underwent type 4 polysomnography due to a suspected diagnosis of OSA. The information was obtained from August 2019 to August 2023. PWV was measured using a validated oscillometric device (DynaMapa AOP®). OSA assessment was performed using home type 4 polysomnography (BiologixTM). Results: 102 patients were evaluated, with a mean age of 60.4±12.4 years, 62 (60.8%) male, 54 (52.9%) with obesity, 29 (28.4%) with diabetes and 80 (78.4%) with systemic arterial hypertension. Mean (or median) PWV values in the sample were 8.6±1.7 m/s. The classification of OSA according to polysomnography was: 29 (27.5%) without OSA, 33 (33.3%) mild apnea, 29 (28.4%) moderate and 11 (10.8%) severe. In the ROC curve analysis, the area under the curve was 0.536 (95%CI 0.423-0.649) (P=0.542), based on the highest Yuden Index. The predictive ability of the SAGE score in evaluating patients with OSA had PPV (0.419), NPV (0.679), S (0.775), SP (0.306). Conclusion: The predictive capacity of the SAGE score to determine arterial stiffness in patients with or without OSA has not been established. More studies on the subject are needed to determine possible statistical relationships between OSA, PWV and the SAGE score.