Distúrbios do sono, risco de disfagia e impacto no estado de saúde em indivíduos com DPOC

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterized by persistent prescription symptoms and progressive airflow limitation. This condition implies the natural progression of COPD, with a decrease in lung function, reduction in daily functionality and functional capacity, negative impact on health conditions that are associated with the presence of multiple comorbidities. Systemic manifestations of COPD arise during the clinical evolution of the disease, such conditions and/or diseases are related to shared risk factors, such as age, exposure to toxic inhalation and systemic inflammation. Among the associated diseases associated with COPD, obstructive sleep apnea syndrome, skeletal muscle dysfunction and changes in swallowing can interfere with the course of the disease. Objective: To evaluate and relate the occurrence of symptoms indicative of daytime sleepiness, risk of dysphagia, and impact on health status in individuals with chronic obstructive pulmonary disease. Methods: 37 individuals, 19 female (51.4%) and 18 (48.6%) male with a spirometric diagnosis of mild to very severe COPD (FEV1 56.6±24.9) treated at the pulmonary rehabilitation program were recruited. Inclusion criteria were Spirometric diagnosis with the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) FEV1/FVC<70 (forced expiratory volume in one second/forced vital capacity), stable at the time of assessments, and exclusion: Condition coexistence neurological; Acute exacerbation requiring hospital admission or systemic corticosteroid use preceding 4 weeks. All were evaluated in terms of diagnosis by spirometry, body composition by bioelectrical impedance and measurement of neck, waist, abdomen, and hip circumferences, sleepiness assessment by the Epworth instrument (ESS), and risk for Obstructive Sleep Apnea (OSA) by the questionnaire of Berlin (QB), assessment of dysphagia symptoms by the Questionnaire for Dysphagia Screening (QDS) and finally the impact on health status assessed by the COPD Assessment Test™– (CAT). Results: They were overweight (BMI 26.3 ± 5.5); Moderate 11 (29%) and severe 12 (32.4%) COPD were prevalent. Sleep disorders were present in 14 (37.8%), the risk for OSA 23 (62.2%), and the risk for dysphagia was prevalent regardless of COPD severity and moderate impact on health status (19.4±8.9 ). The QDS correlated positively and strongly with CAT (r=0.53; p=0.001) and moderately with Epwhort (r=0.42; p=0.01). Conclusion: Study data indicate that sleep and swallowing disorders were prevalent in individuals with COPD. Furthermore, the risk for dysphagia was related to the impact on health status and daytime sleepiness.