• A utilização de questionários, especialmente quando auto-preenchidos, sujeitam a pesquisa ao subrrelato. Apesar do questionário de Berlim ser um instrumento validado e confiável, a baixa prevalência de alto risco e baixa confiabilidade detectadas mostram que sua estrutura pode não ser adequada para essa população.
• O fato da atual pesquisa avaliar fatores como sonolência, cochilos ao volante e tabagismo, que comprometeriam a estabilidade dos trabalhadores em seus empregos, podem ter sido alguns dos grandes responsáveis pelo subrrelato.
• Por ser uma população específica de motoristas de máquinas de extração de minério de ferro, não é possível extrapolar nossos resultados para a população brasileira de trabalhadores de turnos alternantes.
7 CONCLUSÕES
• A prevalência de alto risco para AOS foi baixa quando comparada a outros estudos. Devido à alta prevalência de fatores de risco como obesidade, consumo de bebidas alcoólicas e por serem indivíduos do sexo masculino, esperava-se que essa prevalência fosse maior.
• Os sintomas de AOS – sonolência ao acordar, sonolência durante o dia e dormir ao volante – apresentaram frequências inferiores a outros estudos. Dormir ao volante foi a questão que mais prejudicou a confiabilidade geral do questionário e, portanto, é necessário avaliar a sonolência considerando outras situações cotidianas para essa população.
• A presença de um entrevistador avaliando alguns dos sintomas presentes no questionário de Berlim proporcionou aumento na frequência de respostas positivas. Portanto, a utilização de questionários em presença de profissional da saúde poderia aumentar a confiança dos trabalhadores em assumir alguns dos sintomas relacionados à apnéia.
• Na população de trabalhadores o questionário de Berlim permitiu afirmar que indivíduos com estado nutricional adequado apresentam pouca probabilidade de desenvolver alto risco para AOS. Apesar disso, a grande proporção de erros de classificação e a baixa sensibilidade levam a concluir que sua utilização precisa ser melhor avaliada.
• A população avaliada apresentou alta prevalência de sobrepeso e obesidade. Também foi observado excesso de adiposidade corporal, com acúmulo de tecido adiposo na região central ou abdominal.
• Todos os indicadores de adiposidade corporal apresentaram relação positiva com o alto risco para AOS e podem, portanto, ser utilizados na prática clínica para avaliar o risco do trabalhador para desenvolver AOS.
• Idade maior que 40 anos e obesidade foram os fatores capazes de explicar a ocorrência de alto risco para AOS nessa população.
8 RECOMENDAÇÕES
• O questionário desenvolvido e validado por Chung et al., o STOP-BANG Questionnaire foi elaborado a partir do questionário de Berlim. É uma ferramenta que inclui 8 questões com respostas sim/não, sendo elas: presença de ronco intenso; presença de cansaço, fadiga e sonolência excessivos; presença de pausas na respiração observadas por terceiros; hipertensão arterial sistêmica; IMC > 35kg/m²; idade > 50 anos; CP > 40 cm; gênero masculino. Trata-se de um questionário direto, que avalia os principais fatores relacionados à AOS e não inclui as 2 questões que prejudicaram a confiabilidade do questionário de Berlim no presente estudo (“Você ronca?” e “Já dormiu enquanto dirigia?”). Por esse motivo, recomenda-se que seja testado e validado na população de operadores de máquinas da Região dos Inconfidentes, MG.
• Todos os indicadores de adiposidade corporal utilizados neste estudo estiveram relacionados ao alto risco para apnéia e, portanto, podem ser incluídos em inquéritos clínicos para avaliar o risco desses trabalhadores de desenvolverem AOS.
• Para avaliar o grau de atividade física destes trabalhadores, recomenda-se a realização de outros estudos considerando apenas a seção 4 do IPAQ, que avalia somente situações de lazer, recreação e esportes. Isso evitaria a superestimação da real quantidade de exercício físico praticado pelos indivíduos.
• É necessário que os indivíduos avaliados neste estudo sejam submetidos à polissonografia para efetivar o diagnóstico de apnéia obstrutiva do sono. Assim, será possível determinar especificidade, sensibilidade e validade do questionário de Berlim para essa população, reprovando ou não sua adequação para indicar o alto risco para apnéia. Além disso, será possível decidir qual o melhor tratamento da apnéia de acordo com as características de cada trabalhador afetado.
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