Avaliação, desenvolvimento e validação de instrumentos para apneia obstrutiva do sono à luz do modelo biopsicossocial

Abstract

Obstructive Sleep Apnea (OSA) is a sleep-disordered breathing characterized by narrowing the upper airways, resulting in impaired ventilation during sleep. Hypoxemia, fragmented sleep, transient hypercapnia, intrathoracic pressure oscillations, increased sympathetic activity, are consequences of untreated OSA, which are associated with impairments in both organic functions and social and behavioral aspects of individuals, with repercussions on quality of life and functionality. Several instruments are used in clinical practice for screening the risk of OSA and for clinical follow-up of the individual diagnosed through polysomnographic study. Due to the complexity of OSA, it is routine to use combined instruments in a clinical assessment process. In this context, the article “Are the International Classification of Functioning, Disability and Health (ICF) domains considered in the obstructive sleep apnea instruments? An integrative review" analyzed whether the instruments available in the literature and validated for individuals with OSA include the domains of the International Classification of Functioning, Disability and Health (ICF). The analyses identified that, in only one instrument (Sleep Apnea Quality Index-SAQLI) all ICF domains were included. It is evident that, for the context of evaluation of this health condition, functioning does not appear as a significant outcome, revealing that the biopsychosocial model is not yet strategic for managing OSA. Also in the context of the biopsychosocial perspective in comprehensive health care, the approach of patients with OSA, performed more efficiently, involves the efforts of an interdisciplinary team. Considering that the performance in this context requires specific skills and competences, the objective was the development and validation of an instrument entitled AOS-CAF (Obstructive Sleep Apnea - Knowledge and Attitudes in Physiotherapy) that analyzes the knowledge and attitudes of physiotherapists about OSA. The results showed that the AOS-CAF presents satisfactory psychometric properties of validity and reliability, making it possible to identify differences in the knowledge of physiotherapists from different specialties and levels of experience. During the construction process of AOS-CAF, the OSAKA (Obstructive Sleep Apnea Knowledge and Attitudes) instrument was used, which analyzes the knowledge and attitudes of physicians about OSA. With approval from the University of Washington, the translation and cross-cultural adaptation of the questionnaire for the Portuguese in Brazil was conducted. In the OSAKA validation process, it was revealed that physicians from different specialties consider themselves confident for the diagnosis of OSA, but do not exhibit the same confidence for positive pressure treatment. This finding further supports the importance of interdisciplinary action in OSA, and the performance of a sleep-trained physiotherapist for managing positive airway pressure therapy of patients with OSA is pertinent. These studies bring information to a gap in the scientific literature that does not yet associate aspects of sleep with functioning. They also allow a reflection on the importance of recognizing the area of sleep in Physiotherapy directed to the Cardiorespiratory specialty, as well as on the importance of the theme Sleep being an integral part of the curricular matrix of health courses.