Obstructive sleep apnea: from the beginnings, to the risk factors and to occupational medicine assessment

Mihaela Trenchea, A. Rascu, O. Arghir
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Abstract

Abstract Over the last thirty years, the pathogenesis of obstructive sleep apnea syndrome (OSAS) has begun to be elucidated worldwide due to the presence of standardized diagnostic and treatment. In adults, the clinical diagnosis may be suggestive of OSAS when symptoms like fatigue, lack of concentration, poor work performance, absenteeism, daytime sleepiness, insomnia, snoring, nocturnal respiratory distress or apnea episodes witnessed by others are present. Some medical conditions found in employees’ personal history such as craniofacial abnormalities, some endocrine diseases, arterial hypertension, especially resistant arterial hypertension, coronary artery disease, atrial fibrillation, congestive heart failure, stroke, obesity, diabetes mellitus, cognitive dysfunction or mental disorders may be the alarm signal for OSAS. The assessment of all risk factors, clinical presentation and diagnosis must become an important part of occupational medical examinations and performed in all workers due to its major public health potential and impact on survival. The early identification of OSAS among workers performed by the occupational physician can potentially reduce the risk of work injuries and fatalities. In conclusion, OSAS is a complex entity and an important public health problem. The delay in diagnosis and treatment contributes to the increase of healthcare services demand and implicitly to general mortality.
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阻塞性睡眠呼吸暂停:从开始,到危险因素和职业医学评估
在过去的三十年里,阻塞性睡眠呼吸暂停综合征(OSAS)的发病机制已经开始在世界范围内被阐明,由于标准化的诊断和治疗的存在。在成人中,当出现疲劳、注意力不集中、工作表现不佳、旷工、白天嗜睡、失眠、打鼾、夜间呼吸窘迫或他人目睹的呼吸暂停发作等症状时,临床诊断可能提示OSAS。在员工的个人病史中发现的一些疾病,如颅面异常、某些内分泌疾病、动脉高血压,特别是顽固性动脉高血压、冠状动脉疾病、心房颤动、充血性心力衰竭、中风、肥胖、糖尿病、认知功能障碍或精神障碍,都可能是OSAS的警报信号。对所有危险因素、临床表现和诊断的评估必须成为职业医疗检查的重要组成部分,并在所有工人中进行,因为它具有重大的公共卫生潜力和对生存的影响。由职业医生在工人中进行OSAS的早期识别可以潜在地减少工伤和死亡的风险。总之,OSAS是一个复杂的实体,也是一个重要的公共卫生问题。诊断和治疗的延误导致医疗保健服务需求的增加,并隐含地增加了一般死亡率。
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