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Comparing the OSA severity and symptoms among patients from the private and public health systems


Obstructive sleep apnea (OSA) is a common disorder among adults. Despite of a high prevalence, OSA remains underdiagnosed and undertreated, especially in underdeveloped countries. In Brazil, very few public services offer OSA diagnosis and treatment. Our laboratory is one of a few in our state that performs polysomnography (PSG) for the public health system. Our hypothesis was that patients referred from the public health system would have more severe OSA than patients coming from the private sector due the differences in access to polysomnography between these populations.


The aim of this study was to compare anthropometric characteristics, sleepiness, and OSA severity among public and private patients referred for PSG with a suspicion of OSA.


We analyzed data from 1381 patients that underwent PSG at our Sleep Laboratory from January 2017 to December 2018. Studies with inconsistent data (n = 69), portable devices (n = 47), research protocols (n = 386), titration studies or split night studies (n = 153) were excluded. Anthropometric, clinic and polysomnographic data were collected. Statistical analysis was performed in GraphPad Prism software version 7.


A total of 726 patients were included in this study, of which 410 were from the public health system (Group 1) and 316 from the private health system (Group 2). The proportion of men was higher among private health system patients(59.1% men) as compared to public health system patients (45.4% men) (P=0.0003). Age was similar in both groups (56.8±13.7 years and 57.0±15.4 years, Group 1 and 2, respectively; P=0.7345). Body-mass index (BMI) was higher in Group 1 (32.8±7.4 vs. 29.6±5.6 kg/m² in Group 2; P<0.0001). OSA severity was higher in Group 1 (36.4±29.4 versus 30.3±25.9 events per hour; P=0.0123). Epworth Sleepiness Scale was higher among public sector patients as compared to private sector patients (11.4±6.2 and 9.6±5.0, respectively; P=0.0002).


Patients from the public health system are sleepier and have higher OSA severity as compared to private health system. These findings may reflect a greater difficulty for public health system patients to access specialized sleep diagnostic centers when compared to patients from private health assistance.


Sleep Apnea, Obstructive; Polysomnography; Health Systems.


Área Clínica


INCOR - Sao Paulo - Brasil


Mariana Delgado Fernandes, Viviane Vieira Passini, Cassio Batista Lacerda, Bruno Sergio Vasconcellos, Thais Cano, Marcela Yanagimori, Geraldo Lorenzi-Filho, Pedro Rodrigues Genta