Patients with severe/moderate asthma crisis show abnormal stanford sleepiness scale score

Abstract

Asthmatic patients have difficulty maintaining sleep due to breathing difficulty or nocturnal cough. The emergency physician usually does not evaluate the degree of sleepiness in these patients, and there are no studies evaluating this population when they seek care in the asthmatic acute phase. We applied the Stanford Sleepiness Scale in 42 patients treated at the Emergency Room of the São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo. Patients had moderate or severe asthma and SSS was applied one hour after the initial measures recommended by the Global Initiative for Asthma. We guided patients to return to the clinic for reassessment of SSS and respiratory functions. SSS was applied to patients seen in the emergency room during the morning and afternoon. We did not include patients seen at night. The SSS scores range from 1 to 8 (fully alert to sleeping). Data were analyzed through the Mann–Whitney test. Median SSS in 42 patients in admission was 3, and 7 had a score of 6. Thirty patients returned 7 days later for reevaluation and presented a median SSS of 1, and only 3 had scores 6. There was statistically significant reduction in SSS (p = 0.015). Patients with moderate/severe asthma had high scores on the SSS during their stay in the emergency room. The SSS score decreased one week after treatment of the acute phase and treatment reorientation. In this preliminary work we did not investigate the reasons for these findings, but it is possible that the patient had poor sleep at night (or nights) before the visit to the emergency room, or inflammatory mechanisms of asthma itself, or association with obstructive sleep apnea, were responsible for drowsiness. It should be noted that the evaluations were performed one hour after the initial measures (GIA), and that patients had received drugs with potential stimulating effect (beta agonist and corticosteroid). Supported by FAPESP 2009/16758–4, 2010/02633–2, #2010/06188–3.