Navegando por Palavras-chave "Aparelho Intra-oral"

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    Efetividade de um Aparelho Intra-Oral (AIO) sobre Parâmetros Cardiovasculares e Qualidade de Vida em pacientes com Síndrome da Apneia Obstrutiva do Sono (SAOS)
    (Universidade Federal de São Paulo (UNIFESP), 2010) Dal-Fabbro, Cibele [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Obstructive Sleep Apnea Syndrome (OSAS) is a high prevalence condition, associated with high morbidity due to cardiovascular and cognitive consequences. According to certain studies, those consequences can be reverted with OSA clinical treatment, with CPAP („Continuous Positive Airway Pressure‟) or OA (Oral Appliance). Objectives: compare the effect of an OA to CPAP on 24-hour ambulatory blood pressure monitoring (ABPM), heart rate variability (HRV), oxidative stress, quality of life and attention, in the same group of patients with moderate to severe OSAS. Methods: in a randomized, crossover, double-blind controlled trial, 29 moderate to severe OSAS patients were submitted to the following treatments during one month: OA, CPAP and an OA placebo. Diaries were used to access compliance to both treatments. At baseline and after one month of each treatment the following procedures were undertaken: full night Polysomnography, Epworth sleepiness scale, Fletcher & Lucket questionnaire, 24-hour ABPM, HRV evaluation, fasting blood samples to oxidative stress parameters (MDA, catalase, SOD, vitamins C, E, B6, B12, folate, homocysteine, uric Acid), SF-36 quality of life inventory and attention test by Complex Reaction Test (CRTL-NY). Correlations were done between polysomnographic data and ABPM, HRV, oxidative stress, quality of life and attention parameters. Results: both active treatments led to a decrease in the apnea and hypopnea index and SDS, although CPAP had a greater effect. The compliance rate was higher during OA treatment than during CPAP (86.3±3.0% versus 72.0±4.2%; p<0.05). For BP parameters, only diastolic-BP dipping with CPAP (mean±SEM: 8.5±1.3 mmHg) was worse than the baseline parameter (11.5±1.5 mmHg) (p<0.05). Also, the proportion of diastolic BP dippers subjects was reduced with CPAP compared to OA (37% x 62.9%, p<0.05). For HRV parameters, there was repercussion on autonomic modulation with both treatments. We found decrease in total power at night with CPAP (14608.6±960.9 m2/Hz) and OA (15576.9±1123.3 m2/Hz), both compared to placebo (19108.8±1759.1 m2/Hz) (p<0.05). We also observed a reduction in LF/HF ratio (LF: low frequency; HF: high frequency) of the night with OA (3.7±0.4) compared to placebo (4.6±0.7) (p<0.05) and CPAP (4.7±0.4) (p<0.05); and also a reduction in LF/HF ratio of REM sleep with OA (5.1±0.6) compared to CPAP (9.3±2.1) (p<0.05). Also, there was a decrease in ISAV (index of sleep autonomic variation = LF REM – LF SWS) with OA (1491.0±328.6) compared to baseline (2854.9±580.0) (p<0.05). A significant drop from baseline in the levels of catalase activity was observed after OA (95.3±4.6 versus 115.8±5.2_U/mgHb; p<0.01), specially to OA responders. For SF-36, we found significant improvement in four out of eight domains: social aspects, vitality, mental health and general state of health. The results were slightly superior to OA than to CPAP. We also found significant improvement in attention with both treatments. Conclusion: Even though CPAP proved to be more effective in attenuating OSAS, the better compliance with OA favored the repercussion on autonomic modulation, reduction of one of the enzymes which participates in oxidative stress, and the betterment of quality of life and attention in moderate to severe OSAS patients.