Navegando por Palavras-chave "Pressões Flexíveis"

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    Comparação Dos Efeitos Das Diferentes Modalidades De Cpap Na Estrutura Do Sono E Adesão De Pacientes Com Apneia Obstrutiva Do Sono
    (Universidade Federal de São Paulo (UNIFESP), 2017-08-31) Pinto, Evelyn Lucien Brasil Vieira [UNIFESP]; Poyares, Dalva Lucia Rollemberg [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Obstructive sleep apnea (OSA) is associated with behavioral, cognitive, metabolic and cardiovascular consequences. CPAP (Continuous Positive Airway Pressure) is the gold standard treatment of OSA. However, the benefits of CPAP treatment are limited because of poor adherence to therapy. To improve CPAP use and adherence, flexible pressure devices were developed with the purpose of increasing patient´s comfort namely: C-Flex Plus, which reduces inspiratory/expiratory pressure and Sensawake, which allows the reduction of pressure when it identifies that patient is awake. Studies evaluating polysomnographic parameters and adherence of these devices compared to fixed pressure CPAP are scarce. Objective: To examine the effect of different CPAP modalities on sleep and adherence parameters in patients with moderate to severe OSA. Methods: Patients with a recent diagnosis of OSA and with apnea and hypopnea index (AHI) ≥ 20 events/hour, aged 30 to 65 years, were randomized and used CPAP for 30 days in each of the three modalities: CPAP fixed pressure, C-Flex Plus and Sensawake, followed by a 7-day washout between modalities. At the end of each modality, participants performed polysomnography (PSG) with the CPAP in use according to the randomized order of treatments. They also filled Epworth Sleepiness Scale, FOSQ, Pittsburgh scale, and visual analog scale. CPAP adherence was systematically checked for each modality. Results: Of the 23 patients evaluated, 15 patients were recruited for the study. The mean age and body mass index (BMI) of the participants was 42.4 ± 15.1 years, 29.9 ± 4.8 kgs, respectively. The mean AHI was 43.5 ± 22.9 events/hour. The arousal index was significantly lower in SensaWake compared to fixed pressure CPAP (10 ± 5.2 versus 12.7 ± 5.5 events / hour, p = 0,05) and the Respiratory DisturbanceIndex was also significantly lower in SensaWake modality compared with C- Flex Plus (3.5 ± 3.6 versus 5 ± 3.1 events / hour, p = 0,02). Adherence to therapy was higher in C-Flex Plus (C-Flex Plus: 5.8 ± 1.2 versus SW: 4.4 ± 1.1 versus fixed pressure: 4.67 ± 1.48 hours, p = 0.01). We also found an improvement in sleep quality with the use of fixed pressure compared with baseline (p = 0.01). All CPAP modalities significantly improved sleepiness in a similar manner (p <0.001). Conclusions: SensaWake significantly reduced the arousal index and RDI; C-Flex Plus showed higher compliance compared with Fixed Pressure and SensaWake. The three modalities improved sleepiness when compared to baseline. The Fixed Pressure CPAP improved the quality of sleep measured by the Pittsburgh questionnaire. The authors propose that CPAP modalities may benefit different patient profiles. Future studies will evaluate the patients` profile who will benefit most from each CPAP mode.