Navegando por Palavras-chave "SAOS"

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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.
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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.
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    Medidas cefalométricas e polissonográficas em pacientes com deficiência transversal e sagital da maxila tratados cirurgicamente
    (Universidade Federal de São Paulo (UNIFESP), 2019-11-30) Bittar, Renato Fortes [UNIFESP]; Pereira, Max Domingues [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OSAS is characterized by obstruction of the upper airway during sleep. Middle third face DDFs may be a predisposing factor for the syndrome. Cephalometric measurements have been studied to look for an association with polysomnographic changes. Goals: Define if ERMAC or AM provided improvement polysomnography and whether there is an association between polysomnography and cephalometry. Methods: 48 patients divided into 2 groups. Cephalometry and polysomnography at T1 and T2 were analyzed. Through of variance of means and categorical association, we sought identify which surgery provided the best results polysomnography. Pearson correlation was performed between both exams. Result: The variance of the means showed that SatminO2 and TTSsat02 <90% improved in ERMAC (p = 0.021 and P <0.001). At categorical association, ERMAC provided better results for IAH and SatminO 2. Pearson's correlation showed an association between AHI and BMI; awakenings and BMI. At ERMAC, there were associations between IAH and SNA, EAS and MP-H; awakenings and SNA, Co-A and MP-H. In AM there were associations between AHI and Co-A, PoOr-A and MP-H; awakenings and EAS; SatminO2 and SNA, SNB and Co-A. Conclusion: A ERMAC showed improvement of SatminO2 and TTSsatO2 <90% and improvement of categorical values ​​for AHI and SatminO2, when compared to AM. BMI correlated with AHI and awakenings. In ERMAC there was a correlation between AHI and ANS, EAS and MP-H; awakenings and SNA, Co-A and MP-H. In AM, between IAH and Co-A, PoOr-A and MP-H; awakenings and EAS; SatminO2 and SNA, SNB and Co-A.
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    Oropharyngeal examination as a predictor of obstructive sleep apnea: pilot study of gag reflex and palatal reflex
    (Academia Brasileira de Neurologia - ABNEURO, 2011-10-01) Valbuza, Juliana Spelta [UNIFESP]; Oliveira, Márcio Moysés de [UNIFESP]; Conti, Cristiane Fiquene [UNIFESP]; Prado, Lucila Bizari Fernandes do [UNIFESP]; Carvalho, Luciane Bizari Coin de [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Maranhão
    Obstructive sleep apnea (OSA) has high prevalence and may cause serious comorbities. The aim of this trial was to show if simple noninvasive methods such as gag reflex and palatal reflex are prospective multivariate assessments of predictor variables for OSA. METHOD: We evaluate gag reflex and palatal reflex, of fifty-five adult patients, and their subsequent overnight polysomnography. RESULTS: Forty-one participants presented obstructive sleep apnea. The most relevant findings in our study were: [1] absence of gag reflex on patients with severe obstructive apnea (p=0.001); [2] absence of palatal reflex on moderate obstructive apnea patients (p=0.02). CONCLUSION: Gag reflex and palatal reflex, a simple noninvasive test regularly performed in a systematic neurological examination can disclose the impact of the local neurogenic injury associated to snoring and/or obstructive sleep apnea syndrome.
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    Tratamento dos distúrbios respiratórios do sono com retentor lingual: ensaio clínico randomizado cross-over
    (Universidade Federal de São Paulo (UNIFESP), 2018-12-20) Jung, Aline [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Machado, Marco Antônio Cardoso [UNIFESP]; Prado, Lucila Bizari Fernandes do [UNIFESP]; http://lattes.cnpq.br/3844314810128616; http://lattes.cnpq.br/9922055566135433; http://lattes.cnpq.br/2617510083171521; http://lattes.cnpq.br/0793635204250482; Universidade Federal de São Paulo (UNIFESP)
    Objective. Check the efficiency of the dental appliance retainer lingual TSD (Tongue Stabilizing Device) in the treatment of Obstructive Sleep Apnea Syndrome (OSAS). Method. Randomized Clinical Trial Cross-over 64 patients with polysomnographic diagnosis of obstructive sleep apnea. Patients were randomized into two groups, one treated with TSD and another treated with acetate plate as control (CG) for 4 weeks. After 2 weeks of wash-out, the treatments were exchanged and the patients used the new device for 4 weeks. They were assessed with polysomnography, daily use and adverse events. Results: Patients who used the TSD device compared to control group had lower apneahypopnea index (AHI) (11.5±10.6 events/hour versus 14.8±11.7 events/hour, p <0.05), and more discontinuing use because of adverse events (18 patients, 28,1% versus 1 patient, 1.6%; p <0.05). Of the patients treated with TSD, 25 (39%) had a reduction in AHI and 14 (22%) patients reduced AHI to less than 5. TSD patients younger than 56 years compared to those older than 56 years had a lower AHI (8.1 ± 5.9 events/hour versus AHI 14.9 ± 13.4 events/hour, p <0.05), higher TTS (357.4 ± 64.8min versus 323.1 ± 48.8min; p <0.05) and better sleep efficiency (84.2 ± 9.7% versus 77.3 ± 7.4%, p <0.05). Conclusion: The treatment of mild and moderated OSA with TSD is an option that can benefits only a few number of patients. The reduction of respiratory events in the treated group was small, and only a fifth of the patients normalized the number of the events. The TSD connected to side effects that motivated the suspension of a high number of the patients.