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- ItemAcesso aberto (Open Access)Apneia obstrutiva do sono em crianças(Sociedade Brasileira de Pneumologia e Tisiologia, 2010-06-01) Fagondes, Simone Chaves; Moreira, Gustavo Antonio [UNIFESP]; Universidade Federal do Rio Grande do Sul Faculdade de Medicina Hospital de Clinicas de Porto Alegre; Universidade Federal de São Paulo (UNIFESP)Childhood obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. The disease encompasses a continuum from primary snoring (a benign condition without physiological alterations or associated complications) to increased upper airway resistance, obstructive hypoventilation and OSAS. The prevalence of snoring is high, ranging from 1.5% to 15%, depending on how it is defined. Based on parent-reported questionnaires and complementary tests, the prevalence of OSAS is 1-4%. This syndrome is more common in boys, overweight children, of African ancestry, with a history of atopy and prematurity. The most common symptoms are snoring that is frequent and loud; family-reported apnea; and restless sleep. The physical examination should assess growth status, signs of chronic upper airway obstruction, and craniofacial malformations. Overnight polysomnography is the gold standard test for the diagnosis and for the determination of the appropriate positive pressure level, as well as for postsurgical treatment evaluation. Intermittent hypoxia and multiple arousals resulting from obstructive events contribute to the well-described cardiovascular, neurocognitive, and behavioral consequences in pediatric patients with OSAS. Although the main treatment for OSAS in children is adenotonsillectomy, treatment with CPAP or Bilevel is becoming more widely used in the pediatric population.
- ItemAcesso aberto (Open Access)Avaliação clínica e polissonográfica do aparelho BRD no tratamento da Síndrome da Apneia Obstrutiva do Sono(Dental Press International, 2010-02-01) Dal-fabbro, Cibele [UNIFESP]; Chaves Junior, Cauby Maia [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do CearáOBJECTIVES: The current investigation aimed to carry out a clinical and polysomnographic assessment of treatment of Obstructive Sleep Apnea Syndrome (OSAS) with an oral appliance (OA) developed and tested by two Brazilian federal universities. METHODOLOGY: The sample was composed of 50 patients (aged between 18 and 65 years, 33 men and 17 women) with initial polysomnographic diagnosis of light to moderate OSAS. All patients underwent a second, full-night polysomnography with the use of the OA approximately 6 months after the first assessment. Based on the reduction of respiratory events obtained with the OA, patients were distributed in good responders (Apnea and Hypopnea Index/AHI under 10 and with reduction of at least 50% in relation to baseline); and poor responders (AHI of 10 or over with OA). RESULTS AND CONCLUSION: In 54% of the sample, AIH reduced to less than five events/hour with OA; in 38% the AHI reduction was more than 50% in relation to baseline (but more than five); and in 6% of the sample, the AHI reduced less than 50%. Good responders corresponded to 86% of the studied sample, while poor responders to 14%. We noticed significant improvement in somnolence, in AIH, in microarousals and also in minimum oxygen saturation with the treatment. Increased body mass index (BMI) seemed to interfere unfavorably in the performance of the OA studied.
- ItemAcesso aberto (Open Access)Consenso brasileiro de ronco e apneia do sono: aspectos de interesse aos ortodontistas(Dental Press International, 2011-02-01) Chaves Junior, Cauby Maia; Dal-fabbro, Cibele; Bruin, Veralice Meireles Sales de [UNIFESP]; Tufik, Sergio [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Universidade Federal do Ceará Depto. Clínica Odontológica; Universidade Federal do Ceará Faculdade de Medicina; Universidade Federal de São Paulo (UNIFESP)The objective of this article is to clarify the positions of the medical societies that have worked together to establish a consensus regarding the clinical and laboratory parameters involved in sleep-disordered breathing, particularly snoring and obstructive sleep apnea syndrome (OSAS). Orthodontists have gradually come to take part in multidisciplinary teams that act in the area of human sleep, but few know about the uniformity coordinated by the Brazilian Association of Sleep. Clinical and scientific studies from the field of dentistry (particularly orthodontics) also must observe and follow these diagnosis and treatment criteria established by the Brazilian medical community.
- ItemAcesso aberto (Open Access)Efetividade do aparelho ortopédico Bionator de Balters no tratamento do ronco e apnéia do sono(Dental Press Editora, 2008-08-01) Nabarro, Paulo Alberto Donadelli [UNIFESP]; Höfling, Roberta Tarkany Basting; Universidade Federal de São Paulo (UNIFESP)AIM: to assess the effectiveness of the Balters Bionator orthopedic appliance for the treatment of the Obstructive Sleep Apnea Syndrome (OSAS). METHODS: Sixteen patients (18.8% women and 81.3% men) that presented OSAS on diagnosis were selected. Of the 16 patients that used the Balters Bionator orthopedic appliance, only 9 presented good acceptance (56.25%) and concluded the treatment. They were submitted to another polysomnography exam, performed with the patients using the Balters Bionator orthopedic appliance, in order to assess the effectiveness of this device in treating apnea snoring. Comparison between the results of the initial (11.5) and final (4.2) RDI (respiratory disturbance index) was made by the paired t test (α = 0.05). RESULTS: A statistically significant improvement in the RDI was observed after the device was used. CONCLUSIONS: The use of the Balters Bionator orthopedic appliance may be considered as a method for treating OSAS in light or moderate cases, in spite of being a method hardly tolerated by patients.
- ItemSomente MetadadadosInter-examiner agreement of the systematic physical examination in patients with obstructive sleep disorders(Springer Heidelberg, 2016) Sguillar, Danilo Anunciatto [UNIFESP]; Vidigal, Tatiana de Aguiar [UNIFESP]; Mangussi, Joao Paulo [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Gregorio, Luiz Carlos [UNIFESP]; Tufik, Sergio [UNIFESP]; Haddad, Fernanda Louise Martinho [UNIFESP]The goal of this study was to investigate the agreement between examiners who were or were not trained in the physical examination of the upper airway (UA) and the craniofacial skeleton of individuals with obstructive sleep disorders (OSD). A systematic assessment of the UA and craniofacial skeleton was performed on 55 individuals with OSD. The participants were consecutively assessed by three otorhinolaryngologists who specialized in sleep medicine for at least 1 year (trained examiners) and two doctors who were attending a residency program in otorhinolaryngology (untrained examiners). When analyzing all of the parameters assessed, the concordance was better in the trained group (k = 0.694, which is considered "good") compared to the untrained group (k = 0.475, "fair") (p < 0.001). The inter-examiner agreement was also better in the trained compared to the untrained group, as follows: craniofacial (k = 0.643 vs. 0.349), nasal (k = 0.657 vs. 0.614), and pharyngeal (k = 0.729 vs. 0.276) abnormalities (p < 0.05). The overall concordance of the physical examination of the UA and craniofacial skeleton was "good" among the trained specialists and "fair" among examiners without appropriate training, despite its subjectivity.
- ItemAcesso aberto (Open Access)Reprodutibilidade do exame físico sistemático da via aérea superior e do esqueleto craniofacial em pacientes com distúrbio respiratório obstrutivo do sono(Universidade Federal de São Paulo (UNIFESP), 2015-06-30) Sguillar, Danilo Anunciatto [UNIFESP]; Haddad, Fernanda Louise Martinho [UNIFESP]; Gregório, Luiz Carlos [UNIFESP]; http://lattes.cnpq.br/3121718741179338; ttp://lattes.cnpq.br/2110917250638917; http://lattes.cnpq.br/8595790480543393; Universidade Federal de São Paulo (UNIFESP)INTRODUÇÃO: A avaliação da via aérea superior (VAS) e do esqueleto craniofacial, por meio do exame físico otorrinolaringológico sistematizado, é fundamental para o diagnóstico e tratamento de pacientes com distúrbio respiratório obstrutivo do sono (DROS); porém, a subjetividade do exame tem sido uma das limitações desse tipo de avaliação. OBJETIVOS: Determinar a concordância entre examinadores treinados e não treinados, em relação ao exame físico da VAS e do esqueleto craniofacial em pacientes com DROS. MÉTODO: 55 pacientes com DROS foram submetidos a, avaliação sistemática da VAS e do esqueleto craniofacial. Os pacientes foram examinados, de forma cega e consecutiva, por três otorrinolaringologistas com especialização em medicina do sono há pelo menos um ano (examinadores treinados) e por dois residentes em otorrinolaringologia (examinadores não treinados). RESULTADOS: Quando considerados todos os parâmetros de avaliação, os examinadores treinados apresentaram maior concordância (k = 0,694, considerado "bom") do que os não treinados (k = 0,475 considerado "regular") (p<0,001). Na comparação de sítios anatômicos específicos, em relação a alterações craniofaciais (k = 0,643 vs 0,349), nasais (k = 0,657 vs 0,614) e faríngeas (k = 0,729 vs 0,276), foi também observada maior concordância entre examinadores treinados (p<0,05). CONCLUSÃO: Apesar de subjetivo, o exame físico da VAS e do esqueleto craniofacial apresentou "boa" concordância geral entre especialistas treinados e "regular" entre examinadores sem treinamento adequado.
- ItemAcesso aberto (Open Access)Sintomas da síndrome de apnéia-hipopnéia obstrutiva do sono em crianças(Sociedade Brasileira de Pneumologia e Tisiologia, 2008-06-01) Gregório, Paloma Baiardi; Athanazio, Rodrigo Abensur [UNIFESP]; Bitencourt, Almir Galvão Vieira; Neves, Flávia Branco Cerqueira Serra; Terse, Regina; Hora, Francisco; Instituto Cardiopulmonar; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia Faculdade de Medicina; Escola Bahiana de Medicina e Saúde Pública; Fundação Baiana para Desenvolvimento das Ciências; Instituto Cárdio Pulmonar Laboratório do SonoOBJECTIVE: To investigate the symptoms most frequently found in children with a polysomnographic diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: We evaluated 38 children consecutively referred to the sleep laboratory with suspicion of OSAHS between June of 2003 and December of 2004. The patients were submitted to a pre-sleep questionnaire and to polysomnography. RESULTS: The mean age was 7.8 ± 4 years (range, 2-15 years), and 50% of the children were male. Children without apnea accounted for 7.9% of the sample. The obstructive sleep apnea observed in the remainder was mild in 42.1%, moderate in 28.9% and severe in 22.1%. Severe cases of apnea were most common among children under the age of six (pre-school age). In children with OSAHS, the most common symptoms were snoring and nasal obstruction, which were observed in 74.3 and 72.7% of the children, respectively. Excessive sleepiness and bruxism were seen in 29.4 and 34.3%, respectively, and reflux disease was seen in only 3.1%. Restless legs and difficulty in falling asleep were identified in 65 and 33%, respectively. All of the children diagnosed with severe OSAHS also presented snoring and bruxism. CONCLUSIONS: Snoring and nasal obstruction were the most common symptoms found in our sample of children and adolescents with OSAHS. In addition, OSAHS severity was associated with being in the lower age bracket.
- ItemAcesso aberto (Open Access)Tratamento Miofuncional para os Transtornos Respiratórios do Sono Baseado em Evidências(Universidade Federal de São Paulo (UNIFESP), 2010-08-25) Valbuza, Juliana Spelta [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introdução: O Ronco é o ruído causado pela vibração da úvula, palato e paredes faríngeas durante a inspiração, cujas causas envolvem diversos fatores. Objetivo: O tratamento do ronco pelos métodos para aumento do tônus muscular da via aérea superior tem sido controverso e pouco relatado, portanto uma revisão sistemática em busca de evidências é necessária para avaliar a efetividade destes métodos. Método: Revisão sistemática de ensaios clínicos randomizados ou quasi-randomizados, duplo-cegos para o tratamento do ronco, com métodos que visam o aumento do tônus da via aérea superior, tais como fonoterapia e fisioterapia. Desfechos: diminuição ou cura do ronco, qualidade do sono, qualidade de vida e efeitos adversos. Resultados: Três estudos elegíveis foram potencialmente analisados, porém nenhum deles foi capaz de prover evidência científica suficiente para favorecer a intervenção. As análises objetivas de um estudo demonstraram melhora do ronco, entretanto as subanálises objetivas e as análises subjetivas demonstraram resultados controversos. Os efeitos adversos não foram relatados. Conclusão: Não existe evidência científica suficiente para sustentar a recomendação de métodos para aumentar o tônus muscular da via aérea superior no tratamento do ronco. Ensaios clínicos randomizados bem elaborados são necessários para avaliarmos a efetividade de tais métodos e uma padronização com métodos mundialmente aceitos de intervenção para o ronco seriam necessários para pesquisas futuras. Palavras-chave: Ronco, distúrbios do sono, tratamento, revisão.