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1.
J Fam Pract ; 72(5): 210-214, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37339495

RESUMO

A hybrid model of care embracing office visits and remote consultations may provide the benefits and curtail the disadvantages of both.


Assuntos
Consulta Remota , Telemedicina , Humanos , Pacientes
2.
Otolaryngol Head Neck Surg ; 130(6): 643-8, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15195047

RESUMO

BACKGROUND: Autonomic dysfunction (AD) has been independently associated with obstructive sleep apnea (OSA). Autonomic abnormalities are generally considered to be secondary to OSA. Autonomic dysfunction may also contribute to OSA. If AD contributes to OSA, we postulated that abnormalities may be present in mild OSA where the confounding causal effects of hypoxemia and sleep disruption are reduced. OBJECTIVE: We evaluated autonomic function tests and sleep studies in a cohort of subjects with no known diagnosis of OSA. METHODS: We prospectively enrolled a cohort without diagnosed OSA who were part of an ongoing study of vasomotor rhinitis (VMR) for testing. A battery of autonomic nervous system tests (sudomotor and cardiovagal), nonattended polysomnography, and three-site esophageal/pharyngeal pH monitoring were performed. RESULTS: Twenty of 22 patients completed the test battery and 12 (60%) met criteria for OSA (Apnea/Hypopnea Index "AHI" >5 events/hour). AHI correlated to mean tilt table blood pressure decrease (R = 0.58, P = 0.007) and the Valsalva-mediated phase 2 mean blood pressure decrease (R = 0.52, P = 0.017). OSA severity was related to sympathetic but not parasympathetic abnormalities. No differences in blood pressure responses were related to age, oxygen desaturation nadir, gastroesophageal reflux, VMR, or sleepiness. CONCLUSION: Autonomic abnormalities suggestive of decreased adrenergic tone are associated with mild OSA. These abnormalities may potentially be secondary but may also precede development of OSA.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Rinite Vasomotora/complicações , Rinite Vasomotora/fisiopatologia , Inquéritos e Questionários , Pressão Sanguínea/fisiologia , Regulação da Temperatura Corporal/fisiologia , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Refluxo Gastroesofágico/metabolismo , Refluxo Gastroesofágico/fisiopatologia , Frequência Cardíaca/fisiologia , Humanos , Concentração de Íons de Hidrogênio , Doenças Faríngeas/metabolismo , Doenças Faríngeas/fisiopatologia , Polissonografia/métodos , Respiração com Pressão Positiva , Estudos Prospectivos , Respiração , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/terapia , Rinite Vasomotora/diagnóstico , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Sudorese/fisiologia , Nervo Vago/fisiologia , Manobra de Valsalva/fisiologia
3.
Otolaryngol Head Neck Surg ; 128(3): 353-7, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12646837

RESUMO

OBJECTIVE: Automatic adjusting nasal continuous positive airway pressure titration (APAP) has been introduced as an alternative method of establishing pressures for patients with sleep apnea. The performance and accuracy of APAP in nonattended home environment are controversial. This study assessed APAP polysomnographic outcomes and accuracy in a nonattended home environment. STUDY DESIGN AND SETTING: We conducted a retrospective consecutive case series of 24 consecutive patients who had nonattended APAP and simultaneous full polysomnography (PSG). RESULTS: APAP was tolerated and reduced obstructive Apnea-Hypopnea Index (AHI) to <10 events/h in all patients. Mean AHI decreased from 38.4 (21.2) to 5.9 (6.6) events/h. Central apneas worsened in one patient. A therapeutic pressure was determined in 91% of patients. Autoset accurately measured residual AHI compared with PSG (R = 0.77, P < 0.001). APAP overestimated the AHI by 1.4 events/h. CONCLUSIONS: Nonattended APAP is successful in many patients in determining a therapeutic positive pressure setting. Reported AHI via Autoset is similar to that of PSG. SIGNIFICANCE: APAP reduces AHI and is tolerated in a nonattended environment.


Assuntos
Respiração com Pressão Positiva/métodos , Apneia Obstrutiva do Sono/terapia , Adulto , Automação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Retrospectivos
5.
Am J Rhinol ; 19(4): 340-3, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16171165

RESUMO

BACKGROUND: Patients commonly present with complaints of postnasal drainage (PND). This study reports the pharyngeal pH probe findings in patients without rhinitis/rhinosinusitis who present with complaints of PND. METHODS: This is a prospective study of patients presenting with PND but no historical or endoscopic evidence of rhinitis/rhinosinusitis. Twenty-four-hour pharyngeal pH probe studies were done on 32 consecutive patients and compared with historical controls. RESULTS: There were a total of 32 patients with PND (mean age, 54 years) and 51 controls (mean age, 49 years). The proportion of patients with positive pH probe studies was higher in PND (28.1%) versus controls (17.6%) but did not reach statistical significance (p = 0.27). However, when comparing the mean number of pharyngeal acid exposure events, patients with PND had significantly more events (1.6) than controls (0.3; p < 0.002). In addition, the mean acid exposure time was significantly higher in PND (0.18%) versus controls (0.01%; p < 0.004). CONCLUSION: The proportion of patients with PND displaying positive pharyngeal 24 pH probe studies is not significantly greater than controls. However, patients with PND do exhibit a statistically greater degree of pharyngeal acid exposure as compared with controls. Additional research is required to delineate the role of pharyngeal reflux in patients with PND.


Assuntos
Faringe/fisiologia , Rinite/fisiopatologia , Estudos de Casos e Controles , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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