Efeitos do dilatador nasal Qiar® na obstrução nasal, ronco, apneia obstrutiva do sono, exercícios físicos e na respiração pelo nariz / Effects of nasal dilator Qiar® on nasal obstruction, snoring,obstructive sleep apnea, physical exercise, and nose breathing

Introdução: O objetivo deste estudo é avaliar o uso do Dilatador Nasal Qiar®– Abridor Nasal e Levantador da Ponta Nasal, em pacientes com obstrução nasal e seus efeitos no ronco, apneia obstrutiva do sono, exercício físico, congestão nasal e respiração nasal. Métodos: Participaram do estudos 30 pacientes que responderam ao questionário da escala de sonolência Epworth, Índice de Qualidade de Sono de Pittsburgh, realizaram exame otorrinolaringológico completo, Rinometria Acústica e Polissonografia. Resultados: Polissonografias demonstraram diferenças significativas entre noite controle e noite de tratamento com Qiar®na eficiência, arquitetura e fragmentação do sono, tempo de ronco e Índice de apneias-hipopneias; Qiar® teve bom impacto no IAH, reduziu 50% do número de eventos respiratórios e em 64,1% o tempo de ronco. Testes de aptidão física demonstraram melhora significativa no tempo e VO2 máximo no grupo Qiar® (31,8 ml/kg/min), comparado ao controle (25,8 ml/kg/min). Houve significativo bem-estar usando Qiar®, 28 pacientes (93,3%) relataram ser melhor ou muito melhor sua respiração e desempenho no teste físico. Todos os resultados foram correlacionados com Rinometria, PSG e Teste de Aptidão Física. Conclusões: Este estudo demonstrou que Qiar® é eficaz na redução da obstrução nasal, roncos e apneia obstrutiva do sono, melhora da respiração durante exercícios físicos, diminuição da congestão nasal, facilita respiração pelo nariz, melhora arquitetura e qualidade do sono. Seu efeito é imediato, sem efeitos colaterais, com ação mecânica, sem medicamentos, pode ser recomendado como alternativas para descongestionantes e corticosteroides nasais tópicos e também para pacientes que não querem ou não podem fazer outros tipos de tratamentos.

Introduction: The aim of this study is to evaluate the use of Nasal Dilator Qiar®, a nasal opener and nasal tip lifter, in patients with nasal obstruction and its effect on snoring, obstructive sleep apnea, exercise, nasal congestion and nasal breathing. Methods:The study included 30 patients who answered the Epworth Sleepiness Scale and the Pittsburgh sleep quality index questionnaires, and underwent complete ENT examination, acoustic rhinometry and polysomnography (PSG). Results: PSG showed significant differences between control night and night with Qiar® treatment in the efficiency, architecture and fragmentation of sleep, time snoring and apnea-hypopnea index (AIH); Qiar® had good impact on the AHI, and it reduced the number of respiratory events by 50% and time snoring by 64.1%. Physical fitness tests demonstrated significant improvement in time and peak VO2 in the Qiar® group (31.8 ml/kg/min) as compared to the control group (25.8 ml/kg/min). There was significant well-being using Qiar®, as 28 patients (93.3%) reported better or much better breathing and physical performance. All results were correlated with Rhinometry, PSG and Physical Fitness Test. Conclusions: This study demonstrated that Qiar® is effective in reducing nasal obstruction, snoring and obstructive sleep apnea, improves breathing during exercise, reduces nasal congestion, eases breathing through the nose and improves the architecture and quality of sleep. Its effect is immediate, without side effects, with mechanical action, without medication, and it can be recommended as an alternative to decongestants and topical nasal corticosteroids and also for patients who do not want or cannot use other types of treatments.

Quality of care, quality of life, and attitudes toward disabilities: perspectives from a qualitative focus group study in Porto Alegre, Brazil.

OBJECTIVE: To explore the concepts of quality of life (QOL), quality of care (QOC), and attitudes toward disabilities in Porto Alegre, Brazil, from the perspective of people living with disabilities, including their relatives and caregivers. METHODS: This was a qualitative study that interviewed a total of 23 participants in five focus groups, during May-August 2006. After an open discussion about QOL, the WHOQOL-Bref, a generic questionnaire for the assessment of QOL, was presented to participants. The study was performed simultaneously in 15 international centers. Analysis was based on Bardin's content analysis. RESULTS: Regarding QOL, important themes that emerged were: work, education, leisure, universal accessibility, integration in the society, and social inclusion. Concerning QOC, professional qualifications, disabilities-related training for health and education professionals, and access to health services were considered important. Regarding attitudes toward disabilities, the participants perceived the attitudes of others, especially of caregivers, to significantly impact the QOL of people with disabilities. CONCLUSIONS: People living with disabilities value many of the same themes considered important by the general public; however, several additional themes specific to disabilities and specific to these groups of participants emerged. This information highlights the importance of taking into account the unique perceptions and cultural traits of the target population when measuring QOL, QOC, and attitudes toward disabilities.

Quality of care, quality of life, and attitudes toward disabilities: perspectives from a qualitative focus group study in Porto Alegre, Brazil / Calidad de atención, calidad de vida y actitudes hacia la discapacidad: perspectivas de un estudio cualitativo con grupos de discusión en Porto Alegre, Brasil

OBJECTIVE: To explore the concepts of quality of life (QOL), quality of care (QOC), and attitudes toward disabilities in Porto Alegre, Brazil, from the perspective of people living with disabilities, including their relatives and caregivers. METHODS: This was a qualitative study that interviewed a total of 23 participants in five focus groups, during May-August 2006. After an open discussion about QOL, the WHOQOL-Bref, a generic questionnaire for the assessment of QOL, was presented to participants. The study was performed simultaneously in 15 international centers. Analysis was based on Bardin's content analysis. RESULTS: Regarding QOL, important themes that emerged were: work, education, leisure, universal accessibility, integration in the society, and social inclusion. Concerning QOC, professional qualifications, disabilities-related training for health and education professionals, and access to health services were considered important. Regarding attitudes toward disabilities, the participants perceived the attitudes of others, especially of caregivers, to significantly impact the QOL of people with disabilities. CONCLUSIONS: People living with disabilities value many of the same themes considered important by the general public; however, several additional themes specific to disabilities and specific to these groups of participants emerged. This information highlights the importance of taking into account the unique perceptions and cultural traits of the target population when measuring QOL, QOC, and attitudes toward disabilities.

OBJETIVO: Explorar los conceptos de calidad de vida, calidad de atención y actitudes hacia la discapacidad en Porto Alegre, Brasil, desde la perspectiva de las personas con discapacidad, incluidos los familiares y cuidadores del individuo discapacitado. MÉTODOS: En este estudio cualitativo se entrevistaron 23 participantes en cinco grupos de discusión entre mayo y agosto del 2006. Después de un debate abierto acerca de la calidad de vida, se presentó el WHOQOL-Bref, un cuestionario genérico empleado para su evaluación. El estudio se realizó simultáneamente en 15 centros internacionales. El análisis se basó en el análisis del contenido de Bardin. RESULTADOS: Respecto de la calidad de vida, los temas importantes que surgieron fueron el trabajo, la educación, el ocio, la accesibilidad universal, la integración en la sociedad y la inclusión social. Respecto de la calidad de atención, se consideraron importantes la formación profesional, la capacitación relacionada con la discapacidad en los profesionales de la educación y la salud y el acceso a los servicios de salud. Con respecto a las actitudes hacia la discapacidad, los participantes percibieron que las actitudes de los demás, en especial las de los cuidadores, repercuten significativamente en la calidad de vida de las personas con discapacidad. CONCLUSIONES: Las personas con discapacidad valoran muchos de los temas también considerados importantes por la población en general; sin embargo, surgieron varios otros temas específicos de la discapacidad y de estos grupos de participantes. Esta información destaca la importancia de tener en cuenta las percepciones y los rasgos culturales singulares de la población destinataria cuando se miden la calidad de vida, la calidad de atención y las actitudes hacia la discapacidad.

Restless legs syndrome: study of prevalence among medical school faculty members.

The aim of this study was to assess the prevalence of idiopathic restless legs syndrome (RLS) and its correlations in a sample of Medical School faculty members. A transversal study was conducted at a Medical School in the south of Brazil included 78 faculty members. The subjects answered to a structured questionnaire specific to RLS diagnosis and the Epworth and the Stanford scales to measure daytime sleepiness. Severity of the disease was also evaluated. The variables were analyzed to statistical significance. RLS was diagnosed in 10.25% of the subjects evaluated and most were women (62.5%). The prevalence of daytime sleepiness was significantly greater among the subjects suffering from RLS (p=0.04). RLS subjects were significantly younger than the group without the syndrome (p=0.02). RLS had a considerable prevalence in the sample studied. Daytime sleepiness and young age showed an important correlation to this syndrome, as other potential factors were not confirmed.

Restless legs syndrome: study of prevalence among medical school faculty members / Síndrome das pernas inquietas: estudo de prevalência entre professores do curso de medicina

The aim of this study was to assess the prevalence of idiopathic restless legs syndrome (RLS) and its correlations in a sample of Medical School faculty members. A transversal study was conducted at a Medical School in the south of Brazil included 78 faculty members. The subjects answered to a structured questionnaire specific to RLS diagnosis and the Epworth and the Stanford scales to measure daytime sleepiness. Severity of the disease was also evaluated. The variables were analyzed to statistical significance. RLS was diagnosed in 10.25 percent of the subjects evaluated and most were women (62.5 percent). The prevalence of daytime sleepiness was significantly greater among the subjects suffering from RLS (p=0.04). RLS subjects were significantly younger than the group without the syndrome (p=0.02). RLS had a considerable prevalence in the sample studied. Daytime sleepiness and young age showed an important correlation to this syndrome, as other potential factors were not confirmed.

O objetivo deste estudo foi analisar a prevalência da síndrome das pernas inquietas (SPI) e suas implicações clínicas em uma amostra envolvendo docentes de um curso de Medicina. Foi realizado um estudo transversal que envolveu 78 docentes do curso de Medicina de uma Universidade do Sul do Brasil. Os indivíduos avaliados responderam um questionário com perguntas epidemiológicas e de diagnóstico para SPI, assim como escalas de sonolência de Epworth e Stanford. Os portadores de SPI responderam questionário de gravidade. As variáveis foram analisadas quanto à significância estatística. Obtivemos uma prevalência de indivíduos portadores de SPI de 10,25 por cento, sendo 62,5 por cento destes do sexo feminino. A existência de sonolência diurna excessiva foi significativamente maior em pacientes portadores da síndrome (p=0,04). Os pacientes portadores de SPI possuíam idade significativamente inferior ao grupo não sindrômico (p=0,02). A SPI mostrou-se bastante prevalente em nossa amostra. A prevalência de sonolência diurna e menos idade mostrou importante relação com esta síndrome, enquanto outros fatores possivelmente relacionados não foram confirmados.

Apnéia obstrutiva do sono e alterações cardiovasculares: [revisão] / Obstructive sleep apnea and cardiovascular disorders: [review]

Objetivos: abordar a fisiopatologia e os aspectos clínicos das comorbidades cardiovasculares associadas à síndrome da apnéia obstrutiva do sono. Fonte de dados: os artigos selecionados para esta revisão foram obtidos em pesquisa no PubMed. Os principais critérios de seleção foram publicações avaliadas por pares e autores de destaque na área da medicina do sono. Síntese dos dados: a síndrome da apnéia obstrutiva do sono é caracterizada pela obstrução completa ou parcial recorrente das vias aéreas superiores durante o sono, resultando em períodos de apnéia, dessaturação de oxihemoglobina e despertares frequentes, com consequente sonolência diurna. Artigos recentes confirmam a relação entre esta síndrome e as doenças cardiovasculares. O tratamento com pressão positiva na via aérea superior é altamente eficaz, melhorando o padrão respiratório durante o sono, instituindo o sono reparador e, dessa forma, otimizando a qualidade de vida desses pacientes, além de atenuar ou reverter muitas das complicações cardiovasculares relacionadas à apnéia obstrutiva do sono. Conclusões: existem fortes evidências da associação entre apnéia do sono e alterações cardiovasculares. Embora o diagnóstico e tratamento correto da síndrome da apnéia obstrutiva do sono e da respiração de Cheyne-Stokes seja determinado pela polissonografia de noite inteira, a suspeita clínica deve ser levantada pela história de roncos, apnéias assistidas pelo companheiro e sonolência diurna excessiva.

Aims: To review the pathophysiology and the clinical features of the cardiovascular disorders associated to the obstructive sleep apnea syndrome. Source of data: The review was based on a search in PubMed. The main criteria were peer-reviewed journals and well-known authors in the area of sleep medicine. Summary of findings: The obstructive sleep apnea syndrome is characterized by a recurrent complete or partial obstruction of the upper airway during sleep, resulting in periods of apnea, oxyhemoglobin desaturation and frequent awakenings, leading to excessive daytime sleepiness. Recent articles confirm the relationship between this syndrome and cardiovascular diseases. The treatment with continuous positive airway pressure is highly effective, improving the breathing pattern during sleep and the sleep setting repairer, and thus, optimizing the quality of life, and reducing or reverse many of the cardiovascular complications related to obstructive sleep apnea.Conclusions: There is strong evidence of association between sleep apnea and cardiovascular disorders. Although the correct diagnosis and treatment of obstructive sleep apnea syndrome and Cheyne-Stokes breathing is determined by polysomnography, a clinical suspicion for these respiratory sleep disorders should be raised by history of snoring, apnea assisted by a partner, and excessive daytime sleepiness.

A controlled trial of nortriptyline, sustained-release bupropion and placebo for smoking cessation: preliminary results.

PURPOSE AND METHODS: Cognitive behavior therapy (CBT) constitutes the basis of smoking cessation programs. Quitting rates are usually increased by the concomitant use of CBT and pharmacotherapy. There are studies showing the efficacy of bupropion and nortriptyline compared to placebo, but there is just one published comparison between these drugs, unfortunately with low power to detect significant differences. This study was designed to compare the efficacy of bupropion, nortriptyline and placebo in a group of smokers who also received intensive counseling therapy. We conducted a double blind, double-dummy, placebo-controlled trial for smoking cessation that lasted 9 weeks. Patients were randomized to receive nortriptyline 75 mg/day (52 subjects), bupropion 300 mg/day (53 subjects) or placebo (51 subjects). All smokers also received the same intensive cognitive behavior therapy. The target day for quitting smoking was usually day 10. Intensive counseling was provided at baseline, weekly during treatment, and at 10, 13, 16, 20 and 26 weeks. Abstinence was defined as continuous when the subject was not smoking since the target-quitting day (self-report) and had an expired carbon monoxide concentration of 10 ppm or less. RESULTS: The sustained abstinence rates at 6 months were 21.6% in the placebo group, 30.8% in the nortriptyline group (p = 0.40), and 41.5% in the bupropion group (p = 0.05). The odds ratio was not statistically different for smokers using nortriptyline or bupropion (OR 1.60; 95% CI 0.66-3.86; p = 0.35). The most common adverse events were dry mouth and drowsiness in the nortriptyline group and dry mouth and insomnia in the bupropion group. CONCLUSIONS: Treatment with CBT + bupropion resulted in a better 6-month rate of smoking cessation compared to CBT+nortriptyline or CBT + placebo. Abstinence rate in the nortriptyline group was not statistically different from patients in the bupropion or placebo group.